Characterizing selective mutism: Is it more than social anxiety?

Abstract

Selective mutism (SM) occurs when a child persistently lacks speech in some social situations but not in others, despite the ability to use and comprehend language. While considered to be related to anxiety, SM is poorly understood and studies of SM children are often based on parent reports. This study developed a unique, non-verbally based assessment protocol for SM children in order to better characterize their clinical profile, language abilities, and learning abilities. A comparison was done with a group of children of similar age, with social phobia (SP) but no SM, to search for characteristics that might distinguish SM from other anxiety disorders. Twenty-three children participated in the study (14 SM and 9 SP). The assessment protocol included standardized anxiety rating scales, cognitive and academic tests, and a speech and language assessment. SM and SP groups showed similar levels of anxiety and academic ability, but the SM group showed some language impairments relative to the SP group. Though requiring replication with a larger sample and nonclinical comparison group, the results suggest that SM children can be assessed by non-verbal means and that their disorder is characterized by anxiety and subtle language impairments.

Social anxiety disorder: questions and answers for the DSM-V

“…[96,104] Comorbidity rates with anxiety disorders, in general, range from 61 to 97%. [96,104,105] Additional comorbid anxiety disorders include separation anxiety disorder (17-32%; [94,102] ) and specific phobia (30-50%; [104,106] ). Although children with SM often are viewed as ''shy,'' ''anxious,'' or ''timid'' (e.g., [107] ), one study found higher parent-reported social anxiety in children with SAD than children with SM, [106] whereas another found that children with diagnoses of SM and SAD were indistinguishable on self-report measures of social anxiety, trait anxiety, and general fears [108] from children with SAD only.…”

Differential Diagnosis of Selective Mutism in Bilingual Children

“…Such broad assessment needs to involve multiple domains of language development (Toppelberg and Shapiro, 2000) in the two languages. New methods for the assessment of language function in children with SM have been developed (Manassis et al, 2003), with clear applicability to bilingual children. Clinicians also need to be aware of potential characteristics of the school environment that can trigger SM in a vulnerable child.…”

“…First, because language minority children (e.g., immigrant and Latino children in the United States) are more likely to be underserved (Hernandez et al, 1998), which can lead to fewer opportunities to be diagnosed in their developmental trajectory. Second, because SM often severely hinders social functioning (through poor social communication), second language acquisition, and educational achievement (American Psychiatric Association, 1994;Manassis et al, 2003). Third, because SM presents additional instructional challenges that often require a diagnosis to be appropriately addressed.…”

Selektiver Mutismus bei mehrsprachigen Kindern

“…Sprachliche Auffälligkeiten finden sich bei etwa einem Drittel bis der Hälfte der Kinder mit SM (Andersson & Thomsen, 1998;Kristensen, 2000;Kumpulainen et al, 1998;Manassis et al, 2003;Steinhausen & Juzi, 1996). In der Studie von Kristensen (2000) (Cohan, Price et al, 2006, S. 352)…”