ABSTRACT
This chapter explains how to reach a diagnosis of selective mutism (SM). With low profile SM, the child manages to speak a little when absolutely necessary (fear of the consequences of not speaking outweighs the fear of speaking) but does not spontaneously initiate conversation or make requests. This is sometimes called 'reactive mutism'. It comes under the umbrella term post-traumatic stress disorder (PTSD) and is usually managed by psychologists or Child and Adolescent Mental Health Services (CAMHS). In the UK, the primary clinicians responsible for diagnosis are usually speech and language therapists who have a clear professional remit to address SM because it is a communication difficulty. Parents or teachers, who know the child best, may have picked up other difficulties that need addressing as well as the mutism. An extended assessment is indicated where additional concerns about cognitive, emotional, social or physical development emerge.
