Elective mutism.

Eleven children who had received a diagnosis of elective mutism upon admission to the children's psychiatric clinic, were followed up 8--18 years later. The average age upon admission was 9 1/2 years, and at the time of follow-up, 23 years. Nine of the children came from homes with a strong familial shyness and reservation, and eight lived in social isolation. Six were particularly overprotected. Six came from discordant family constellations. All were diagnosed neurotic, eight specified as compulsion-neurosis. All were of normal intelligence. Six children received extensive individual psychotherapy (four upon admission to the clinic, two by way of out-patient treatment). We were unable to offer similar treatment to the remaining five. During the course of treatment three of the admitted patients improved, the fourth and the two ambulatory patients remained unchanged after up to 4 years of therapy. The follow-up study showed the three unchanged patients and the five who had received treatment, now were cured of the symptom; improvement took place in connection with a change of environment. The five who had not received treatment were better adjusted than those who had been separated from home for several years, at a vulnerable age. The importance of early prophylactic intervention is emphasized.