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Eur Child Adolesc Psychiatry 2019 Jan 25. Epub 2019 Jan 25.

Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Justus-Liebig-University of Giessen, Otto-Behaghel-Straße 10c, 35394, Giessen, Germany.

Selective mutism (SM) is classified under the category of anxiety disorders in DSM-5 [1], although concrete fears that underlie the condition are not specified contrary to all other anxiety disorders. Given the lack of studies systematically investigating fears in SM, content and frequency of concrete fears as well as related cognitions have remained unclear so far. One hundred and twenty-four participants [M = 13. Read More

Dtsch Arztebl Int 2018 09;155(37):611-620

Department of Psychiatry and Psychotherapy, Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin; Institute of General Practice, Faculty of Medicine, Ludwig-Maximilians-Universität München; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg.

Background: Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65. Their onset is usually in adolescence or early adulthood. The affected patients often develop further mental or somatic illnesses (sequential comorbidity). Read More

Assessment 2018 Jul 1:1073191118787328. Epub 2018 Jul 1.

1 Goethe University, Frankfurt, Germany.

Assessment of selective mutism (SM) is hampered by the lack of diagnostic measures. The Frankfurt Scale of Selective Mutism was developed for kindergarteners, schoolchildren, and adolescents, including the diagnostic scale (DS) and the severity scale (SS). The objective of this study was to evaluate this novel, parent-rated questionnaire among individuals aged 3 to 18 years ( n = 334) with SM, social phobia, internalizing disorders, and a control group. Read More

Psychiatr Pol 2018 Apr 30;52(2):323-343. Epub 2018 Apr 30.

III Klinika Psychiatrii, Instytut Psychiatrii i Neurologii.

The position of selective mutism disorder - SM - has been modified in the last edition of the classification of mental disorders DSM-5. It was removed from "Disorders of childhood and adolescence" and placed in "Anxiety disorders". This caused two important changes in the interpretation of the symptoms of selective mutism. Read More

Nervenarzt 2018 May;89(5):591-602

Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.

Selective mutism was first described in the medical literature 140 years ago. The diagnosis came into the focus of adult psychiatry with the appearance of DSM-5. Henceforth, selective mutism during infancy, adolescence and also adulthood is specified as an independent anxiety disorder. Read More

J Psychosoc Nurs Ment Health Serv 2018 Feb;56(2):14-18

It is important for psychiatric nurses to be familiar with the clinical presentation and recommended treatment for selective mutism (SM), as it is a childhood anxiety disorder that is not commonly studied. This article provides a brief overview of its diagnostic criteria, prevalence, assessment, and history. Special attention is given to misconceptions regarding the disorder and differentiation of trauma and oppositional disorders. Read More

Eur Child Adolesc Psychiatry 2018 Aug 22;27(8):997-1009. Epub 2018 Jan 22.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.

Selective mutism (SM) has been defined as an anxiety disorder in the diagnostic and statistical manual of mental disorders (DSM-5). Cognitive behavioral therapy (CBT) is the recommended approach for SM, but prospective long-term outcome studies are lacking. Reports from the children themselves, and the use of more global quality of life measures, are also missing in the literature. Read More

Child Psychiatry Hum Dev 2017 02;48(1):1-17

Virenze-RIAGG Maastricht, Maastricht, The Netherlands.

The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Read More

Psychopathology 2016;49(2):95-107. Epub 2016 Apr 19.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, Frankfurt am Main, Germany.

Background: Selective mutism (SM) is an anxiety disorder with a close link to childhood social phobia (SP). Our studies compare behavioral problem profiles in children and adolescents with SM and SP and control groups and assess the comorbidity patterns of SM and SP.

Methods: Participants aged 3-18 years with SM (n = 95), SP (n = 74) and internalizing disorders (INT, n = 46) and a typically developing control group (CG, n = 119) were assessed with the Child Behavior Checklist (CBCL); adolescents were additionally assessed with the Youth Self-Report (YSR). Read More

Eur Child Adolesc Psychiatry 2016 Oct 12;25(10):1113-20. Epub 2016 Mar 12.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany.

Behavioral inhibition (BI) is a suspected precursor of selective mutism. However, investigations on early behavioral inhibition of children with selective mutism are lacking. Children aged 3-18 with lifetime selective mutism (n = 109), social phobia (n = 61), internalizing behavior (n = 46) and healthy controls (n = 118) were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire. Read More

Curr Opin Pediatr 2016 Feb;28(1):114-20

aYale University, New Haven, Connecticut bDivision of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of NY, New Hyde Park, New York, USA.

Purpose Of Review: Selective mutism is a disorder in which an individual fails to speak in certain social situations though speaks normally in other settings. Most commonly, this disorder initially manifests when children fail to speak in school. Selective mutism results in significant social and academic impairment in those affected by it. Read More

J Commun Disord 2016 Jan-Feb;59:16-23. Epub 2015 Nov 14.

University of Nevada, Las Vegas, United States. Electronic address:

Unlabelled: Selective mutism (SM) is a debilitating condition in which a child does not speak in social situations where speech is expected. The clinical conceptualization of SM has been debated historically, with evidence pointing partly to anxious and oppositional behavior profiles. Behavioral characteristics were examined in a clinical sample of 57 youth formally diagnosed with selective mutism. Read More

Eur J Pediatr 2016 Apr 24;175(4):481-7. Epub 2015 Oct 24.

The Anxiety Clinic at the Child Psychiatry Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 52621, Israel.

Unlabelled: Selective mutism (SM) is a relatively rare childhood disorder and is underdiagnosed and undertreated. The purpose of the retrospective naturalistic study was to examine the long-term outcome of children with SM who were treated with specifically designed modular cognitive behavioral therapy (MCBT). Parents of 36 children who met diagnostic criteria of SM that received MCBT treatment were invited for a follow-up evaluation. Read More

Am J Med Genet A 2015 Jul 21;167(7):1436-50. Epub 2015 Apr 21.

Departments of Medicine and Molecular Genetics and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

To begin to delineate the psychological characteristics associated with classic 7q11.23 duplication syndrome (duplication of the classic Williams syndrome region; hereafter classic Dup7), we tested 63 children with classic Dup7 aged 4-17 years. Sixteen toddlers aged 18-45 months with classic Dup7 and 12 adults identified by cascade testing also were assessed. Read More

J Autism Dev Disord 2014 May;44(5):1168-82

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JW Goethe University Hospital, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany,

Autism spectrum disorder (ASD) as well as social phobia (SP), and selective mutism (SM) are characterised by impaired social interaction. We assessed the validity of the Social Responsiveness Scale (SRS) to differentiate between ASD, and SP/SM. Raw scores were compared in 6-18 year old individuals with ASD (N = 60), SP (N = 38), SM (N = 43), and typically developed (N = 42). Read More

Duodecim 2013 ;129(24):2641-6

Turun yliopisto, Satakunnan sairaanhoitopiiri.

Selective mutism is a disorder closely linked to anxiety disorders in particular social phobia. Heightened sensitivity to emotional stress factors and coping with social anxiety may be part of the causes leading to the failure to speak. Follow-up studies confirm the fact that selective mutism is a very persistent disorder with a general tendency of poor outcome in particular if not intensively treated. Read More

Harefuah 2012 Oct;151(10):597-9, 603

Pediatric Neurology Department, Child Development Institute, Assaf Harofeh Medical Center, Zerifin, Israel.

Selective mutism is an uncommon disorder in young children, in which they selectively don't speak in certain social situations, while being capable of speaking easily in other social situations. Many etiologies were proposed for selective mutism including psychodynamic, behavioral and familial etc. A developmental etiology that includes insights from all the above is gaining support. Read More

Child Adolesc Psychiatr Clin N Am 2012 Jul 16;21(3):621-41. Epub 2012 Jun 16.

Department of Psychiatry, Johns Hopkins University School of Medicine, 550 North Broadway/Suite 201, Baltimore, MD 21205, USA.

Social phobia (SOP) and selective mutism (SM) are related anxiety disorders characterized by distress and dysfunction in social situations. SOP typically onsets in adolescence and affects about 8% of the general population, whereas SM onsets before age 5 and is prevalent in up to 2% of youth. Prognosis includes a chronic course that confers risk for other disorders or ongoing social disability, but more favorable outcomes may be associated with young age and low symptom severity. Read More

Behav Modif 2012 Jul 7;36(4):525-44. Epub 2012 May 7.

The Mayo Clinic, Rochester, MN, USA.

Although children with social phobia (SP) and selective mutism (SM) present similarly in a clinical setting, it remains unclear whether children with SM are unable to speak due to overwhelming anxiety, or whether withholding speech functions as an avoidance mechanism. A total of 35 children (ages 5-12 years) with either SM (n = 10), SP (n = 11), or no diagnosis (n = 14) participated in the current study. Measurements included clinician, child, and parent ratings as well as behavioral observations and psychophysiological measures. Read More

J Child Psychol Psychiatry 2012 Jan 28;53(1):64-72. Epub 2011 Jul 28.

Waisman Center, University of Wisconsin-Madison, Madison, WI 537051, USA.

Background: Although impaired sensory processing accompanies various clinical conditions, the question of its status as an independent disorder remains open. Our goal was to delineate the comorbidity (or lack thereof) between childhood psychopathology and sensory over-responsivity (SOR) in middle childhood using phenotypic and behavior-genetic analyses.

Method: Participants (N = 970) were drawn from the Wisconsin Twin Project, a population-based sample of twins and their families. Read More

Curr Psychiatry Rep 2011 Aug;13(4):251-7

Department of Psychology, University of Central Florida, Orlando, FL 32828, USA.

Speculation continues regarding the accurate classification of selective mutism and potential etiologic factors. Current research has shed some light on several factors that may predispose some children to this disorder, but conclusions are difficult to draw due to reliance on subjective measures, few comparison groups, and/or limited theoretical grounding. This article provides an update on recent efforts to elucidate the etiologic pathways of selective mutism and on the current debate regarding its strong overlap with anxiety disorders, most notably social phobia. Read More

Curr Psychiatry Rep 2011 Apr;13(2):99-110

Department of Psychiatry/Institute for Juvenile Research, University of Illinois Medical Center at Chicago, 1747 West Roosevelt Road, Mail Room 155, Chicago, IL 60608, USA.

This article reviews the current screening and assessment tools for anxiety disorders in children and adolescents, as well as evidence-based treatment interventions for these disorders. The following anxiety disorders are discussed: separation anxiety disorder, generalized anxiety disorder, specific phobia, panic disorder, social anxiety disorder (social phobia), and selective mutism. There are several well-studied screening and assessment tools to identify childhood anxiety disorders early and differentiate the various anxiety disorders. Read More

Biol Psychiatry 2011 May 30;69(9):825-31. Epub 2010 Dec 30.

Department of Psychiatry, University of California, San Diego, La Jolla, California 92093-0855, USA.

Background: Selective mutism (SM), considered an early-onset variant of social anxiety disorder, shares features of impaired social interaction and communication with autism spectrum disorders (ASDs) suggesting a possible shared pathophysiology. We examined association of a susceptibility gene, contactin-associated protein-like 2 (CNTNAP2), for ASDs and specific language impairment with SM and social anxiety-related traits.

Methods: Sample 1 subjects were 99 nuclear families including 106 children with SM. Read More

J Ment Health 2010 Aug;19(4):337-51

Silver School of Social Work and Department of Psychiatry, New York University, New York, NY 10025, USA.

Background: In psychiatry's transformation from primarily an asylum-based profession to a community-oriented profession, false positive diagnoses that mistakenly classify normal intense reactions to stress as mental disorders became a major challenge to the validity of psychiatric diagnosis. The shift to symptom-based operationalized diagnostic criteria in DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder, which often display similar symptoms. The problem has particular urgency because the DSM's symptom-based criteria are often applied in studies and screening instruments outside of the clinical context and by non-mental-health professionals. Read More

J Abnorm Child Psychol 2010 Nov;38(8):1057-67

McMaster Integrative Neuroscience, Discovery, & Study (MiNDS), McMaster University, Hamilton, ON, Canada.

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8. Read More

Psychiatry (Edgmont) 2010 Mar;7(3):23-31

Dr. Wong is from the Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington.

Selective mutism is a rare and multidimensional childhood disorder that typically affects children entering school age. It is characterized by the persistent failure to speak in select social settings despite possessing the ability to speak and speak comfortably in more familiar settings. Many theories attempt to explain the etiology of selective mutism. Read More

Depress Anxiety 2010 Feb;27(2):168-89

Child Development and Education, University of Amsterdam, 1018VZ Amsterdam, The Netherlands.

Background: This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues.

Method: A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Read More

Isr J Psychiatry Relat Sci 2009 ;46(1):34-44

Anxiety and Traumatic Stress Disorders Clinic, Department of Psychiatry, University of California San Diego, La Jolla, California 92093-0985, USA.

Childhood social phobia (SP) is common and associated with varying forms of impairment. The cause of social anxiety disorder is often complex, involving both genetic and environmental factors. Shyness in young children may be a possible precursor to social anxiety later in life, although not the sole antecedent. Read More

J Abnorm Child Psychol 2010 Jan;38(1):1-17

University of North Carolina at Greensboro, Greensboro, NC, USA.

It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxiety disorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxiety disorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community sample of 688 children attending public elementary schools. Half of these children were selected because they were identified as anxious solitary by peers and the other half were demographically-matched controls. Read More

J Clin Psychiatry 2008 Sep;69(9):1485-96

J Clin Child Adolesc Psychol 2008 Oct;37(4):770-84

Department of Psychiatry, University of California, San Diego, CA, USA.

The goal of this study was to develop an empirically derived classification system for selective mutism (SM) using parent-report measures of social anxiety, behavior problems, and communication delays. The sample consisted of parents of 130 children (ages 5-12) with SM. Results from latent profile analysis supported a 3-class solution made up of an anxious-mildly oppositional group, an anxious-communication delayed group, and an exclusively anxious group. Read More

Z Kinder Jugendpsychiatr Psychother 2007 Nov;35(6):399-407; quiz 408-9

Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Würzburg.

Selective mutism is a communication disorder of childhood in which the child does not speak in specific social situations despite the ability to speak in other situations. A literature review was completed in order to provide practical guidelines for the assessment and treatment of children with selective mutism. There are many different behavioral approaches in the treatment of this disorder, e. Read More

Eur Child Adolesc Psychiatry 2008 Aug 20;17(5):255-63. Epub 2008 Mar 20.

Cherry Orchard Hospital, HSE Dublin Mid-Leinster, Dublin 8, Ireland.

Elective mutism is a rare disorder of communication, where the child speaks fluently in familiar situations, such as home, despite lack of speech in less familiar settings, for example school. A variety of temperamental and behaviour characteristics, co-morbid psychiatric conditions, neurodevelopmental delay and family factors have been associated with the disorder. EM children are described as excessively shy, withdrawn, 'slow to warm up', inhibited, often avoid eye contact, fear social embarrassment and experience significant separation anxiety, on separation from their attachment figures. Read More

J Am Acad Child Adolesc Psychiatry 2007 Nov;46(11):1464-72

Department of Psychiatry, University of California, San Diego, USA.

Objective: To examine the history of lifetime psychiatric disorders in the parents of children with selective mutism (SM) compared to parents of children in a control group.

Method: Seventy parent dyads (n = 140) of children with lifetime SM and 31 parent dyads (n = 62) of children without SM were interviewed with the Structured Clinical Interview for DSM-IV (IV and II) anxiety disorders, mood disorders, avoidant personality disorder, and schizoid personality disorder modules via telephone. Interviewers were blind to proband status. Read More

Psychopharmacology (Berl) 2007 Mar 5;191(1):67-86. Epub 2007 Jan 5.

Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., CMSC 312, Baltimore, MD, USA.

Rationale: Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and increasing empirical evidence helps guide current clinical practice.

Objective: To review studies which examine the pharmacological treatment of pediatric anxiety disorders, including obsessive-compulsive disorder and to summarize treatment implications. Read More

Eur Child Adolesc Psychiatry 2006 Aug 9;15(5):245-55. Epub 2006 May 9.

Chedoke Campus, Hamilton Health Sciences, Hamilton, ON, Canada, L8N 3Z5.

We compared social phobia, anxiety, oppositional behavior, social skills, and self-concept in three groups: (1) 28 children with specific mutism (who did not speak to teachers but were more likely to speak to parents and peers at home and school); (2) 30 children with generalized mutism (whose speaking was restricted primarily to their homes); and (3) 52 community controls. Children with generalized mutism evidenced higher anxiety at school, and more separation anxiety, OCD, and depressive symptoms at home. Parents and teachers reported that the social phobia and anxiety scores of children in both the specific and generalized mutism subgroups were higher than controls. Read More

J Dev Behav Pediatr 2006 Apr;27(2):129-33

Lucena Clinic, Tallaght, Dublin 24, Ireland Regional Child and Family Centre, North Eastern Health Board, St. Mary's Hospital, Dublin Rd., Drogheda, Co. Louth, Ireland.

Selective mutism is a rare social anxiety disorder characterized by a total lack of speech in certain specific situations despite the ability to speak in others. Both genetic and psychosocial factors are thought to be involved in its presentation, persistence, and response to treatment. This case report describes a case of young female monozygotic twins who presented with selective mutism and their treatment spanning a 2-year period. Read More

Eur Child Adolesc Psychiatry 2006 Mar;15(2):111-7

Dept. of Psychiatry for Children and Adolescents, University of Wuerzburg, Fuechsleinstr. 15, 97080, Wuerzburg, Germany.

The aim of the study was to investigate the extent of social anxiety in different mental disorders. A total of 341 patients aged 7-18 years participated in the study. To measure social anxiety, the German version (SPAIK) of the Social Phobia and Anxiety Inventory for Children (SPAI-C) was used. Read More

Depress Anxiety 2006 ;23(3):117-23

Maryland Center for Anxiety Disorders, University of Maryland-College Park, USA.

This study investigated the relationship between selective mutism (SM), social phobia (SP), oppositionality, and parenting styles. Twenty-one children with SP, 21 children with SM and SP, and 21 normal children ages 7-15, and the mother of each child, participated in an assessment of psychopathological factors potentially related to SM. Children with SM did not endorse higher levels of social anxiety than did children with SP, although clinicians gave higher severity ratings to those who had both disorders. Read More

Child Adolesc Psychiatr Clin N Am 2005 Oct;14(4):877-908, x

Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

This article reviews the psychopharmacologic treatment of child and adolescent anxiety disorders and is divided into the following sections: historical background, general treatment principles, obsessive-compulsive disorder, other anxiety disorders, including separation anxiety disorders, generalized anxiety disorder, and social phobia, elective mutism, and post-traumatic stress disorder and specific phobia. Short-term and long-term psychopharmacologic treatment strategies are reviewed, as are approaches for managing comorbidity and treatment-refractory cases. This article is organized by diagnostic categories rather than by medication classes to emphasize the clinical perspective. Read More

Semin Speech Lang 2005 Aug;26(3):201-10

Department of Psychiatry Research, Hospital for Sick Children, Toronto, Ontario, Canada.

Selective mutism (SM) is a rare disorder that is associated with both anxiety and communication impairments. Preliminary evidence suggests that educational attainment and development of social skills and self-esteem may be affected by SM in a significant proportion of cases. There is a critical need for cross-disciplinary research from the fields of speech-language pathology, psychiatry, and clinical psychology to develop protocols for assessing language and cognitive functioning in children with SM and developing interventions that address psychiatric, communicative, and social aspects of this disorder. Read More

Am J Speech Lang Pathol 2004 Nov;13(4):304-15

The Hospital for Sick Children, Toronto, Ontario, Canada.

Selective mutism (SM) is a rare and complex disorder associated with anxiety symptoms and speech-language deficits; however, the nature of these language deficits has not been studied systematically. A novel cross-disciplinary assessment protocol was used to assess anxiety and nonverbal cognitive, receptive language, and expressive narrative abilities in 7 children with SM and a comparison group of 7 children with social phobia (SP). The children with SM produced significantly shorter narratives than children with SP, despite showing normal nonverbal cognitive and receptive language abilities. Read More

Depress Anxiety 2004 ;20(4):155-64

Department of Psychiatry, University of California San Diego, La Jolla, California 92037, USA.

We present prevalence and treatment utilization rates for child anxiety disorders in a university-affiliated primary care clinic. Families were recruited from a pediatric patient list and 714 families participated in an initial study wherein they completed child anxiety questionnaires. According to parent and child self-report questionnaires (n=714), 22% and 20% of children, respectively, were above a suggested clinical cutoff on a brief anxiety screen; 19% and 14% of children exceeded clinical cutoffs on a separate social anxiety questionnaire. Read More

J Am Acad Child Adolesc Psychiatry 2003 Dec;42(12):1451-9

Psychology Department, The Hebrew University, Jerusalem, Israel.

Objective: To assess the incidence of selective mutism (SM) in West Jerusalem's state preschools and evaluate social anxiety/phobia disposition (SAP), social competence (SC), markers of neurodevelopmental delay/disorder (NDD), mothers' psychological adjustment, and marital conflict in immigrant and native children with SM and their matched controls.

Method: Mothers of 9 immigrant and 10 native children with SM and their matched controls completed questionnaires evaluating themselves, their marriages, and their children.

Results: A response rate of 30% (19/64) was obtained. Read More

Depress Anxiety 2003 ;18(3):153-61

Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.

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. Read More

J Am Acad Child Adolesc Psychiatry 2003 Sep;42(9):1069-75

Department of Psychiatry, University of Maryland, College Park, MD 20742, USA.

Objective: To investigate the hypothesis that children with selective mutism are more socially anxious than children with social anxiety disorder but who are not selectively mute.

Method: Twenty-three children with comorbid selective mutism and social phobia and 23 age-matched controls with social phobia alone and their parents participated in a comprehensive assessment of social anxiety and related aspects of psychopathology.

Results: The results do not uniformly support previous suggestions that children with selective mutism refuse speech because they are "frozen with fear. Read More

J Psychol 2003 Jan;137(1):29-40

Clinical Psychology, University of North Dakota, USA.

Selective mutism is a disorder characterized by a persistent failure to speak in certain social situations. It is typically diagnosed in childhood, and the disorder can last from just a few months to several years in some individuals. Debate surrounds the origins and causes of this disorder. Read More

Ugeskr Laeger 2003 Feb;165(7):678-81

Borne- og Ungdomspsykiatrisk Hospital, Harald Selmers Vej 66, DK-8240 Risskov.

Elective mutism is a relatively uncommon disorder characterized by consistent failure to speak in specific social settings, such as in school, despite speaking fluently in a variety of other situations. Elective mutism is a very debilitating disorder for the affected child, as well as for their families, with detrimental implications for the development of social skills and learning if not offered appropriate support and treatment. The most promising treatment results have thus by far been achieved through a combination of cognitive behaviour therapy and supportive cooperation between parents, the school, and the treating child psychiatrist, occasionally supplemented with pharmacological treatments such as selective serotonin reuptake inhibitors. Read More

Psychiatr Clin North Am 2002 Dec;25(4):757-74

Anxiety Disorders Clinic, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA.

Social anxiety disorder is well suited to the spectrum concept because it has trait-like qualities of early onset, chronicity, and no empirically derived threshold that demarcates normal from clinically significant trait social anxiety. Social anxiety disorder has been shown to respond to relatively specific pharmacologic and cognitive-behavioral therapies, which makes identification of other conditions that may lie on the social anxiety disorder spectrum important because of possible treatment implications. Biologic markers associated with social anxiety disorder also may be shared by similar but nonidentical traits, such as behavioral inhibition and detachment. Read More