A Selective Mutism Arising from First Language Attrition, Successfully Treated with Paroxetine-CBT Combination Treatment

Abstract

After immersion in a foreign language, speakers often have difficulty retrieving native-language words and may experience a decrease in its proficiency, this phenomenon, in the non-pathological form, is known as first language attrition. Self-perception of this low native-language proficiency and apprehension occurring when speaking is expected and, may sometimes lead these people to a state of social anxiety and, in extreme forms, can involve the withholding of speech as a primitive tool for self-protection, linking them to selective mutism. We report an unusual case of selective mutism arising from first language attrition in an Italian girl after attending a two-year "German language school", who successfully responded to a paroxetine-cognitive behavioral treatment (CBT) combination treatment.

Diagnosing selective mutism: a critical review of measures for clinical practice and research

“…This measure is short and comprises a severity scale investigating speaking in three different contexts and a scale to investigate interference of the symptoms on the child's and family functioning. The reliability of the measure has been assessed in different cultural samples, showing acceptable to excellent internal consistency [19][20][21][24][25][26][27][28][29][30]. There is support for adequate convergent, discriminant and incremental validity [17,18].…”

“…Additionally, the three-factor structure as found by Bergman et al [17] was replicated. Furthermore, the SMQ has been translated and used in Italy [26,27], Israel [28,29] (reported Cronbach's α = 0.77), and Turkey ( [30] Cronbach's α = 0.87). Convergent validity of the SMQ was indicated by significant correlations with two (social) anxiety scales (SASC-R and MASC-P) for children and with the ADIS severity score (r = − 0.67) [17].…”

“…The Speech situations questionnaire (SpSQ-P and SpSQ-T) was used in 4 publications (see Table 3, Study ID: 27,31,42,43). The questionnaire for parents comprises 15 items and measures the extent to which the child speaks to different people in different settings including home, school, and community.…”

“…The SM section is mostly used to assess the classification SM for inclusion in the study. In seven studies, the CSR was used as a measure of severity or outcome measure [19,21,27,29,34,[53][54][55]. In these studies, the ADIS was sensitive to treatment change.…”

“…Additionally, the three-factor structure as found by Bergman et al [ 17 ] was replicated. Furthermore, the SMQ has been translated and used in Italy [ 26 , 27 ], Israel [ 28 , 29 ] (reported Cronbach’s α = 0.77), and Turkey ([ 30 ] Cronbach’s α = 0.87).…”