The use of medication in selective mutism: a systematic review

Abstract

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.

Treatment of selective mutism: a 5-year follow-up study

“…This is also in line with the earliest SM literature suggesting that an early intervention may have been particularly important for those who improved with treatment [8, 46], in studies of the effect of medication in children with SM [7, 15], as well as findings from treatment of children with anxiety disorders in general [34]. As the effect of age at inclusion was not examined in the Bergman study [26], we cannot directly compare our findings on age.…”

“…SM has over the years been considered difficult to treat, and both medication and psychosocial treatment have been tried. Concerning medication, a systematic review found some evidence for symptomatic improvement in SM with selective serotonin reuptake inhibitors (SSRIs) [ 15 ]. However, controlled- and naturalistic follow-up studies have noted that both treated and untreated children were still very symptomatic, and/or diagnoses persisted [ 16 , 17 ].…”

Clinical Perspective on Passive Audio Vocal Measurement in the Evaluation of Selective Mutism

“…Cognitive behavioral therapy has also demonstrated efficacy in this population, consistent with conceptualizations of SM as an anxiety disorder ( 24 , 25 ). Pharmacological approaches to SM tend to prioritize selective serotonin reuptake inhibitors, again supporting anxiety-focused conceptualizations ( 17 , 26 , 27 ). Technology-based methods, such as using iPads for modeling or feedback, or augmentative and alternative communication (AAC) methods (e.g., text-to-speech systems) have been employed in SM treatment as well ( 28 , 29 ).…”

Passive Audio Vocal Capture and Measurement in the Evaluation of Selective Mutism

“…Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have each demonstrated some efficacy and are commonly used; the effectivenesses of these treatments are consistent with conceptualizations of SM as an anxiety disorder (Carlson et al, 1999;Dummit et al, 1996). Research in the field of SM treatments has generally remained scarce, and more research is needed concerning different interventions (Manassis et al, 2016;Zakszeski and DuPaul, 2017). A focus on new and improved assessment methods in future research will help to illuminate why and how SM develops.…”