A pattern of continually refusing to speak in almost all social situations, including school, even though the child understands spoken language and is able to speak.
Elective mutism (also known as selective mutism) is a psychiatric condition occurring primarily during childhood that is characterized by the refusal or failure to speak in specific situations (in school or with classmates) despite speaking in other situations (American Psychiatric Association [APA], 1994). The disorder was previously referred to as “elective mutism,” but with the publication of Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition the name was changed to emphasize that the resistance to speak is not a volitional act but a behavioral response related to environmental context.