There is some debate about whether selective mutism represents the severe end of a continuum that includes social anxiety disorder, or whether it is a separate phenomenon that also includes some degree of oppositionality and speech deficits. Regardless of these debates, CBT has been effective with selective mutism and many of the guiding principles of treatment are similar, particularly the use of exposure. The main difference is that items on the hierarchy would be more focused on communication (e.g. making nonverbal gestures, whispering in easy situations, whispering in more difficult situations, giving one word answers, giving previously scripted answers, etc.). Also, the use of rewards as reinforcement is more critical because the end result of a successful exposure may not be as intrinsically motivating to the child as a successful social interaction (as in a social anxiety exposure). If your family or the family you have in mind when asking this question is near the NYC area, there is a week-long treatment camp for kids with selective mutism that will be run by the NYU Child Study Center in mid-August.

Rapee’s book is geared a little more toward children but all the core concepts will certainly be applicable to adolescents.

I am not aware of specific data about the comorbidity of eating disorders and social anxiety disorder, but it is important to evaluate the content of the fear. Individuals with social anxiety disorder avoid eating in front of others for a variety of different reasons, but the core fear is related to making a “social mistake” or doing something embarrassing, rather than gaining weight. These individuals often have no difficulty eating in front of close friends or family members.

I am far from an expert on autism spectrum disorders, but the main distinction between social anxiety disorder and autism spectrum disorders is the ability and desire to form social relationships. While kids with social anxiety disorder may have some deficits in social skills, they do not have the same level of impairment as children with autism, and they are very aware (sometimes overly aware) of social cues. This is not the case in kids with autism. Another factor to consider is whether the child seems to have a desire to interact and form relationships with others. Individuals with social anxiety often feel lonely and isolated, and have a strong desire to form relationships. They sometimes make excuses that they are happy being alone, but it is usually easy to tell that this is just avoidance. On the other hand, children on the autistic spectrum are usually content to play/entertain themselves and do not seek social interaction. Autism Spectrum Disorders also include other behaviors that are not seen in Social Anxiety Disorder, such as restricted interests and repetitive behavior.