Acquired neurologic mutism in childhood is a complex phenomenon occurring in various neurologic conditions with different etiologies. We illustrate its clinical heterogeneity as reflected in a wide range of concomitant behavioral features by presenting 4 children with acquired neurologic mutism. Neuropsychologic examinations revealed differential patterns of defective or preserved phonation, orofacial movements, communicative behavior, and linguistic functions. We propose that detailed neuropsychologic analysis contributes to descriptions of the evolution of the speech impairment beyond the mute phase and the long-term disability. A framework for the clinical evaluation of children is therefore presented.