EpistemisSelective mutism
Specialty: Psychiatry.
Why it occurs
- Childhood social anxiety disorder
- Autism spectrum disorders (ASD)
- Post-traumatic stress disorder (PTSD) or acute childhood trauma
- Reactive attachment disorder
- Dysfunctional family dynamics or child abuse
Initial workup
Multidisciplinary evaluation (child psychiatry, psychology, speech therapy); audiometry to rule out hearing loss; anxiety scales for children (SCARED); structured clinical observation in different environments (school, family, clinical).
red flags
Sudden onset total mutism that is accompanied by regression of cognitive development, signs of physical abuse or severe malnutrition.
Standard management
- Fluoxetine — First choice SSRI in children and adolescents with severe social anxiety
- Sertraline — serotonergic alternative to modulate the avoidance response and anxious blocking
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 2