I wasn't psychiatrist nor psychologist. In fact, I majored in economics when I went to college.
I searched the literature that analyze selective mutism from economists' point of view. But I couldn't find them as I expected. But I found related literature. I read only abstract, though.
[Economic impact of autism]
One of them is Jarbrink, K., and Knapp, M. (2001). The economic impact of autism in Britain. Autism, 5(1), 7-22. According to the abstract, this study estimates economic consequences of autism in the UK. The lifetime cost for a person with autism exceeded ￡2.4 million. The main costs are for living support and day activities.
[Economic impact of selective mutism?]
I get a hint from the study. "Economic impact of selective mutism." But as far as Japan, almost all children with selective mutism don't receive living support nor go to day activity centers.
[Direct cost]
As far as selective mutism, some Japanese children see doctors or counselors. Some of their parents pay their money to see doctors or counselors. But some don't.
Some children undergo counseling in schools or child consultation centers. If they do so, their parents didn't have to pay counseling fee. But as the saying goes, there's no such thing as a free lunch. School counseling costs are covered by tax revenues or tuition. Counseling in child consultation centers are financed from tax revenues.
Some children may not see doctors nor counselors. Some of them are left without being noticed their selective mutism. Even if they are recognized as selectively mute children, teachers and parents don't necessarily refer to doctors nor counselors. When the children grow up but their symptom don't disappear, they or their parents may need to pay some cost.
So, how much cost?
[Indirect cost]
If we think cost in the context of economics, we also need to estimate "opportunity cost."
Let's think of a working mother. She recognizes that her daughter has selective mutism. So, she reduces her working hours to help her daughter. To help her daughter, she gives up her income that she earned before. The income that she gives up is opportunity cost.
Homemakers who have children with selective mutism also pay opportunity cost. They may study about selective mutism, negotiate with teachers or share their thoughts with other mothers on web forums. But if they put their time into any jobs, they will earn some income. That's opportunity cost.
Children also pay opportunity cost. For instance, if nobody treat thier selective mutism, their disturbances will interfere their educational or future occupational achievements. That may decrease their lifetime wages. That's opportunity cost.
[The most cost-effective treatment]
Anyway, I think that the most cost-effective treatment for selective mutism is early intervention. If early intervention is made, the symptom will disappear soon. But if early intervention isn't made, prognosis will be less favorable. If the symptom worsens, it takes considerable time and money to treat selective mutism.
But as far as Japan, early intervention is not necessarily made. I think that's because of imperfect information. Not all people know about selective mutism. Not all people know early intervention is cost-effective.
