spectrum disorder, schizophrenia, or another psychotic disorder.
Diagnostic Features
When encountering other individuals in social interactions, children with selective mut-
ism do not initiate speech or reciprocally respond when spoken to by others. Lack of
speech occurs in social interactions with chil dren or adults. Children with selective mut-
ism will speak in their home in the presence  of immediate family members but often not
even in front of close friends or second-degr ee relatives, such as grandparents or cousins.
The disturbance is often marked by high social  anxiety. Children with selective mutism of-
ten refuse to speak at school, leading to ac ademic or educational impairment, as teachers
often find it difficult to assess skills such as reading. The lack of speech may interfere with
social communication, although children wi th this disorder sometimes use nonspoken or
nonverbal means (e.g., grunting, pointing, wr iting) to communicate and may be willing or
eager to perform or engage in social encounters when speech is not required (e.g., nonver-
bal parts in school plays). 
Associated Features Supporting Diagnosis
Associated features of selectiv e mutism may include excessive shyness, fear of social em-
barrassment, social isolation and withdrawal , clinging, compulsive traits, negativism,
temper tantrums, or mild oppositional beha vior. Although children  with this disorder
generally have normal language skills, ther e may occasionally be an associated commu-