The essential element of selective mutism is that the child has the ability to both comprehend and speak, but fails to do so in certain settings or environments. This syndrome differs from mutism because the child sometimes speaks, depending on the situation. Children with mutism never speak.
Cultural issues, such as recent immigration and bilingualism, should be noted. Children who are uncomfortable with a new language may be reluctant to use it outside of a familiar setting. This is not necessarily selective mutism, so it should be considered (if this diagnosis is being considered).
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