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Compr Psychiatry 2022 07 10;116:152326. Epub 2022 May 10.

Albert Einstein College of Medicine, Director of Psychotherapy Research, PRIME, (Psychiatric Research Institute of Montefiore Einstein), New York, NY, USA.

Background: Behavioral Inhibition (BI) is an early temperamental trait characterized by shyness, withdrawal, avoidance, uneasiness, and fear of unfamiliar situations, people, objects, and events. The DSM-5 refers to behavioral inhibition as a temperamental factor related to neurodevelopmental conditions in childhood, including attention deficit hyperactivity disorder, selective mutism, and specific phobias; and to its influence on adult anxiety disorders including social anxiety disorder, agoraphobia, and generalized anxiety disorder, but, interestingly, not separation anxiety disorder (SAD). However, there are phenomenological overlaps between BI and SAD. Read More

Child Adolesc Psychiatry Ment Health 2021 Dec 28;15(1):81. Epub 2021 Dec 28.

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

Background: Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. In contrast, children with SAD are characterized by a combination of a chronically elevated physiological arousal and a blunted physiological fear response to social stress. Read More

J Neural Transm (Vienna) 2021 09 14;128(9):1433-1443. Epub 2021 Aug 14.

Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University Zurich, Neumunsterallee 3, P.O. Box 233, 8032, Zurich, Switzerland.

The study presented in the following verifies some assumptions of the novel 'unsafe world' model of selective mutism (SM). According to this model, SM is a stress reaction to situations erroneously experienced via cognition without awareness as 'unsafe'. It assumes a high sensitivity to unsafety, whereby the nervous system triggers dissociation or freeze mode at relatively low thresholds. Read More

J Affect Disord 2021 08 24;291:140-153. Epub 2021 May 24.

Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia.

Background: Anxiety disorders are highly prevalent and cause substantial personal, social and economic burden. Altered attentional control has been shown to be present across anxiety disorders and is associated with specific changes in brain activity which can be recorded by electroencephalogram (EEG). These include changes in the EEG markers of error-related negativity (ERN) and correct-response negativity (CRN), both believed to reflect response monitoring and attentional control pathophysiology in anxiety. Read More

Clin Child Fam Psychol Rev 2021 06 19;24(2):294-325. Epub 2021 Jan 19.

Virginia Polytechnic Institute and State University, Blacksburg, USA.

In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. Read More

Neuropsychopharmacol Hung 2020 Sep;22(3):91-100

Pest Megyei Pedagógiai Szakszolgálat Budakeszi Tagintézménye, Budaörs, Hungary.

This review aims to present social anxiety disorder from a developmental psychopathological perspective. Evolutionary theories share the view that social anxiety might be adaptive in specific contexts, and suggest several mechanisms of dysfunction (adaptive trade-off , mismatch, individual differences). The aetiology of social anxiety disorder is characterized by a complex interplay of genetic and environmental factors including gene-environment interactions,correlations and epigenetic mechanisms. Read More

Eur Child Adolesc Psychiatry 2021 Jul 4;30(7):1059-1069. Epub 2020 Jul 4.

Department of Psychology, Neuroscience and Behaviour, McMaster University, Room 130, Psychology Building, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.

Selective mutism (SM) is an anxiety disorder in which a child fails to speak in some situations (e.g., school) despite the ability to speak in other situations (e. Read More

Child Psychiatry Hum Dev 2020 04;51(2):330-341

Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.

This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). Read More

Eur Child Adolesc Psychiatry 2019 Sep 25;28(9):1169-1181. 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 2020 07 16;27(5):1007-1015. Epub 2018 Jul 16.

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 ( = 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

J Psychiatr Pract 2018 Jan;24(1):2-14

BARTERIAN: Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH SANCHEZ: The Right Door for Hope, Recovery and Wellness, Ionia, MI, and Wedgwood Christian Services, Grand Rapids, MI MAGEN: Department of Psychiatry, Michigan State University, East Lansing, MI SIROKY and CARLSON: Department of Counseling, Educational Psychology, & Special Education, Michigan State University, East Lansing, MI MASH: Howell, MI.

This study examined the utility of fluoxetine in the treatment of 5 children, aged 5 to 14 years, diagnosed with selective mutism who also demonstrated symptoms of social anxiety. A nonconcurrent, randomized, multiple-baseline, single-case design with a single-blind placebo-controlled procedure was used. Parents and the study psychiatrist completed multiple methods of assessment including Direct Behavior Ratings and questionnaires. 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

Child Adolesc Ment Health 2014 Sep 26;19(3):192-198. Epub 2013 Oct 26.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO box 4623 Nydalen, Oslo, N-0405, Norway.

Background: Randomized controlled psychosocial treatment studies on selective mutism (SM) are lacking.

Method: Overall, 24 children with SM, aged 3-9 years, were randomized to 3 months treatment (n = 12) or wait list (n = 12). Primary outcome measure was the School Speech Questionnaire. 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