Selective mutism — viva

Stem

Examiner-led viva on selective mutism. ^[14]

Examiner: How do you open this "never heard her voice all year" presentation? ^[14]

Strong answer: I take a multi-informant history — the parent about home speech, a structured teacher report about school — because the diagnosis lives in the gap between the two. I engage the child gently through play or her mother and avoid any "say something for me" demand, since pressure re-creates the freeze. I frame this as a full assessment, not a same-day label. ^[14]

Examiner: What defines this as selective mutism rather than shyness or defiance? ^[14]

Strong answer: The setting-specific, anxiety-driven freeze: a child who speaks fluently and appropriately at home but is consistently silent in specific demanding social settings such as school, for at least one month, with interference in education or social communication, and not explained by a communication disorder, language-comfort issue, autism or psychosis. Shyness resolves in weeks without impairment; defiance implies a choice, whereas this is a "can't". ^{[14] [15]}

Examiner: What is the one investigation you will not skip? ^[14]

Strong answer: A hearing assessment. A child who is silent because of undiagnosed hearing loss or glue ear has a communication problem, not an anxiety disorder, and must never be labelled with selective mutism. I also confirm adequate spoken language in at least one home language. ^[14]

Examiner: What is first-line treatment? ^[5]