Presently, many psychologist and psychiatrists accept the findings in DSM-V that Selective Mutism cannot be comorbid with autism. Others, however, do not concur with this, and routinely care for children and adults who experience long periods in which their ability to verbalize is either limited, or non-existent.
We hold that autism is a multi-faceted, broad spectrum disorder, in which many children, teens and adults do not speak, either consistently or under selective circumstances, or to selected people. These communications aspects of autism match, almost exactly, Selective Mutism. However, these are considered two distinct conditions, and unrelated.
It certainly seems logical that selective mutism can be a condition comorbid with autism. As there are hundreds of conditions that have been diagnosed as comorbid with autism, it is only reasonable that these two conditions, despite their commonalities can overlap within some individuals. Many autistic individuals show the signs and evidence of both autism and mutism, so let’s review and consider them.
Autism is already known as a communications disorder, but is not limited to that. Most experience sensory overloads from a variety of stimuli that do not necessarily affect their communication capacity. Many however, have an inability to speak even to their parents since birth, without any physical limitations preventing speech. Others have the ability to, and do speak, but only to selective people with whom they have a ‘comfort zone’ – like a sibling or grandparent. Still others, cannot stop speaking, while some have dysfunctional speech.
The ability to communicate by verbal communication in those with autism is, without a doubt, as infinite in variety as autism itself. As we’ve said, there is no routine autism. It seems illogical that persons on the autism spectrum can be subject to so many varied, unrelated conditions including Tourette Syndrome, Obsessive Compulsive Disorder, Bipolar disorder, Depression, Social Phobia, DiGeorge Syndrome, Avoidant Personality, Exposure Anxiety, Dyslexia, Scotopic Sensitivity, Tinnitus, L/R hemisphere integration problems, learning disabilities, Epilepsy, Gut/Immune problems, articulation problems, receptive or expressive aphasia, other auditory or visual receptive language processing problems – but not to Selective Mutism.
It’s like suggesting one can suffer fungal infections of the toenails, but not the right pinkie. We work with many autistic individuals. They sometimes express to us that what stops them speaking is extreme anxiety making it impossible for them to dare speak. Some of these people are terrified of allowing the social connection (Exposure Anxiety), other’s however, are terrified of failure, of being imperfect at something they’ve never tried or practiced, afraid others might stare or laugh. Some have suggested that if they speak to strangers they fear being abused or mistreated, or even killed. These people speak of a severe version of Selective Mutism, but they are also autistic, demonstrating other symptoms than those found with the DSM-V definition of Selective Mutism, but readily found in autism.
Such behaviors as minimal or lack of eye contact, tics, meltdowns, self-abusive behaviors, etc. If the two conditions cannot be comorbid, some of these things would not be present in those suffering only from Selective Mutism. We must conclude therefore, that DSM-V’s distinction is based on false or misguided documentation and call upon psychiatrists, neurologists, and others to review this matter, with all due urgency.
Let’s never forget that when people are non-verbal, whether temporarily or permanently, they still have much to say. It is up to us to give voice to their needs, wants and wishes.