By Dr. Elisa Shipon Blum 

Individuals with Selective Mutism (SM) may also experience difficulties with attention, executive functioning, organization, task initiation, working memory, impulse control, and emotional regulation. In some individuals, these challenges may be related to co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD).

However, identifying ADHD in someone with Selective Mutism can be complicated.

Anxiety, communication difficulties, social discomfort, processing differences, sensory challenges, and the tendency to become quiet, withdrawn, or “shut down” in certain environments can sometimes look like inattention or executive functioning difficulty. Conversely, true ADHD symptoms may be overlooked because Selective Mutism and anxiety are assumed to explain the individual’s difficulties.

At the SMart Center, our goal is to understand the “why” behind the behavior and determine what is related to Selective Mutism, what may represent ADHD or another co-occurring condition, and how these factors interact.

What Is Included in an ADHD Evaluation?

Every evaluation is individualized based on age, developmental history, communication level, current concerns, and the reason for referral.

Depending on the individual, evaluation may include:

  • Comprehensive clinical interview and developmental history
  • Assessment of Selective Mutism and social communication functioning
  • Standardized cognitive and executive functioning measures
  • Attention and concentration assessment
  • Behavioral and emotional rating scales
  • Parent, teacher, spouse/partner, and/or self-report questionnaires
  • Review of school, treatment, and previous evaluation records, when available
  • Consideration of functioning across different settings and communication environments

Importantly, testing procedures can be adapted to accommodate Selective Mutism and the individual’s current level of communication so that anxiety and difficulty speaking do not unnecessarily interfere with the assessment process.

Areas We Evaluate

Testing may examine:

  • Attention and concentration
  • Executive functioning
  • Working memory
  • Processing speed
  • Organization and planning
  • Task initiation and completion
  • Need for prompting or redirection
  • Hyperactivity and impulsivity
  • Emotional and behavioral functioning
  • Social communication and functioning across settings

We also consider how an individual’s performance may change depending on comfort, familiarity, communication demands, anxiety level, environment, and expectations for verbal responding.

ADHD, Selective Mutism, or Both?

This is one of the most important questions our evaluation seeks to answer.

A child who does not begin an assignment, appears distracted, needs frequent redirection, or has difficulty completing work may have ADHD—but there may also be other explanations. For an individual with Selective Mutism, these behaviors may be influenced by:

  • Anxiety or social anxiety
  • Fear of making mistakes or being evaluated
  • Difficulty asking for help or clarification
  • Processing or learning challenges
  • Sensory overload
  • Social communication or pragmatic language difficulties
  • Autism spectrum disorder
  • Emotional dysregulation
  • Executive functioning weaknesses
  • Selective Mutism itself

And, of course, ADHD and Selective Mutism can coexist. Our goal is to tease apart these possibilities rather than assuming that every difficulty is caused by anxiety or Selective Mutism.

What Can an ADHD Evaluation Diagnose?

A comprehensive evaluation can help determine whether an individual meets criteria for:

  • ADHD, Predominantly Inattentive Presentation
  • ADHD, Predominantly Hyperactive/Impulsive Presentation
  • ADHD, Combined Presentation

Equally important, the evaluation may identify additional developmental, learning, emotional, or social communication concerns that warrant further assessment or intervention.

Why ADHD Testing at a Selective Mutism Specialty Center?

Traditional assessment can be challenging for individuals with Selective Mutism, particularly when testing relies heavily on verbal responding, interaction with an unfamiliar examiner, or observations made in settings where the individual is unable to communicate comfortably.

Our clinicians understand that what an individual demonstrates in one setting may not reflect what they know or are capable of doing in another. As a specialty center for Selective Mutism, we understand how to:

  • Accommodate an individual’s current communication level during testing
  • Reduce unnecessary verbal and social demands
  • Differentiate anxiety-related behaviors from attention and executive functioning concerns
  • Consider how Selective Mutism affects school, testing, and everyday performance
  • Integrate findings with the individual’s Selective Mutism treatment needs
  • Develop recommendations that address both ADHD-related challenges and social communication anxiety

The goal is to obtain the most accurate picture possible of the whole individual—not simply their performance while anxious or unable to communicate comfortably.

What You’ll Receive

Following the evaluation, families or individuals receive:

  • A personalized feedback session
  • A comprehensive written report
  • Diagnostic impressions, when appropriate
  • Individualized treatment recommendations
  • Executive functioning and organizational strategies
  • School, college, and/or workplace accommodations, when appropriate
  • Recommendations specific to Selective Mutism and social communication needs
  • Guidance regarding appropriate next steps

For children and adolescents, findings can help inform 504 Plans, IEPs, classroom accommodations, and intervention planning.

For college students and adults, results can help guide academic accommodations, workplace supports, treatment planning, executive functioning strategies, and everyday functioning.

Our Goal: Understanding the “Why”

Our goal is not simply to answer “Does this person have ADHD?”

We want to understand: Why is this individual struggling?

What is related to Selective Mutism or anxiety? What may be related to ADHD? Are processing, learning, sensory, social communication, or other developmental factors contributing? Most importantly:

What does this individual need to be more successful?

By identifying both strengths and areas of challenge, we can develop more targeted recommendations for treatment, school, home, work, and everyday life.

When Might Additional Testing Be Recommended?

Sometimes an ADHD evaluation identifies concerns that cannot be fully explained by ADHD or Selective Mutism alone.

Additional assessment may be recommended when there are concerns related to:

  • Reading, writing, or mathematics
  • Learning disabilities, including dyslexia, dysgraphia, or dyscalculia
  • Cognitive or intellectual functioning
  • Processing or memory
  • Speech, language, or social-pragmatic communication
  • Autism spectrum disorder
  • Anxiety, depression, or other emotional concerns
  • Broader psychological or neurodevelopmental functioning

When appropriate, a full psychological evaluation, autism evaluation, speech-language evaluation, or other specialized assessment may provide a more comprehensive understanding of the individual’s needs.

At the SMart Center, assessment findings are considered within the context of the individual’s Selective Mutism, social communication functioning, anxiety, developmental profile, and real-world functioning so recommendations can be integrated rather than viewed as separate diagnoses or isolated test scores.