A developmental psychopathology perspective is offered in an effort to organize the existing literature regarding the etiology of selective mutism (SM), a relatively rare disorder in which a child consistently fails to speak in 1 or more social settings (e.g., school) despite speaking normally in other settings (e.g., home). Following a brief description of the history, prevalence, and course of the disorder, multiple pathways to the development of SM are discussed, with a focus on the various genetic, temperamental, psychological, and social/environmental systems that may be important in conceptualizing this unusual childhood disorder. The authors propose that SM develops due to a series of complex interactions among the various systems reviewed (e.g., a strong genetic loading for anxiety interacts with an existing communication disorder, resulting in heightened sensitivity to verbal interactions and mutism in some settings). Suggestions are provided for future longitudinal, twin/adoption, molecular genetic, and neuroimaging studies that would be particularly helpful in testing the pathways perspective on SM.
1Department of Psychology, San Diego State University, San Diego, CA; Department of Psychiatry, University of California San Diego, La Jolla, CA
2Department of Psychology, San Diego State University, San Diego, CA
3Department of Psychology, San Diego State University, San Diego, CA; Department of Psychiatry, University of California San Diego, La Jolla, CA; VA San Diego Healthcare System, San Diego, CA
Address for reprints: Sharon L. Cohan, M.S., Anxiety and Traumatic Stress Disorders Research Program, University of California San Diego, 8950 Villa La Jolla Drive, Suite C207, La Jolla, CA 92037; e-mail: email@example.com.