A 5-year-old girl speaks normally and fluently at home but consistently fails to speak at school despite speaking in other situations where she is comfortable. The disturbance interferes with her education and lasts more than one month. She shows no stuttering, no communication disorder, and no autistic features. What is the most likely diagnosis?
- A Selective mutism, classified among the anxiety disorders ✓
- B Autism spectrum disorder
- C Childhood-onset social (pragmatic) communication disorder
- D Expressive language disorder
Correct answer: A. Selective mutism, classified among the anxiety disorders
Explanation
Selective mutism is classified under Anxiety Disorders in DSM-5 and is conceptualised as failure to speak in specific social situations despite speaking in others, persisting beyond one month and not attributable to a communication disorder or autism. The key discriminator from autism and pragmatic communication disorder is that speech is entirely normal in comfortable settings, which rules out options B, C, and D.
Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5, 5th ed.
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Written and medically reviewed by the StethoPrep medical team.