Selective mutism — structured clinical viva

This is classic selective mutism: speech capacity demonstrated at home (and on SLP home video), consistent failure to speak in the expected school setting for 8 months (exceeds ≥1 month; not limited to first school month), with educational impact. DSM-5 frames this as an anxiety disorder, not elective wilful silence.^[1]

School-inclusive behavioural care is non-negotiable. Packages such as IBTSM and Oerbeck home/school programmes target graduated speaking in real contexts and reduce accommodation. Refusing all school work while requesting indefinite diazepam is a formulation and engagement problem, not a reason to abandon exposure principles.^[2][3]

Benzodiazepines are not disease-modifying first-line care for SM and risk dependence plus interference with learning. Fluoxetine is the most studied SSRI adjunct for moderate–severe cases or partial psychological response, with activation and suicidality monitoring under specialist supervision.^[4][5][6]