Classification of elective mutism.

In this study of 68 children displaying elective mutism, four types of mutism are distinguished: (a) symbiotic mutism, characterized by a symbiotic relationship with a caretaker and a submissive but manipulative relationship with others; (b) speech phobic mutism, characterized by fear of hearing one’s own voice and use of ritualistic behaviors; (c) reactive mutism, characterized by withdrawal and depression which apparently resulted from trauma and (d) passive-aggressive mutism, characterized by hostile use of silence as a weapon. The prevalence of physical and sexual child abuse in all four groups was high. The classification of elective mutism into subgroups is clinically relevant for a better understanding of the etiology and for devising appropriate intervention. Journal of the American Academy of Child Psychiatry, 19:118—133,1980 Elective mutism, a term first employed by Trainer (1934), has been used traditionally to describe those children who refuse to speak to all but a small number of intimates. This definition excludes all other nonpsychogenic forms of mutism, including hearing loss, aphasia, schizophrenia, and autism. Although the behavior is a perplexing problem to the families of preschool children, it becomes a seemingly insurmountable problem when the children enter the educational system. Consequently, the elective mutes become candidates for grade retention, special class placement, and frequently residential institutionalization, mounting failure on top of an already complex psychological problem.