A 5-year-old girl speaks in full, fluent sentences at home. For the past 4 months she has not spoken a single word at school despite knowing the answers, communicating there only by nodding and pointing. She plays alongside classmates and shows no repetitive behaviors. Her hearing and receptive language are normal. What is the most likely diagnosis?

• A Selective mutism ✓
• B Autism spectrum disorder
• C Expressive language disorder
• D Childhood-onset fluency disorder

Explanation

Selective mutism is consistent failure to speak in specific social situations despite speaking normally in other settings, persisting at least 1 month, and it is classified among the anxiety disorders in DSM-5. Fluent home speech with normal comprehension excludes expressive language disorder. Absence of restricted interests, repetitive behaviors, and social reciprocity deficits excludes autism. Stuttering (fluency disorder) affects speech production in all settings rather than silence confined to one setting.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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