Elective Mutism in Childhood

Introduction Elective mutism was first described in the literature in 1877 by Kussmaul who used the term "aphasia voluntaria" in order to describe children who, though not severely disturbed, are willfully mute for purposes they refuse to disclose. From this time until the 1930's there was very little else in the German literature. In 1934, Tramer coined the name "elective mutism" which has gained a world wide acceptance. More recently in the German literature there have been papers by vonMisch (1952) Spieler (1944) and Weber ( 1950) . Spieler, in his review of 50 cases of elective mutism, came to the conclusion that a "neurotic personality" was the outstanding feature in the mute children. In 1945, Tramer interpreted the behavior as "an archaic defense reflex retained for an abnormally long time." Weber's four cases were compared by vonMisch in his paper in which vonMisch also had a number of observations. They were: 1) environmental factors may precipitate mutism; 2) mutism often occurred upon the child's separation from the family, especially at the time of his entry into school; 3) while possibly hereditary and intelligence factors might play some part, the disorder was basically psychogenic; 4) all cases demonstrated excessive ties to mother; and 5) the selection of mutism is a symptom with possible relation to traumatic experience at the time when the child was developing speech. Galnzmann, a Swiss pediatrician, also described the "anal sulker syndrome," the three main symptoms being: l ) mutism, 2) urinary retention, and 3) voluntary retention of stools. The first major report in the English language literature was made by J. D. Salfield in 1950. He reported the following observations: 1) the onset of elective mutism occurs between 3 and 5 years of age; 2) there is no mental defect; 3) there frequently seems