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Puberty-Onset Selective Mutism in a Female Adolescent With Autism Spectrum Disorder
Tiago Soares1, Joana Coelho Santos1, Daniela Couto1
1Department of Child and Adolescent Psychiatry, Local Health Unit of Western Lisbon, Lisbon, PRT.
Cureus
|May 16, 2025
Summary
Selective mutism (SM), a rare anxiety disorder, can emerge in adolescence, particularly in individuals with autism spectrum disorder (ASD). Early, combined treatments show effectiveness for this atypical presentation.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Anxiety Disorders
Background:
- Selective mutism (SM) is typically a childhood anxiety disorder, characterized by consistent failure to speak in specific social settings.
- Adolescent onset of SM is uncommon but may indicate atypical anxiety presentations, potentially linked to autism spectrum disorder (ASD).
Observation:
- An 11-year-old girl developed SM during puberty amidst significant life changes like school transition and relocation.
- The patient was subsequently diagnosed with autism spectrum disorder (ASD).
Findings:
- A multidisciplinary treatment approach, including cognitive behavioral therapy and medications (fluoxetine, pregabalin), resulted in complete remission of SM.
- Significant improvements in academic and social functioning were observed post-treatment.
Implications:
- Highlights the importance of recognizing atypical anxiety in adolescents with ASD.
- Emphasizes the value of early, individualized, and multimodal interventions for SM in this population.
- Raises ethical considerations regarding covert medication use in treatment-resistant cases.
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