A child understands language but refuses to speak in social situations. This is:

UP NHM CHO 7 Sept 2022 (Shift-2)

Child Health Nursing (Pediatrics)

Easy

Appeared in: UP NHM CHO 7 Sept 2022 (Shift-2)

Explanation

Selective mutism is an anxiety disorder characterized by a child's consistent failure to speak in specific social situations (e.g., school) where speaking is expected.
A key diagnostic feature is that the child can speak and understand language perfectly well in other, more comfortable settings (e.g., at home with family).
The condition is not due to a communication disorder (like aphasia) or a lack of knowledge of the spoken language.
It is understood as a manifestation of severe anxiety, closely related to social anxiety disorder.

Option A: Autism Spectrum Disorder involves more widespread deficits in social communication and interaction, along with restricted, repetitive behaviors. The problem is not limited to a selective failure to speak.
Option B: Stubbornness is a personality trait or a temporary behavior. Selective mutism is a clinical diagnosis of an anxiety disorder where the child feels unable to speak due to overwhelming fear, not simple defiance.
Option C: Aphasia is a language disorder caused by damage to the parts of the brain that control language. It affects the ability to produce or comprehend speech and is a neurological deficit, not a situational refusal.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Childhood anxiety and communication disorders as background academic context rather than a clinical decision trigger.
Nurses, especially in pediatric and school settings, play a crucial role in identifying signs of selective mutism and differentiating it from shyness or defiance.
Early recognition and referral to mental health specialists are vital for appropriate intervention, which often includes behavioral therapy and family counseling to manage the underlying anxiety.
It is a critical patient-safety and well-being issue to not mislabel a child with an anxiety disorder as 'stubborn' or 'oppositional,' as this can worsen their anxiety and delay proper treatment.

How to Approach the Question

First, analyze the key information in the question stem: The child 'understands language' but 'refuses to speak in social situations'.
The phrase 'understands language' rules out primary comprehension disorders.
The phrase 'in social situations' indicates the problem is situational or selective, not global.
Evaluate the options based on this analysis. 'Autism' and 'Aphasia' typically involve more global language and communication deficits.
'Stubbornness' is a behavioral trait, not a clinical diagnosis for a consistent, situational pattern.
'Selective mutism' perfectly describes a condition where a child can speak but is unable to in specific social settings due to anxiety.

Concept Tested & Keywords

Concept Tested: Childhood anxiety and communication disorders
Stem keywords: child, understands language, refuses to speak, social situations
Lead-in keywords: This is
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

Qal4X2vemF9NuTZAVW9PUf

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 637-639, 638-640

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 375-377