Episode 74 features a discussion between Dr. Elisa Shipon-Blum and Dr. Jenna Blum, Director and lead clinical psychologist at the SMart Center’s Counseling and Assessments department, tackling one of the most frequently asked — and misunderstood — questions in the selective mutism community: Is it Selective Mutism, autism, or both?

During the course of this discussion, Dr. E and Dr. Jenna break down the core features of each condition, explain why they so often look alike on the surface while stemming from very different underlying causes, and walk through what a thorough evaluation at the SMart Center actually looks like.

Is It SM, Autism, or Both? Introducing the Overlap and Core Features of Each Condition

Episode 74 begins with Dr. E and Dr. Jenna establishing why this question comes up so frequently — and why getting it wrong has real consequences for children, teens, and adults who spend years without the right diagnosis or the right help.

This chapter covers the core features of both conditions: SM as a social communication anxiety disorder rooted in anxiety — where mutism is a symptom, not the cause — and autism as a neurodevelopmental disorder with two primary categories: language and communication differences, and restricted interests and repetitive behaviors. They emphasize that both conditions can cause a child to go silent in certain settings, and that the overlap in presentation is exactly why families so often receive inconclusive or incorrect diagnoses.

Dr. Jenna explains that evaluations frequently come back inconclusive because a child was nonverbal during testing — leaving families in limbo for years. She reminds listeners that the SMart Center approaches re-evaluation from both directions: confirming a diagnosis that doesn’t feel right, or identifying one that was missed entirely.

The Social Puzzle: How Motivation and Peer Interest Reveal What’s Really Driving the Shutdown

Dr. E and Dr. Jenna dive into one of the most telling — and most frequently overlooked — distinctions between SM and autism: motivation for peer connection.

For a child with SM, the desire to connect is very much present — it’s the anxiety that gets in the way. Parents of children with SM often describe a child who desperately wants to play, make friends, and belong, but freezes in the moment. With autism, the picture can look very different. Dr. E describes an eight-year-old sitting in class while her peers laugh together — not because anxiety is stopping her, but because peer connection simply isn’t on her radar.

This is what Dr. E calls the “social puzzle” — the challenge individuals on the spectrum face in knowing what to say, when to say it, and how to say it. Unlike SM, where the skills are there but the anxiety blocks them, many individuals with autism have never been handed the social manual. The chapter introduces the critical comfort vs. skills distinction: children with SM have innate social know-how that anxiety prevents them from accessing; children on the spectrum often need those social skills explicitly and systematically taught.

The Passenger in the Car: Why Social Communication Skills Must Be Taught, Not Just Unlocked

Dr. Jenna introduces the “passenger in the car” analogy to explain why so many individuals with autism — and even those with SM — reach adolescence and young adulthood without the social skills to navigate relationships independently.

Just as a child who has always been the passenger can’t suddenly drive without instruction, a child whose parents, siblings, and peers have always spoken for them, prompted them, or filled in the social blanks has never learned the steps. In treatment, the goal is to move that child from passenger to driver — in their own social communication journey.

Dr. E illustrates this with a compelling case study: a 13-year-old with autism and SM who struggled to navigate even a simple friend get-together. Using what Dr. E calls an “SM roadmap” and integrated “sandwich questions,” the team mapped out every aspect of the event in advance — the greeting, the activity, the conversation starters, and the goodbye. The result was a transformative success. The child’s mother called that evening in disbelief at the confidence and ease her daughter had displayed. She had control. She knew what to say, when to say it, and she was motivated to show up.

Same Behaviors, Different Reasons: How to Distinguish SM From Autism Across Settings

This chapter addresses the diagnostic challenge head-on: if both SM and autism can cause a child to go silent, avoid eye contact, shut down in loud environments, and gravitate toward specific interests, how do you tell them apart?

Dr. Jenna walks through the key differentiators one by one. For eye contact, a child with SM will generally make full eye contact in comfortable settings — at home, with family, in relaxed environments. A child on the spectrum will show a more universal pattern of limited eye contact across all settings. For restricted interests, both populations may gravitate toward specific topics or activities — but for a child with SM, that interest is an area of confidence where anxiety lowers enough for communication to emerge. For a child on the spectrum, it’s a core feature of how they engage with the world.

The most important diagnostic clue, both doctors agree, is the home environment. SM symptoms, by definition, are setting-specific — a timid child who is fully expressive and elaborative at home is unlikely to have autism. But when the challenges persist across all settings, including at home, that consistency points toward autism. Dr. Jenna also covers echolalia — a speech pattern in which a child repeats words or phrases they’ve just heard rather than generating original responses — and narrated speech, illustrating both with vivid clinical examples from her own practice.

Masking, Misdiagnosis, and the Evaluation Process: What a Thorough Assessment Actually Looks Like

The episode closes with a discussion of masking — the ability some individuals on the spectrum develop to camouflage their challenges within their community — and why it so frequently leads to missed or delayed diagnoses, particularly in girls and young adults.

Dr. E shares the case of a young teacher who had been diagnosed with SM but never identified as autistic. She was talented, beloved by her students, and genuinely wanted to connect with colleagues — but she couldn’t figure out how. She had never had a real friendship. She couldn’t think about romance. When Dr. E recommended formal autism testing, the result was level one autism — very clear. And for that young woman, it was profoundly validating. Not a flaw. Not a failure. A different kind of wiring, with its own gifts and its own challenges.

Dr. Jenna then walks through the SMart Center’s evaluation process, explaining how the SME (Selective Mutism Evaluation) or SMI (Selective Mutism Interview) serves as the first step, and how formal autism testing — using the ADOS, ADIR, GARS, and adapted virtual platforms — is recommended when clinicians observe indicators during treatment intensives or CommuniCamp. She also notes that several children referred to the SMart Center with an autism diagnosis were formally re-evaluated and found not to have autism at all — their SM presentation had mimicked the profile closely enough to result in a misdiagnosis.

Key Takeaways from Episode 74

  • SM and autism frequently co-occur — and frequently get confused with each other, resulting in years of misdirected treatment
  • The home environment is one of the most important diagnostic clues: SM symptoms are setting-specific; autism symptoms are universal across settings
  • The comfort vs. skills distinction is foundational: children with SM have the social know-how but need anxiety reduced to access it; children on the spectrum often need those skills explicitly taught
  • Motivation for peer connection is a key differentiator — a child with SM desperately wants to connect but is blocked by anxiety; a child on the spectrum may simply not be drawn to peer interaction
  • Masking — the ability to camouflage autism symptoms — is more common in girls and becomes more pronounced with age, often leading to missed diagnoses well into adulthood
  • Echolalia and narrated speech are important clinical markers that distinguish autism from SM
  • Formal testing using the ADOS, ADIR, and other tools is essential — clinical observation alone, especially when a child is mute during an evaluation, is not sufficient for an accurate diagnosis
  • Getting the right diagnosis is not just about labeling — it’s about validation, clarity, and building a treatment approach that actually fits the individual

Final Thoughts

The silence may look the same. The reason behind it rarely is. As Dr. E and Dr. Jenna remind us throughout this episode, understanding the “why” behind a child’s shutdown isn’t just a clinical exercise — it’s the foundation of everything that comes next. When families finally receive the right diagnosis, the right framework, and the right support, something profound shifts. There’s nothing wrong with their child. It’s just hard. And hard things, with the right roadmap, can be navigated.