Selective mutism
Encyclopedia
Selective mutism is an anxiety disorder
in which a person, most often a child, who is normally capable of speech
is unable to speak in given situations, or to specific people. Selective mutism usually co-exists with shyness
or (often severe) social anxiety
.
Selective mutism is by definition characterized by the following:
Particularly in young children, SM can sometimes be confused with an autism spectrum disorder
, especially if the child acts particularly withdrawn around his or her diagnostician, which can lead to incorrect treatment. Although autistic people may also be selectively mute, they display other behaviors—hand flapping, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism. People with higher-functioning autism may be selectively mute due to anxiety in social situations that they do not fully understand. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.
Selective mutism may co-exist with or cause the child to appear to have Attention Deficit Disorder. Many people with the inattentive form of ADHD show little or no interest in other people primarily. People with inattentive ADHD may appear to be "space cadets" or "out in their own world", and may be slower to respond to social stimuli. Children with selective mutism, especially when they have severe social anxiety, may also look like this. Also, they might be distracted by their anxiety or by sensory input, if they are highly sensitive, or from the task at hand.
Most people with selective mutism have social phobia, and many have other anxiety disorder such as obsessive compulsive disorder or panic disorder
.
The former name elective mutism
indicates a widespread misconception among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they often wish to speak but cannot. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994.
The incidence
of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry estimated the incidence to be 7 in 1000, 0.7%.
On the positive side, many sufferers have:
. This area receives indications of possible threats and sets off the fight-or-flight response
.
Some children with selective mutism may have sensory integration dysfunction
(trouble processing some sensory information). This would cause anxiety and a sense of being overwhelmed in unfamiliar situations, which may cause the child to "shut down" and not be able to speak (something that some autistic people also experience). Many children with SM have some auditory processing difficulties.
About 20–30% of children with SM have speech or language disorders that add stress to situations in which the child is expected to speak.
Despite the change of name from "elective" to "selective", a common misconception remains that a selectively mute child is defiant or stubborn. In fact, children with SM have a lower rate of oppositional behavior than their peers in a school setting. Another common belief is that selectively mute children have experienced abuse or trauma, but most professionals who have treated many children with selective mutism currently believe this is not true.
However, a study of six adults who were selectively mute as children suggests that those with selective mutism are more likely to have suffered abuse, which may contribute to the onset of their mutism. The interviewees also said that there was a conscious determination not to speak and that they were afraid of speaking, indicating that both choice and fear may be involved in selective mutism. Only two of the interviewees specifically reported childhood social anxiety, and those were twins. Other anxiety and emotional problems seemed to have appeared after the onset of the disorder. This study shows that selective mutism may be more complex than currently believed, with both past and current understandings of the disorder both being partly true.
In their book Adoption Detective: Memoir of an Adopted Child, Judith and Martin Land mention how selective mutism, extreme shyness, and other social anxiety disorders can be evidence of trauma frequently associated with adoption, especially in children under three years old. Selective mutism might be highly functional for a child by reducing anxiety and protecting the child from perceived challenges of social interaction, particularly in situations with high performance expectations, such as school. Adoptees with this anxiety might be highly talkative at home with family and friends, but avoid speaking altogether in classrooms, large groups, and social functions. Adoptees with selective mutism likely have difficulty verbalizing personal thoughts when they are excessively revealing and painful or of a subconscious nature.
In 1980, a study by Torey Hayden
identified four "subtypes" of Elective Mutism. First, and most common, she described "symbiotic mutism" characterized by a vocal and dominating mother and absent father and the use of mutism as controlling behavior around other adults. Second, the least common, was "speech phobic mutism" in which the child showed distinct fear at hearing a recording of his or her voice. This also involved ritualistic behaviors and was thought to be caused by having been told to keep a family secret. Third was "reactive mutism" thought to be caused by trauma or abuse, though not all children put in this category were known to have been abused. These children all showed symptoms of depression and were notably withdrawn, usually showing no facial expressions. Finally, Hayden described "passive-aggressive mutism" in which silence is used as a display of hostility, connected to antisocial behavior. Some of the children in this group had not been mute until age 9–12. These subtypes are no longer recognized, though "speech phobia" is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, first included Elective Mutism in its third edition, published in 1980. Elective Mutism was described as "a continuous refusal to speak in almost all social situations" despite normal ability to speak. While "excessive shyness" and other anxiety-related traits were listed as associated features, predisposing factors included "maternal overprotection", mental retardation, and trauma. Elective Mutism in the third edition revised (DSM III-R) is described similarly to the third edition except for specifying that the disorder is not related to Social Phobia.
In 1994, Sue Newman, co-founder of the Selective Mutism Foundation, requested that the fourth edition of the DSM reflect the name change to selective mutism and described the disorder as a failure to speak. The relation to anxiety disorders was emphasized, particularly in the revised version (DSM IV-TR).
There are no changes to the definition of selective mutism planned for the DSM V.
Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing. Those around such a person may eventually expect him or her not to speak and therefore stop attempting to initiate verbal contact with the sufferer. Alternately, they may pressure the child to talk, making him or her have even higher anxiety levels in situations where speech is expected. Because of these problems, a change of environment (such as changing schools) may make a difference, and treatment in teenage or adult years can be more difficult because the sufferer has become accustomed to being mute.
The exact treatment depends on the sufferer's age, other mental illnesses he or she may have, and a number of other factors. For instance, stimulus fading is typically used with younger children, because older children and teenagers recognize the situation as an attempt to make them speak, and older sufferers and people with depression are more likely to need medication.
, voice or video recordings, and speaking or whispering to an intermediary in the presence of the target person. This can make the subject more comfortable with the idea of communicating with this person.
first for interacting nonverbally, then for saying certain sounds (such as the sound that each letter of the alphabet makes) rather than words, then for whispering, and finally saying a word or more.
Medication, when used, should never be considered the entire treatment for a person with selective mutism. While on medication, the person should be in therapy to help him or her to know how to handle anxiety and prepare him or her for life without medication.
There are a few children's books with a selectively mute protagonist, such as The Secret Voice of Gina Zhang by Dori Jones Yang and Alvin Ho: Allergic to Girls, School, and Other Scary Things by Lenore Look. Both of these books are set in elementary school and specifically mention selective mutism. Furthermore, several children's picture books have been written with the specific purpose of educating readers about selective mutism, such as Understanding Katie by selective mutism expert Elisa Shipon-Blum.
In young adult literature and films, there are several instances of protagonists who do not speak despite having the ability to do so. They usually are mute in all situations, and trauma is a common cause for the mutism, though some make the choice to stop speaking. One of the most well-known examples is the popular book and 2004 film Speak
by Laurie Halse Anderson, the main character, Melinda, does not speak during ninth grade following her rape at a party. Her mutism is due at least partly to fear. Another well-known book, Cut
by Patricia McCormick, features a main character who is entirely silent after facing problems at home and being sent to a mental hospital. These two books have most likely done a great deal to spread the conception of selective mutism as a response to trauma. There are various lesser-known books in both young adult and adult fiction that follow the same idea.
Possibly the most well-known instance of selective (as opposed to total) mutism in popular culture is the character of Raj
in the television sitcom The Big Bang Theory
. Due to social anxiety, he is unable to talk to women who are not family members. Drinking alcohol suppresses his anxiety, allowing him to speak; however, this is a placebo
effect, as seen in "The Terminator Decoupling
", in which he spoke to the actress Summer Glau
while drinking beer that was, unbeknownst to him, non-alcoholic
. In several episodes Raj has also treated his condition with medications, suffering of realistic, if somewhat parodically enhanced, aftereffects (nervous tics, mood swings, decreased cognitive abilities...), forcing him to suspend his therapy. The joke was later added upon in "The Wiggly Finger Catalyst", when Raj began dating a deaf woman, whereupon, though initially needing "Howard Wolowitz
" for an interpreter, he realized that he could talk normally around her, knowing that she could neither hear him nor read his lips.
A few movies also involve this type of difficulty speaking. For instance, Little Voice
seems to be about a selectively mute singer.
At least one song has been written about selective mutism. "She's Given Up Talking" by Paul McCartney
from the 2001 album Driving Rain
conforms almost perfectly to a clinical description of the disorder, describing a young girl who is mute at school yet normally talkative at home ("When she comes home it's a yap yap yap / words are running freely like water from a tap").
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
in which a person, most often a child, who is normally capable of speech
Speech
Speech is the human faculty of speaking.It may also refer to:* Public speaking, the process of speaking to a group of people* Manner of articulation, how the body parts involved in making speech are manipulated...
is unable to speak in given situations, or to specific people. Selective mutism usually co-exists with shyness
Shyness
In humans, shyness is a social psychology term used to describe the feeling of apprehension, lack of comfort, or awkwardness experienced when a person is in proximity to, approaching, or being approached by other people, especially in new situations or with unfamiliar people...
or (often severe) social anxiety
Social anxiety
Social anxiety is anxiety about social situations, interactions with others, and being evaluated or scrutinized by other people...
.
Description
Children and adults with selective mutism are fully capable of speech and understanding language but fail to speak in certain situations, though speech is expected of them. The behaviour may be perceived as shyness or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. There is a hierarchical variation among those suffering from this disorder: some people participate fully in activities and appear social but don't speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. In a severe form known as "progressive mutism", the disorder progresses until the child no longer speaks to anyone in any situation, even close family members.Selective mutism is by definition characterized by the following:
- Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
- The disturbance interferes with educational or occupational achievement or with social communication.
- The duration of the disturbance is at least 1 month (not limited to the first month of school).
- The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
- The disturbance is not better accounted for by a communication disorderCommunication disorderA communication disorder is a speech and language disorder which refers to problems in communication and in related areas such as oral motor function. The delays and disorders can range from simple sound substitution to the inability to understand or use language...
(e.g., stutteringStutteringStuttering , also known as stammering , is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sounds...
) and does not occur exclusively during the course of a pervasive developmental disorderPervasive developmental disorderPervasive developmental disorders is a diagnostic category refers to a group of disorders characterized by delays or impairments in communication, social behaviors, and cognitive development.Pervasive developmental disorders include Autism, Asperger's syndrome, Rett's syndrome, Childhood...
, schizophreniaSchizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, or other psychotic disorder.
Particularly in young children, SM can sometimes be confused with an autism spectrum disorder
Autism spectrum
The term "autism spectrum" is often used to describe disorders that are currently classified as pervasive developmental disorders. Pervasive developmental disorders include autism, Asperger syndrome, Childhood disintegrative disorder, Rett syndrome and Pervasive Developmental Disorder Not Otherwise...
, especially if the child acts particularly withdrawn around his or her diagnostician, which can lead to incorrect treatment. Although autistic people may also be selectively mute, they display other behaviors—hand flapping, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism. People with higher-functioning autism may be selectively mute due to anxiety in social situations that they do not fully understand. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.
Selective mutism may co-exist with or cause the child to appear to have Attention Deficit Disorder. Many people with the inattentive form of ADHD show little or no interest in other people primarily. People with inattentive ADHD may appear to be "space cadets" or "out in their own world", and may be slower to respond to social stimuli. Children with selective mutism, especially when they have severe social anxiety, may also look like this. Also, they might be distracted by their anxiety or by sensory input, if they are highly sensitive, or from the task at hand.
Most people with selective mutism have social phobia, and many have other anxiety disorder such as obsessive compulsive disorder or panic disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
.
The former name elective mutism
Elective mutism
Elective mutism is the former name for selective mutism, a childhood anxiety disorder. Elective mutism was defined as a refusal to speak in almost all social situations , while selective mutism is considered to be a failure to speak in specific situations and is strongly associated with social...
indicates a widespread misconception among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they often wish to speak but cannot. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994.
The incidence
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry estimated the incidence to be 7 in 1000, 0.7%.
Other symptoms
Besides lack of speech, other common behaviors and characteristics displayed by selectively mute people include:- Difficulty maintaining eye contact
- Blank expression and reluctance to smile
- Stiff and awkward movements
- Difficulty expressing feelings, even to family members
- Excessive shyness, fear of social embarrassment, and/or social isolation and withdrawal
- Tendency to worry more than most people of the same age
- Desire for routine and dislike of changes
- Sensitivity to noise and crowds
- Moodiness
- Sleep problems
On the positive side, many sufferers have:
- Above-average intelligence, perception, or inquisitiveness
- Creativity and a love for art or music
- Empathy and sensitivity to others' thoughts and feelings
- A strong sense of right and wrong
Causes
Most children with selective mutism are believed to have an inherited predisposition to anxiety. They often have inhibited temperaments, which is hypothesized to be the result of over-excitability of the area of the brain called the amygdalaAmygdala
The ' are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae are considered part of the limbic system.-...
. This area receives indications of possible threats and sets off the fight-or-flight response
Fight-or-flight response
The fight-or-flight response was first described by Walter Bradford Cannon....
.
Some children with selective mutism may have sensory integration dysfunction
Sensory Integration Dysfunction
Sensory integration dysfunction is a neurological disorder characterized by a neurological sensory integration deficit. The more current diagnostic nosology uses the term sensory processing disorder to describe this condition....
(trouble processing some sensory information). This would cause anxiety and a sense of being overwhelmed in unfamiliar situations, which may cause the child to "shut down" and not be able to speak (something that some autistic people also experience). Many children with SM have some auditory processing difficulties.
About 20–30% of children with SM have speech or language disorders that add stress to situations in which the child is expected to speak.
Despite the change of name from "elective" to "selective", a common misconception remains that a selectively mute child is defiant or stubborn. In fact, children with SM have a lower rate of oppositional behavior than their peers in a school setting. Another common belief is that selectively mute children have experienced abuse or trauma, but most professionals who have treated many children with selective mutism currently believe this is not true.
However, a study of six adults who were selectively mute as children suggests that those with selective mutism are more likely to have suffered abuse, which may contribute to the onset of their mutism. The interviewees also said that there was a conscious determination not to speak and that they were afraid of speaking, indicating that both choice and fear may be involved in selective mutism. Only two of the interviewees specifically reported childhood social anxiety, and those were twins. Other anxiety and emotional problems seemed to have appeared after the onset of the disorder. This study shows that selective mutism may be more complex than currently believed, with both past and current understandings of the disorder both being partly true.
In their book Adoption Detective: Memoir of an Adopted Child, Judith and Martin Land mention how selective mutism, extreme shyness, and other social anxiety disorders can be evidence of trauma frequently associated with adoption, especially in children under three years old. Selective mutism might be highly functional for a child by reducing anxiety and protecting the child from perceived challenges of social interaction, particularly in situations with high performance expectations, such as school. Adoptees with this anxiety might be highly talkative at home with family and friends, but avoid speaking altogether in classrooms, large groups, and social functions. Adoptees with selective mutism likely have difficulty verbalizing personal thoughts when they are excessively revealing and painful or of a subconscious nature.
History
In 1877, a German physician named a disorder aphasia voluntaria to describe children who were able to speak normally but often refused to.In 1980, a study by Torey Hayden
Torey Hayden
Victoria Lynn Hayden, known as Torey L. Hayden , is a female child psychologist, special education teacher, university lecturer and writer of non-fiction books based on her real-life experiences with teaching and counseling children with special needs.Subjects covered in her books include autism,...
identified four "subtypes" of Elective Mutism. First, and most common, she described "symbiotic mutism" characterized by a vocal and dominating mother and absent father and the use of mutism as controlling behavior around other adults. Second, the least common, was "speech phobic mutism" in which the child showed distinct fear at hearing a recording of his or her voice. This also involved ritualistic behaviors and was thought to be caused by having been told to keep a family secret. Third was "reactive mutism" thought to be caused by trauma or abuse, though not all children put in this category were known to have been abused. These children all showed symptoms of depression and were notably withdrawn, usually showing no facial expressions. Finally, Hayden described "passive-aggressive mutism" in which silence is used as a display of hostility, connected to antisocial behavior. Some of the children in this group had not been mute until age 9–12. These subtypes are no longer recognized, though "speech phobia" is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, first included Elective Mutism in its third edition, published in 1980. Elective Mutism was described as "a continuous refusal to speak in almost all social situations" despite normal ability to speak. While "excessive shyness" and other anxiety-related traits were listed as associated features, predisposing factors included "maternal overprotection", mental retardation, and trauma. Elective Mutism in the third edition revised (DSM III-R) is described similarly to the third edition except for specifying that the disorder is not related to Social Phobia.
In 1994, Sue Newman, co-founder of the Selective Mutism Foundation, requested that the fourth edition of the DSM reflect the name change to selective mutism and described the disorder as a failure to speak. The relation to anxiety disorders was emphasized, particularly in the revised version (DSM IV-TR).
There are no changes to the definition of selective mutism planned for the DSM V.
Treatment
Contrary to popular belief, people suffering from selective mutism do not necessarily improve with age. Effective treatment is necessary for a child to develop properly. Without treatment, selective mutism can contribute to chronic depression, further anxiety, and other social and emotional problems.Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing. Those around such a person may eventually expect him or her not to speak and therefore stop attempting to initiate verbal contact with the sufferer. Alternately, they may pressure the child to talk, making him or her have even higher anxiety levels in situations where speech is expected. Because of these problems, a change of environment (such as changing schools) may make a difference, and treatment in teenage or adult years can be more difficult because the sufferer has become accustomed to being mute.
The exact treatment depends on the sufferer's age, other mental illnesses he or she may have, and a number of other factors. For instance, stimulus fading is typically used with younger children, because older children and teenagers recognize the situation as an attempt to make them speak, and older sufferers and people with depression are more likely to need medication.
Stimulus fading
The subject is brought into a controlled environment with someone with whom they are at ease and can communicate. Gradually, another person is introduced into the situation. One example of stimulus fading is the sliding-in technique, where a new person is slowly brought into the talking group. This can take a long time for the first one or two faded-in people but may become faster as the patient gets more comfortable with the technique.Desensitization
The subject communicates indirectly with a person he or she is afraid to speak to through such means as email, instant messaging (text, audio, and/or video), online chatOnline chat
Online chat may refer to any kind of communication over the Internet, that offers an instantaneous transmission of text-based messages from sender to receiver, hence the delay for visual access to the sent message shall not hamper the flow of communications in any of the directions...
, voice or video recordings, and speaking or whispering to an intermediary in the presence of the target person. This can make the subject more comfortable with the idea of communicating with this person.
Shaping
The subject is slowly encouraged to speak. He or she is reinforcedReinforcement
Reinforcement is a term in operant conditioning and behavior analysis for the process of increasing the rate or probability of a behavior in the form of a "response" by the delivery or emergence of a stimulus Reinforcement is a term in operant conditioning and behavior analysis for the process of...
first for interacting nonverbally, then for saying certain sounds (such as the sound that each letter of the alphabet makes) rather than words, then for whispering, and finally saying a word or more.
Drug treatments
Many practitioners believe that there is evidence indicating that antidepressants such as SSRIs may be helpful in treating children and adults with selective mutism and even that medicine is essential to effective treatment. The medication is used to decrease anxiety levels to speed the process of therapy. Use of medication may end after nine to twelve months, once the person has learned skills to cope with anxiety and has become more comfortable in social situations. Medication is more often used for older children, teenagers, and adults whose anxiety has led to depression and other problems.Medication, when used, should never be considered the entire treatment for a person with selective mutism. While on medication, the person should be in therapy to help him or her to know how to handle anxiety and prepare him or her for life without medication.
Selective Mutism in Popular Culture
True selective mutism very rarely appears in popular culture, both because of and contributing to the lack of popular knowledge about the disorder. However, many books, movies, and television shows involve a character who does not speak.There are a few children's books with a selectively mute protagonist, such as The Secret Voice of Gina Zhang by Dori Jones Yang and Alvin Ho: Allergic to Girls, School, and Other Scary Things by Lenore Look. Both of these books are set in elementary school and specifically mention selective mutism. Furthermore, several children's picture books have been written with the specific purpose of educating readers about selective mutism, such as Understanding Katie by selective mutism expert Elisa Shipon-Blum.
In young adult literature and films, there are several instances of protagonists who do not speak despite having the ability to do so. They usually are mute in all situations, and trauma is a common cause for the mutism, though some make the choice to stop speaking. One of the most well-known examples is the popular book and 2004 film Speak
Speak (novel)
Speak is a 1999 novel by Laurie Halse Anderson about a girl named Melinda Sordino who is an outcast as a high school freshman. It was made into a film of the same name in 2004. The novel was a New York Times and Publishers Weekly bestseller...
by Laurie Halse Anderson, the main character, Melinda, does not speak during ninth grade following her rape at a party. Her mutism is due at least partly to fear. Another well-known book, Cut
Cut (novel)
Cut is a 2000 novel by Patricia McCormick, targeted at young adults. It is considered a cult classic among teens. Fifteen-year-old Callie isn't speaking to anybody, not even to her therapist at Sea Pines , the residential treatment facility where her parents and doctor sent her after discovering...
by Patricia McCormick, features a main character who is entirely silent after facing problems at home and being sent to a mental hospital. These two books have most likely done a great deal to spread the conception of selective mutism as a response to trauma. There are various lesser-known books in both young adult and adult fiction that follow the same idea.
Possibly the most well-known instance of selective (as opposed to total) mutism in popular culture is the character of Raj
Rajesh Koothrappali
Rajesh Ramayan "Raj" Koothrappali, Ph.D. is a fictional character on the CBS television series The Big Bang Theory, portrayed by actor Kunal Nayyar....
in the television sitcom The Big Bang Theory
The Big Bang Theory
The Big Bang Theory is an American sitcom created by Chuck Lorre and Bill Prady, both of whom serve as executive producers on the show, along with Steven Molaro. All three also serve as head writers...
. Due to social anxiety, he is unable to talk to women who are not family members. Drinking alcohol suppresses his anxiety, allowing him to speak; however, this is a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
effect, as seen in "The Terminator Decoupling
The Terminator Decoupling
"The Terminator Decoupling" is an episode of the television series The Big Bang Theory that first aired on CBS on March 9, 2009. It is the seventeenth episode of the second season of the series and the thirty-fourth episode overall...
", in which he spoke to the actress Summer Glau
Summer Glau
Summer Lyn Glau is an American actress, known for playing River Tam in the science fiction series Firefly and follow-up film Serenity, and for playing Cameron in the series Terminator: The Sarah Connor Chronicles.-Early life:...
while drinking beer that was, unbeknownst to him, non-alcoholic
Low alcohol beer
Low-alcohol beer is beer with very low or no alcohol content...
. In several episodes Raj has also treated his condition with medications, suffering of realistic, if somewhat parodically enhanced, aftereffects (nervous tics, mood swings, decreased cognitive abilities...), forcing him to suspend his therapy. The joke was later added upon in "The Wiggly Finger Catalyst", when Raj began dating a deaf woman, whereupon, though initially needing "Howard Wolowitz
Howard Wolowitz
Howard Joel Wolowitz, M.Eng is a fictional character on the CBS television series The Big Bang Theory, portrayed by actor Simon Helberg.Among the main male characters in the show, Howard is distinguished for lacking a doctoral degree, for still living with his mother, and for believing himself to...
" for an interpreter, he realized that he could talk normally around her, knowing that she could neither hear him nor read his lips.
A few movies also involve this type of difficulty speaking. For instance, Little Voice
Little Voice (film)
Little Voice is a 1998 British drama film with music written and directed by Mark Herman. The screenplay is based on the play The Rise and Fall of Little Voice by Jim Cartwright.- Plot :...
seems to be about a selectively mute singer.
At least one song has been written about selective mutism. "She's Given Up Talking" by Paul McCartney
Paul McCartney
Sir James Paul McCartney, MBE, Hon RAM, FRCM is an English musician, singer-songwriter and composer. Formerly of The Beatles and Wings , McCartney is listed in Guinness World Records as the "most successful musician and composer in popular music history", with 60 gold discs and sales of 100...
from the 2001 album Driving Rain
Driving Rain
Driving Rain is the twelfth studio album by Paul McCartney, recorded and released in 2001 it has now sold 2 million copies globally. It is his first studio album since publicly announcing his relationship with former model and anti-land mines activist Heather Mills, whom McCartney would marry in 2002...
conforms almost perfectly to a clinical description of the disorder, describing a young girl who is mute at school yet normally talkative at home ("When she comes home it's a yap yap yap / words are running freely like water from a tap").