[Elective mutism--a disorder of social functioning or an emotional disorder?]

Elective mutism is a relatively uncommon disorder characterized by consistent failure to speak in specific social settings, such as in school, despite speaking fluently in a variety of other situations. Elective mutism is a very debilitating disorder for the affected child, as well as for their families, with detrimental implications for the development of social skills and learning if not offered appropriate support and treatment. The most promising treatment results have thus by far been achieved through a combination of cognitive behaviour therapy and supportive cooperation between parents, the school, and the treating child psychiatrist, occasionally supplemented with pharmacological treatments such as selective serotonin reuptake inhibitors. The available literature on this disorder is still very limited and consists predominantly of case reports. In recent years, however, there has been a growing focus on the etiology and general understanding of the disorder. While still disputed, it has been suggested that elective mutism might be understood as an emotional disorder on a par with e.g. separation anxiety and social phobia. Studies looking at the long-term course of the disorder are urgently required to elucidate whether children presenting elective mutism will be more likely to suffer from emotional disorders in adulthood, and may also ultimately lead to improved treatments for this disabling psychiatric disorder of childhood.