Latent Class Symptom Profiles of Selective Mutism: Identification and Linkage to Temperamental and Social Constructs

Abstract

Selective mutism (SM) is a stable, debilitating psychiatric disorder in which a child fails to speak in most public situations. Considerable debate exists as to the typology of this population, with empirically-based studies pointing to possible dimensions of anxiety, oppositionality, and communication problems, among other aspects. Little work has juxtaposed identified symptom profiles with key temperamental and social constructs often implicated in SM. The present study examined a large, diverse, non-clinical, international sample of children aged 6-10 years with SM to empirically identify symptom profiles and to link these profiles to key aspects of temperament (i.e., emotionality, shyness, sociability, activity) and social functioning (i.e., social problems, social competence). Exploratory and confirmatory factor analysis revealed anxiety/distress, oppositionality, and inattention domains. In addition, latent class analysis revealed nuanced profiles labeled as (1) moderately anxious, oppositional, and inattentive, (2) highly anxious, and moderately oppositional and inattentive, and (3) mildly to moderately anxious, and mildly oppositional and inattentive. Class 2 was the most impaired group and was associated with greater emotionality, shyness, and social problems. Class 3 was the least impaired group and was associated with better sociability and social competence and activity. Class 1 was largely between the other classes, demonstrating less shyness and social problems than Class 2. The results help confirm previous findings of anxiety and oppositional profiles among children with SM but that nuanced classes may indicate subtle variations in impairment. The results have implications not only for subtyping this population but also for refining assessment and case conceptualization strategies and pursuing personalized and perhaps less lengthy treatment.

Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder

“…In the latest versions of classification systems such as the DSM (American Psychiatric Association 2013 ) and ICD (World Health Organization 2018 ), SM is categorized as an anxiety disorder. As noted throughout this review, this is justified when looking at the abundant empirical evidence demonstrating that (social) anxiety is a common symptom associated with this psychiatric condition (Driessen et al 2020 ; Cohan et al 2008 ; Diliberto and Kearney 2016 , 2018 ; Schwenck et al 2019 ; Vogel et al 2019 ). The acknowledgement of SM being an anxiety problem is strongly guiding our thinking about the origins of the disorder, which is reflected in developmental psychopathology models that are dominated by anxiety-relevant etiological factors (Cohan et al 2006 ; Muris and Ollendick 2015 ; Viana et al 2009 ).…”

“…The second research line indeed relies more on the notion that psychopathological phenomena should be viewed on a continuum and explores to what extent children with SM display varying levels of social anxiety and several other types of symptoms. The aforementioned study by Cohan et al ( 2008 ) is a good example of such an approach, and in general this type of research has shown that although SM is associated with a heterogeneous set of symptoms, social anxiety appears to be a prominent feature that is present in almost all children with this psychiatric condition (see also Diliberto and Kearney 2016 , 2018 ; Schwenck et al 2019 ).…”

Symptoms of Selective Mutism in Non-clinical 3- to 6-Year-Old Children: Relations With Social Anxiety, Autistic Features, and Behavioral Inhibition

“…Fourth, although this investigation focused on a number of relevant psychopathological and temperamental correlates of SM, it is good to keep in mind that other factors have also been connected to this condition. Prominent examples are developmental delays (Kristensen, 2000), speech and language problems (Manassis et al, 2007), and externalizing symptoms (Diliberto and Kearney, 2018). Thus, in order to get a complete picture of possible antecedents of children's non-speaking behavior, it will be necessary to also include scales or instruments that assess these constructs.…”

“…It is important to note that in most of children, SM is primarily an anxiety-driven condition (Cohan et al, 2008;e.g., Capozzi et al, 2018). However, various scholars have noted out that SM is a heterogeneous disorder (e.g., (Mulligan, 2012)) and that there are children in which-besides (social) anxiety-other problems such as developmental delay (Kristensen, 2000), language expression difficulties (Manassis et al, 2007), oppositional behavior (Diliberto and Kearney, 2018), and presumably ASD or related features are implicated as well.…”

The Heterogeneity of Selective Mutism: A Primer for a More Refined Approach

“…Diliberto and Kearney ( 2018 ) examined a larger and more diverse sample of children aged 6–10 years identified with selective mutism. Anxiety/distress, oppositionality, and inattention domains were identified via initial exploratory and confirmatory factor analysis.…”