This question comes up very often when a child seems to understand everything you tell her, yet she isn’t talking. Many parents report that they feel that their child is able to talk, but is refusing to do so.
Characteristics of selective mutism are described by the American Speech-Language Hearing Association as:
- consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
- interferes with school or work, or with social communication.
- lasts at least 1 month (not limited to the first month of school).
- failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation, and is not due to a communication disorder (e.g., stuttering).
According to the DSM-V (2000), selective mutism is classified as an anxiety disorder, and a child diagnosed with this may demonstrate excessive shyness, fear of social embarrassment, and social isolation and withdrawal.
When a child has a language delay, you may also see that the child is not talking. However, their difficulties with learning and/or using language occur across all environments, situations, and with different communication partners (parents, siblings, teachers, etc.). These children do not learn language in the same way as their peers, and fall behind on language milestones.
Language delay/disorder is an inability to use language, rather than a refusal to use language. The DSM-V defines is as having ‘persistent difficulties in the acquisition and use of language…due to deficits in comprehension or production.’ Language abilities are ‘substantially and quantifiably’ below same-age peers.
If you feel that your child has a language delay, have your child evaluated by a speech-language pathologist (SLP). If selective mutism is suspected, an SLP will work in collaboration with a child psychologist/psychiatrist as well the teacher. In either situation, these professionals work closely with the pediatrician and parent as a cohesive team to help your child develop the way she should.