Autism, Selective Mutism, or both?

Autism and Selective Mutism is an important topic to talk about as there are many misconceptions surrounding the two. Some people may think that Selective Mutism is a form of autism. But that is not the case. Autism and Selective Mutism are two different disorders. They can coexist together, however SM is not a form, or symptom of autism. There are also some professionals that mat say that a person can’t be diagnosed with both autism and SM. However, these professionals could not be more wrong. This confusion is likely caused because of the DSM-5 diagnostic criteria for SM which states “cannot occur exclusively during the course of autism spectrum disorder”, which makes it sound as if the two cannot coexist. However, it is suggested that they are trying to differentiate between SM, where a child can’t speak in some social situations, but are able to do so in others and nonverbal autism where the individual may not speak at all, or if the communication difficulties are unrelated to anxiety and are better explained due to autism. A person can absolutely have both. Autism is in fact one of the most common comorbidities with Selective Mutism.

What is Autism?

Autism, also referred as autism spectrum disorder, is a neurological and developmental condition which affects how people communicate and experience the world around them. ASD is lifelong and affects how a person’s brain works. It is considered a spectrum disorder as each person has their own strengths and challenges.

What is Selective Mutism?

Selective Mutism is an anxiety disorder where a person is unable to speak in certain social situations. It is caused by the body’s freeze response. It can be described as an intense fear of speaking. Those with SM experience extreme anxiety around communication which causes their body to ‘freeze’ in specific situations. SM is strongly linked to social anxiety disorder.

My Experience

When I was about 9 years old a psychologist that worked closely with the school that I attended, conducted some tests with me because I was not speaking in school. The school did not have much understanding of SM. She came over to my house to do this one day and then reported to the school and my parents that I was autistic. The school went with what this psychologist said, but my parents did not believe so as I have never showed any signs of autism. We were later sent to a children’s psychological clinic and the psychologist there confirmed that I was not autistic, but that I was showing signs of Selective Mutism instead, which my parents had suspected for some time.

Is it Autism, Selective Mutism or both?

SM and ASD have some overlapping signs, which can cause confusion and can sometimes lead to a misdiagnosis. Here are some overlapping signs:

• Difficulty with social interactions
• Lack of eye contact
• Show anxiety in other areas
• Sensory sensitivities
• Meltdowns

When children with SM are anxious they may find it difficult to interact with others, engage with less eye contact and show little to no expression. They can sometimes present with similar behaviours that may look like autism, but the main difference is that those with SM only tend to display these traits in specific settings when faced with anxiety. Children with both SM and ASD are generally more talkative at home, but as autism is pervasive these individuals would also display the same behaviour and autistic traits across all situations. Another difference between the two is that autistic individuals may have difficulty with understanding social cues and reading nonverbal communication, while someone with SM would have no difficulty in understanding this type of communication.

Autistic individuals are more likely to struggle with anxiety disorders (such as Selective Mutism). This does not mean though that all autistic individuals have SM. Studies have found that 63-80% of children who were first diagnosed with SM also fit the diagnostic criteria for autism, yet many of them may have initially been missed. However, having SM alone is not always an indicator of autism. Thorough assessments are needed to determine whether the child has both ASD and SM, or one or the other.

Selective Mutism is also different from verbal shutdowns/autistic shutdowns where a person may temporarily lose the ability to speak due to stress, overwhelm, or sensory overload, etc. It is only considered to be Selective Mutism if the person shows a consistent inability to speak in specific social settings (such as at school), while being able to speak freely in others (such as at home). These two terms are often used interchangeably online, and while they may appear similar, it is important to note that they are not the same. Shutdowns do not always follow a consistent pattern and can happen anywhere.

Whether you suspect your child has Autism, Selective Mutism, or both, it’s important that they receive the right support. Try to get another opinion if what you have been told does not seem to fit and keep fighting to get the correct diagnosis.