thought. Selective mutism should not be confused with a child who does not speak and cannot speak due to physical disabilities. It is common for symptoms to occur before the age of five. Not all children express the same symptoms. Selective mutism may occur in conjunction with autism spectrum disorder or other diagnoses. Differential diagnosis between selective mutism and language delay associated with autism or other disorders is needed to determine appropriate treatment. Adults who previously had speech and subsequently ceased talking may not speak for psychological or emotional reasons, though this is rare as a cause for adults. Absence or paucity of speech in adults may also be associated with specific psychiatric disorders. Developmental and neurological causes Absence of speech in children may involve communication disorders or language delays. Communication disorders or developmental language delays may occur for several different reasons. Language delays may be associated with other developmental delays. For example, children with Down syndrome often have impaired language and speech. Children with autism, categorized as a neurodevelopmental disorder in the DSM-V, often demonstrate language delays. Treatment Evaluation of children with language delays is necessary to determine whether the language delay was caused by another condition. Examples of such conditions are autism spectrum disorder, hearing loss and apraxia. The manner of treatment depends on the diagnosed condition. Language delays may impact expressive language, receptive language, or both. Communication disorders may impact articulation, fluency (stuttering) and other specified and unspecified communication disorders. For example, speech and language services may focus on the production of speech sounds for children with phonological challenges. Intervention services and treatment programs have been specifically developed for autistic children with language delays. For example, pivotal response treatment is a well-established and researched intervention that includes family participation. Mark Sundberg's verbal behavior framework is another well-established assessment and treatment modality that is incorporated into many applied behavior analysis (ABA) early intervention treatment programs for young children with autism and communication challenges. Treatment for absence of speech due to apraxia, involves assessment, and, based on the assessment, occupational therapy, physical therapy, and/or speech therapy. Treatment for selective mutism involves assessment, counseling, and positive supports. Treatment for absence of speech in adults who previously had speech involves assessment to determine cause, including medical and surgery related causes, followed by appropriate treatment or management. Treatment may involve counseling, or rehabilitation services, depending upon cause of loss of speech. Management