SILENCE MISDIAGNOSED: MUTISM, AUTISM OR SUBMISSIVENESS? DIAGNOSTIC BIAS IN COLLECTIVISTIC CULTURE

Selective Mutism (SM) is a rare condition which is even rarer in collectivistic cultures. Firstly, SM is most often mistaken/misdiagnosed as autism spectrum disorder (ASD) and other related conditions due to lack of awareness of SM and the presence of mimicking characteristics of autistic behaviors in SM. Secondly, submissive behaviors in collectivistic societies further veil this rare condition by considering SM rather desirable than a problem. Especially in situations where developmental delay is a comorbid condition it became a great challenge tocorrectly diagnose among related conditions. We had a twelve years old girlwith developmental delays who remained falsely diagnosed with ASD for five years. We have highlighted the diagnostic issues in SM and other related conditions especially ASD that might hinder the development of an appropriate management plan. The study also emphasized the need to develop a standardized assessment tool to diagnose SM considering cultural aspects into account.