Abstract
Selective mutism’s core symptom of a failure to speak in select situations that can persist for years causes marked impact on a child’s life and considerable concern for parents and schools. The disorder has had an interesting history, being viewed initially as an almost wilful act of defiance by the child to its current conceptualisation as a form of anxiety disorder with close ties to social anxiety disorder. In this chapter, the characteristics, features and classification of Selective Mutism as a form of anxiety are described, followed by a detailed exploration of factors that increase the risk for the disorder. The chapter then moves to issues of direct clinical relevance including coverage of relevant assessment measures and detailed discussion of strategies of relevance during clinical interview. Finally, empirically validated methods of its management are described, especially cognitive behavioural programs that focus around gradual, in vivo exposure. This includes a brief coverage of the evidence base along with a practitioner-informed description of key components of validated treatments and clinical indications of their application.
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References
Adam, H. M., & Glasner, P. J. (1954). Emotional involvements in some form of mutism. Journal of Speech and Hearing Disorders, 19, 59–69. https://doi.org/10.1044/jshd.1901.59
Alyanak, B., Kilinçaslan, A., Harmanci, H. S., Demirkaya, S. K., Yurtbay, T., & Vehid, H. E. (2013). Parent adjustment, parenting attitudes and emotional and behavioral problems in children with selective mutism. Journal of Anxiety Disorders, 27, 9–15. https://doi.org/10.1016/j.janxdis.2012.10.001
American Psychiatric Association (APA). (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). APA. https://doi.org/10.1176/ajp.145.10.1301
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Andersson, C. B., & Thomsen, P. H. (1998). Electively mute children: An analysis of 37 Danish cases. Nordic Journal of Psychiatry, 52, 231–238. https://doi.org/10.1080/08039489850139157
Bergman, R. L. (2013). Treatment for children with selective mutism: An integrative behavioural approach. Oxford University Press. https://doi.org/10.1093/med:psych/9780195391527.001.0001
Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the Academy of Child and Adolescent Psychiatry, 41(8), 938–946. https://doi.org/10.1097/00004583-200208000-00012
Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L. (2013). Integrated behavior therapy for selective mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51, 680–689. https://doi.org/10.1016/j.brat.2013.07.003
Black, B., & Udhe, T. W. (1995). Psychiatric characteristics of children with selective mutism: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 34(7), 847–856. https://doi.org/10.1097/00004583-199507000-00007
Brison, D. W. (1966). Case studies in school psychology a non-talking child in kindergarten: An application of behaviour therapy. Journal of School Psychology, IV(4), 65–69.
Brown, B. J., & Lloyd, H. (1975). A controlled study of children not speaking at school. Journal of Associated Workers of Maladjusted Children, 3, 49–63.
Browne, E., Wilson, V., & Laybourne, P. C. (1963). Diagnosis and treatment of elective mutism in children. Journal of the American Academy of Child Psychiatry, 2, 605–617.
Bufferd, S. J., Dougherty, L. R., Carlson, G. A., & Klein, D. N. (2011). Parent-reported mental health in preschoolers: Findings using a diagnostic interview. Comprehensive Psychiatry, 52, 359–369. https://doi.org/10.1016/j.comppsych.2010.08.006
Capozzi, F., Manti, F., Trani, M. D., Romani, M., Vigliante, M., & Sogos, C. (2018). Children’s and parent’s psychological profiles in selective mutism and generalized anxiety disorder: A clinical study. European Child and Adolescent Psychiatry, 27, 775–783. https://doi.org/10.1007/s00787-017-1075-y
Carlson, J. S., Mitchell, A. D., & Segool, N. (2008). The current state of empirical support for the pharmacological treatment of selective mutism. School Psychology Quarterly, 23(3), 354–372. https://doi.org/10.1037/1045-3830.23.3.354
Catchpole, R., Young, A., Baer, S., & Salih, T. (2019). Examining a novel, parent child interactional therapy-informed, behavioral treatment of selective mutism. Journal of Anxiety Disorders, 66. https://doi.org/10.1016/j.jsnxdis.2019.102112
Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Cohan, S., & Stein, M. B. (2007). Selective mutism and social anxiety disorder: All in the family? Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1464–1472. https://doi.org/10.1097/chi.0b013e318149366a
Chethik, M. (1973). Amy: The intensive treatment of an elective mute. Journal of the American Academy of Child Psychiatry, 12(3), 482–498. https://doi.org/10.1016/S0002-7138(09)61258-9
Chomlemkery, H., Mojica, I., Rohrmann, S., Gensthaler, A., & Freitag, C. M. (2013). Can autism spectrum disorders and social anxiety disorders be differentiated by the Social Reciprocity Scale in children and adolescents? Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-013-1979-4
Clauss, J. A., & Blackford, J. U. (2012). Behavioral inhibition and risk for developing social anxiety disorder: A meta-analytic study. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1066–1075. https://doi.org/10.1016/j.jaac.2012.08.002
Cline, T. (2015). Selective mutism in children: Changing perspectives over half a century. In B. R. Smith & A. Sluckin (Eds.), Tackling selective mutism: A guide for professionals and parents. Jessica Kingsley Publishers.
Cohan, S. L., Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Roesch, S. C., & Stein, M. B. (2008). Refining the classification of children with Selective Mutism: A latent profile analysis. Journal of Clinical Child and Adolescent Psychology, 37(4), 770–784. https://doi.org/10.1080/15374410802359795
Cornacchio, D., Furr, J. M., Sanchez, A. L., Hong, N., Feinberg, L. K., Tenenbaum, R., Del Dusto, C., Bry, L., Poznanski, B., Miguel, E., Ollendick, T. H., Kurtz, S. M. S., & Comer, J. S. (2019). Intensive group behavioral treatment (IGBT) for children with selective mutism: A preliminary randomized clinical trial. Journal of Consulting and Clinical Psychology, 87(8), 720–733. https://doi.org/10.1037/ccp0000422
Cunningham, C. E., McHolm, A., Boyle, M. H., & Patel, S. (2004). Behavioral and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism. Journal of Child Psychology and Psychiatry, 45(8), 1363–1372. https://doi.org/10.1111/j.1469-7610.2004.00327.x
Cunningham, C. E., McHolm, A., & Boyle, M. H. (2006). Social phobia, anxiety, oppositional behaviour, social skills, and self-concept in children with specific selective mutism, generalized selective mutism, and community controls. European Child and Adolescent Psychiatry, 15, 245–255. https://doi.org/10.1007/s00787-006-0529-4
Czajkowski, N., Roysamb, E., Reichborn-Kjennerub, T., & Tambs, K. (2010). A population based family study of symptoms of anxiety and depression: The HUNT study. Journal of Affective Disorders, 125, 355–360.
Diliberto, R. A., & Kearney, C. A. (2016). Anxiety and oppositional behavior profiles among youth with selective mutism. Journal of Communication Disorders, 59, 16–23. https://doi.org/10.1016/j.comdis.2015.11.001
Driessen, J., Blom, J. D., Muris, P. M., Blashfield, R. K., & Molendijk, M. L. (2020). Anxiety in children with selective mutism: A meta-analysis. Child Psychiatry and Human Development, 51, 330–341. https://doi.org/10.1007/s10578-019-00933-1
Dummitt, E. S., Klein, R. G., Tancer, N. K., Asche, B., Martin, J., & Fairbanks, J. A. (1997). Systematic assessment of 50 children with selective mutism. Journal of the American Academy of Child and Adolescent Psychiatry, 36(5), 653–660. https://doi.org/10.1097/00004583-199705000-00016
Edison, S. C., Evans, M. A., McHolm, A. E., Cunningham, C. E., Nowakowski, M. E., Boyle, M., & Schmidt, L. A. (2011). An investigation of control among parents of selectively mute, anxious and non-anxious children. Child Psychiatry and Human Development, 42, 270–290. https://doi.org/10.1007/s10578-010-0214-1
Elizur, Y., & Perednik, R. (2003). Prevalence and description of Selective Mutism in immigrant and native families: A controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 42(12), 1451–1459. https://doi.org/10.1097/00004583-200312000-00012
Elson, A., Pearson, C., Jones, D., & Schumacher, E. (1965). Follow-up study of childhood elective mutism. Archives of General Psychiatry, 13, 182–187.
Ezpeleta, L., de la Osa, N., & Doménech, J. M. (2014). Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish pre-schoolers. Social Psychiatry and Psychiatric Epidemiology, 49, 145–155. https://doi.org/10.1007/s00127-013-0683-1
Ford, M. A., Sladeczek, I. E., & Carlson, J. (1998). Selective mutism: Phenomenological characteristics. School Psychology Quarterly, 13(3), 192–227. https://doi.org/10.1037/h0088982
Gensthaler, A., Khalaf, S., Ligges, M., Kaess, M., Freitag, C. M., & Schwenck, C. (2016). Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar. European Child and Adolescent Psychiatry, 25, 1113–1120. https://doi.org/10.1007/s00787-016-0835-4
Gensthaler, A., Dieter, J., Raisig, S., Hartmann, B., Ligges, M., Kaess, M., Freitag, C. M., & Schwenck, C. (2020). Evaluation of a novel parent-rated scale for selective mutism. Assessment, 27(5), 1007–1015. https://doi.org/10.1177/107319118787328
Hayden, T. L. (1980). Classification of elective mutism. Journal of the American Academy of Child Psychiatry, 19, 118–133. https://doi.org/10.1016/S0002-7138(09)60657-9
Henkin, Y., & Bar-Haim, Y. (2015). An auditory-neuroscience perspective on the development of selective mutism. Developmental Cognitive Neuroscience, 12, 86–93. https://doi.org/10.1016/j.dcn.2015.01.002
Kagan, J., Reznick, J. S., & Gibbons, J. (1989). Inhibited and uninhibited types of children. Child Development, 60(4), 838–845. https://doi.org/10.2307/1131025
Karakaya, I., Sismanlar, S. G., Öç, Ö. Y., Memik, N. Ç., Ċoskun, A., Ağaoğlu, B., & Yavuz, C. I. (2008). Selective mutism: A school-based cross-sectional study from Turkey. European Child and Adolescent Psychiatry, 17, 114–117. https://doi.org/10.1007/s00787-007-0644-x
Klein, E. R., Armstrong, S. L., & Shipon-Blum, E. (2012). Assessing spoken language competence in children with selective mutism: Using parents as test presenters. Communication Disorders Quarterly, 34(3), 184–195. https://doi.org/10.1177/15257401
Klein, E. R., Armstrong, S. L., Skira, K., & Gordon, J. (2016). Social Communication Anxiety Treatment (S-CAT) for children and families with selective mutism: A pilot study. Clinical Child Psychology and Psychiatry, 1–19. https://doi.org/10.1177/1359/1359104516633497
Koskela, M., Chudal, Lutamo, T., Suominen, A., Steinhausen, H.-C., & Sourander, A. (2020). The impact of parental psychopathology and sociodemographic factors in selective mutism – A nationwide population-based study. BMC Psychiatry, 20(221). https://doi.org/10.1186/s12888-020-02637-6
Kratochwill, T. R., Brody, G. H., & Piersel, W. C. (1979). Elective mutism in children. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 2, pp. 193–240). Plenum Press.
Kristensen, H. (2001). Multiple informants’ report of emotional and behavioural problems in a nation-wide sample of selective mute children and controls. European Child and Adolescent Psychiatry, 10, 135–142.
Kristensen, H., & Torgersen, S. (2001). MCMI-II personality traits and symptom traits in parents of children with selective mutism: A case-control study. Journal of Abnormal Psychology, 110(4), 648–652. https://doi.org/10.1037//0021-843X.110.4.648
Kristensen, H., & Torgersen, S. (2002). A case-control study of EAS child and parental temperaments in selectively mute children with and without a co-morbid communication disorder. Nordic Journal of Psychiatry, 56(5), 347–353. https://doi.org/10.1080/080394802760322114
Krohn, D. D., Weckstein, S. M., & Wright, H. L. (1992). A study of the effectiveness of a specific treatment for elective mutism. Journal of American Academy of Child and Adolescent Psychiatry, 31(4), 711–718. https://doi.org/10.1097/00004583-199207000-00020
Krysanski, V. L. (2003). A brief review of selective mutism literature. The Journal of Psychology: Interdisciplinary and Applied, 137(1), 29–40. https://doi.org/10.1080/00223980309600597
Kumpulainen, K. R., Räsänen, E., Raaska, H., & Somppi, V. (1998). Selective mutism among second-graders in elementary school. European Child and Adolescent Psychiatry, 7, 24–29. https://doi.org/10.1007/s007870050041
Letamendi, A. M., Chavira, D. A., Hitchcock, C. A., Roesch, S. C., Shipon-Blum, E., & Stein, M. B. (2008). Selective mutism questionnaire: Measurement structure and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 47(10), 1197–1204. https://doi.org/10.1097/CHI.0b013e3181825a7b
Manassis, K., Oerbeck, B., & Overgaard, K. R. (2016). The use of medication in selective mutism: A systematic review. European Child and Adolescent Psychiatry, 25, 571–578. https://doi.org/10.1007/s00787-015-0794-1
McEvoy, P. E., Saulsman, L. M., & Rapee, R. M. (2018). Imagery-enhanced CBT for social anxiety disorder. The Guildford Press.
McHolm, A. E., Cunningham, C. E., & Vanier, M. K. (2005). Helping your child with selective mutism: Practical steps to overcome a fear of speaking. New Harbinger Publications Inc.
McInnes, A., Fung, D., Mannassis, K., Fiksenbaum, L., & Tannock, R. (2004). Narrative skills in children with selective mutism: An exploratory study. American Journal of Speech-Language Pathology, 13, 304–315. https://doi.org/10.1044/1058-0360(2004/031)
McLeod, B. D., Wood, J. J., & Weisz, J. R. (2007). Examining the association between parenting and childhood anxiety: A meta-analysis. Clinical Psychology Review, 27, 155–172. https://doi.org/10.1016/j.cpr.2006.09.002
Milic, M. I., & Rapee, R. M. (2015). The nature of anxiety in children with selective mutism. Unpublished doctoral thesis, Macquarie University.
Milic, M. I., Carl, T., & Rapee, R. M. (2020). Similarities and differences between young children with selective mutism and social anxiety disorder. Behaviour Research and Therapy, 133. https://doi.org/10.1016/j.brat.2020.103696
Morris, J. V. (1953). Cases of elective mutism. American Journal of Mental Deficiency, 57, 661–668.
Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: A review on selective mutism, the new anxiety disorder in DSM-5. Clinical Child and Family Psychological Review, 18(2), 151–169. https://doi.org/10.1007/s10567-015-0181-y
Muris, P., & Ollendick, T. H. (2021). Selective mutism and its relations to social anxiety disorder and autism spectrum disorder. Clinical Child and Family Psychology Review. https://doi.org/10.1007/s10567-020-00342-0
Nowakowski, M. E., Tasker, S. L., Cunningham, C. E., McHolm, A. E., Edison, S., Pierre, J., Boyle, M. H., & Schmidt, L. A. (2011). Joint attention in parent-child dyads involving children with selective mutism: A comparison between anxious and typically developing children. Child Psychiatry and Human Development, 42, 78–92. https://doi.org/10.1007/s10578-010-0208-z
Oerbeck, B., Stein, M. B., Pripp, A. H., & Kristensen, H. (2014). Selective mutism: Follow-up study 1 year after end of treatment. European Child and Adolescent Psychiatry, 24, 757–766. https://doi.org/10.1007/s00787-014-0620-1
Oerbeck, B., Overgaard, K. R., Stein, M. B., Pripp, A. H., & Kristensen, H. (2018). Treatment of selective mutism: A 5-year follow-up study. European Journal of Child and Adolescent Psychiatry, 27, 997–1009. https://doi.org/10.1007/s00787-018-1110-7
Oerbeck, B., Overgaard, K. R., Bergman, R. L., Pripp, A. H., & Kristensen, H. (2020). The selective mutism questionnaire: Date from typically developing children and children with selective mutism. Clinical Child Psychology and Psychiatry, 25(4), 754–765. https://doi.org/10.1177/1359104520914695
Omdal, H., & Galloway, D. (2008). Could selective mutism be re-conceptualised as a specific phobia of expressive speech? An exploratory post-hoc study. Child and Adolescent Mental Health, 13(2), 74–81. https://doi.org/10.1111/j.1475-3588.2007.00454.x
Østergaard, K. R. (2018). Treatment of selective mutism based on cognitive behavioural therapy, pharmacology and combination therapy – A systematic review. Nordic Journal of Psychiatry, 72(4). https://doi.org/10.1080/08039488.2018.1439530
Poole, K. L., Cunningham, C. E., McHolm, A. E., & Schmidt, L. A. (2020). Distinguishing selective mutism and social anxiety in children: A multi-method study. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01588-3
Porjes, M. D. (1992). Intervention with the selectively mute child. Psychology in the Schools, 29, 367–376. https://doi.org/10.1002/1520-6807(199210)29:4<367::AID-PITS2310290410>3.0.CO;2-0
Pustrom, E., & Speers, R. W. (1964). Elective mutism in children. Journal of the American Academy of Child Psychiatry, 3, 287–297. https://doi.org/10.1016/S0002-7138(09)61923-3
Rapee, R. M., & Spence, S. H. (2004). The etiology of social phobia: Empirical evidence and an initial model. Clinical Psychology Review, 24, 737–767. https://doi.org/10.1016/j.cpr.2004.06.004
Rapee, R. M., Schniering, C. A., & Hudson, J. L. (2009). Anxiety disorders during childhood and adolescence: Origins and treatment. Annual Review of Clinical Psychology, 5, 311–341. https://doi.org/10.1146/annurev.clinpsy.032408.153628
Reed, G. F. (1963). Elective mutism in children: A re-appraisal. Journal of Child Psychology and Psychiatry, 4, 99–107. https://doi.org/10.1111/j.1469-7610.1963.tb02059.x
Remschmidt, H., Poller, M., Herpertz-Dahlmann, B., Hennighausen, K., & Gutenbrunner, C. (2001). A follow-up study of 45 patients with elective mutism. European Archives of Psychiatry and Clinical Neuroscience, 251, 284–296. https://doi.org/10.1007/pl00007547
Roe, V. (2015). Silent voices: Listening to some young people with selective mutism and their parents. In B. R. Smith & A. Sluckin (Eds.), Tackling selective mutism: A guide for professionals and parents. Jessica Kingsley Publishers.
Salfield, D. J. (1950). Observations on elective mutism in children. Journal of Mental Science, 96(405), 1024–1032. https://doi.org/10.1192/bjp.96.405.1024
Schwenck, C., Gensthaler, A., & Vogel, F. (2019). Anxiety levels in children with selective mutism and social anxiety disorder. Current Psychology. https://doi.org/10.1007/s12144-019-00546-w
Schwenck, C., Gensthaler, A., Vogel, F., Pfeffermann, A., Laerum, S., & Stahl, J. (2021). Characteristics of person, place and activity that trigger failure to speak in children with selective mutism. European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-012-01778-8
Siegel, D. J., & Bryson, T. P. (2018). The whole brain child: 12 revolutionary strategies to nurture your child’s developing brain. Random House.
Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV-parent version. Psychological Corporation.
Steffenburg, H., Steffenburg, S., Gillberg, C., & Billstedt, E. (2018). Children with autism spectrum disorders and selective mutism. Neuropsychiatric Disease and Treatment, 14, 1163–1169. https://doi.org/10.2147/NDT.S154966
Steinhausen, H. C., & Adamek, R. (1997). The family history of children with elective mutism: A research report. European Child and Adolescent Psychiatry, 6, 107–111.
Steinhausen, H. C., & Juzi, C. (1996). Elective mutism: An analysis of 100 cases. Journal of the American Academy of Child and Adolescent Psychiatry, 35(5), 606–614.
Tancer, N. K. (1992). Elective mutism: A review of the literature. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 14, pp. 265–288). Plenum Press.
Toppelberg, C. O., Tabors, P., Coggins, A., Lum, K., & Burger, C. (2005). Differential diagnosis of selective mutism in bilingual children. Journal of the American Academy of Child and Adolescent Psychiatry, 44(6), 592–595. https://doi.org/10.1097/01.chi.0000157549.87078.f8
Vecchio, J., & Kearney, C. A. (2009). Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management. Behavior Therapy, 40, 380–392. https://doi.org/10.1016/j.beth.2008.10.005
Vogel, F., Gensthaler, A., Stahl, J., & Schwenck, C. (2019). Fears and fear-related cognitions in children with selective mutism. European Child and Adolescent Psychiatry, 28, 1169–1181. https://doi.org/10.1007/s00787-019-01281-0
Wright, H. H., Holmes, G. R., Cuccaro, M. L., & Leonhardt, T. V. (1994). A guided bibliography of the selective mutism (elective mutism) literature. Psychological Reports, 74, 995–1007. https://doi.org/10.2466/pr0.1994.74.3.995
Yeganeh, R., Beidel, D. C., Turner, S. M., Pina, A. A., & Silverman, W. K. (2003). Clinical distinctions between selective mutism and social phobia: An investigation of clinical psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 42(9), 1069–1075. https://doi.org/10.1097/01.CHI.0000070262.24125.23
Yeganeh, R., Beidel, D. C., & Turner, S. M. (2006). Selective mutism: More than social anxiety. Depression and Anxiety, 23, 117–123. https://doi.org/10.1002/da.20139
Young, B. J., Bunnell, B. E., & Beidel, D. C. (2012). Evaluation of children with selective mutism and social phobia: A comparison of psychological and psychophysiological arousal. Behavior Modification, 36(4), 525–544. https://doi.org/10.1177/014544551443980
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Milic, M.I., Carl, T., Rapee, R.M. (2023). Understanding Selective Mutism: A Comprehensive Guide to Assessment and Treatment. In: Matson, J.L. (eds) Handbook of Clinical Child Psychology. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-031-24926-6_51
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