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“Elective mutism” appears to be a rare condition in terms of the number of reported cases discussed in the literature. The term was originally used by Tramer1 to describe the behavior of children who speak only to a small group of select people. The original studies appeared only in German; Salfield's paper was the first in English.2 Salfield described the children as “‘sensitives’ in Kretschmer's sense,3—i.e., they are timid, shy, susceptible to teasing and often raised in an unstable milieu; the abnormality is often familial.” Salfield observed the following common features in cases of elective mutism: (1) onset occurring between three and five years of age, (2) normal intelligence, (3) frequent incidence of a familial factor, (4) relatively great resistance to treatment, (5) early somatic, psychological, or compound trauma. Salfield concluded “elective mutism can be understood as a fixation at an early infantile level on which an apprehended danger situation is met by a refusal to speak.”2
All studies emphasized the necessity to differentiate elective mutism from other possible causes of mutism, including mental retardation, schizophrenia, hysterical mutism, and organic causes.
Pustrom and Speers, in presenting a dynamic concept of elective mutism, concluded that “the symptom of elective mutism is a compromise expression of family conflict … one of several manifestations of the neurotic disorder found in these children.” They recommended that therapy be family oriented with the “focus on the marital discord and the mother's needs to maintain an intense mother-child dependency relationship.” The focus in treating the child is on “his potentially aggressive impulses and their anticipated consequences plus his need to maintain a dependency relationship with his mother. The therapeutic general attitude was ‘l can help you whether you talk or not.’”4
Reed, in a report of four cases of elective mutism, concluded that “elective mutism is not, as has been suggested, a clini