European Journal of Pediatrics

, Volume 175, Issue 4, pp 481–487 | Cite as

The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study

  • Claudia Lang
  • Ziv Nir
  • Ayelet Gothelf
  • Shoshi Domachevsky
  • Lee Ginton
  • Jonathan Kushnir
  • Doron Gothelf
Original Article


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. Parents were interviewed using structured scales and completed questionnaires regarding the child, including the Selective Mutism Questionnaire (SMQ). Twenty-four subjects were identified and evaluated. Their mean age ± SD of onset of SM symptoms, beginning of treatment, and age at follow-up were 3.4 ± 1.4, 6.4 ± 3.1, and 9.3 ± 3.4 years, respectively. There was robust improvement from beginning of treatment to follow-up evaluation in SM, social anxiety disorder, and specific phobia symptoms. The recovery rate from SM was 84.2 %.

Conclusion: SM-focused MCBT is feasible in children and possibly effective in inducing long-term reduction of SM and comorbid anxiety symptoms.

What is Known:

There are limited empirical data on selective mutism (SM) treatment outcome and specifically on cognitive-behavioral therapy, with the majority of studies being uncontrolled case reports of 1 to 2 cases each.

There is also limited data on the long-term outcome of children with SM following treatment.

What is New:

Modular cognitive behavioral treatment is a feasible and possibly effective treatment for SM. Intervention at a younger age is more effective comparing to an older age.

Treatment for SM also decreases the rate of psychiatric comorbidities, including separation anxiety disorder and specific phobia.


Anxiety CBT Comorbidity Outcome Prognosis Selective mutism questionnaire 



Attention deficit hyperactivity disorder


Anxiety disorders interview schedule for DSM-IV: Lifetime version


Modular cognitive behavior treatment


Clinical global impression


Clinical global of impression—improvement scale


Clinical global of impressions—severity scale


Diagnostic and statistics manual IV


Diagnostic and statistics manual IV—text revision


Oppositional defiant disorder


Social anxiety disorder


Screen for child anxiety related emotional disorders


Standard deviation


Selective mutism


Selective mutism questionnaire


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Claudia Lang
    • 1
  • Ziv Nir
    • 2
  • Ayelet Gothelf
    • 2
  • Shoshi Domachevsky
    • 1
    • 3
  • Lee Ginton
    • 4
  • Jonathan Kushnir
    • 1
    • 3
  • Doron Gothelf
    • 1
    • 2
  1. 1.The Anxiety Clinic at the Child Psychiatry Unit, The Edmond and Lily Safra Children’s HospitalSheba Medical CenterTel HashomerIsrael
  2. 2.The Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.The Interdisciplinary CenterHerzliyaIsrael
  4. 4.The Psychology DepartmentBoston UniversityBostonUSA

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