# Puberty-Onset Selective Mutism in a Female Adolescent With Autism Spectrum Disorder

## TL;DR

A teenage girl with autism developed selective mutism during puberty and after major life changes, and she improved with a combination of therapy and medication.

## Contribution

This case highlights atypical anxiety presentations in adolescents with autism and the effectiveness of individualized, multimodal interventions.

## Key findings

- Selective mutism emerged during puberty and major life transitions in an adolescent with autism.
- A combination of cognitive behavioral therapy and medication led to remission of symptoms.
- The case emphasizes the need for early and tailored interventions for anxiety in individuals with autism.

## Abstract

Selective mutism (SM) is a rare anxiety disorder typically diagnosed in early childhood. It is characterized by a persistent failure to speak in specific social situations despite having the ability to verbalize in others. Although the onset of SM during adolescence is uncommon, its emergence during puberty or major life transitions may reflect an atypical form of anxiety that is more frequently observed in individuals with autism spectrum disorder (ASD). We describe a case of an 11-year-old girl who developed SM following the onset of puberty and significant environmental changes, including school transition and relocation. She was subsequently diagnosed with ASD. A multidisciplinary treatment approach involving cognitive behavioral therapy, fluoxetine, and pregabalin led to complete remission of SM and marked improvements in academic and social functioning. This case underscores the importance of recognising atypical anxiety presentations in adolescents with ASD and highlights the value of early, individualized, and multimodal interventions. It also raises ethical considerations regarding the temporary use of covert medication in cases with severe resistance to treatment.