parental history of shyness, social isolation,  and social anxiety. Children with selective
mutism may have subtle receptive language difficulties compared wi th their peers, al-
though receptive language is still within the normal range. 
Environmental. Social inhibition on the part of parents may serve as a model for social
reticence and selective mutism in children. Furthermore, parents of children with selective
mutism have been described as  overprotective or more cont rolling than parents of chil-
dren with other anxiety d isorders or no disorder.
Genetic and physiological factors. Because of the significant overlap between selective
mutism and social anxiety disorder, there may be shared genetic factors between these
conditions.
Culture-Related Diagnostic Issues
Children in families who have immigrated to a country where a different language is spo-
ken may refuse to speak the new language beca use of lack of knowledge of the language.
If comprehension of the new language is adequa te but refusal to speak persists, a diagno-
sis of selective mutism may be warranted.
Functional Consequences  of Selective Mutism 
Selective mutism may result in  social impairment, as childr en may be too anxious to en-
gage in reciprocal social interaction with other children. As children with selective mutism
mature, they may face increasing  social isolation. In school settings, these children may
suffer academic impairment, because often th ey do not communicate with teachers re-
garding their academic or personal needs (e.g ., not understanding a class assignment, not