Four latency age girls, diagnosed as having a neurotic symptom complex which centered on an elective refusal to speak except to a small group of relatives and peers, received intensive milieu therapy in a residential treatment center for periods of four to twelve months. Six months to five years after discharge intensive follow-up interviews were made. Common features in these cases were maternal hostility and rejection, paternal disinterest, and school phobia. The dynamic formulation was in the category of passive-aggressive personality. Follow-up revealed that the children had made a surprisingly good adjustment but the mother remained unchanged.