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 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
Selective mutism questionnaire
Anstendig KD (1999) Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification. J Anxiety Disord 13:417–434CrossRefPubMedGoogle Scholar
Arie M, Henkin Y, Lamy D, Tetin-Schneider S, Apter A, Sadeh A, Bar-Haim Y (2007) Reduced auditory processing capacity during vocalization in children with selective mutism. Biol Psychiatry 61:419–421CrossRefPubMedGoogle Scholar
Association AP (2013) The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUSGoogle Scholar
Bergman RL, Gonzalez A, Piacentini J, Keller ML (2013) Integrated behavior therapy for selective mutism: a randomized controlled pilot study. Behav Res Ther 51:680–689CrossRefPubMedGoogle Scholar
Bergman RL, Keller ML, Piacentini J, Bergman AJ (2008) The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychol 37:456–464CrossRefPubMedGoogle Scholar
Bergman RL, Piacentini J, McCracken JT (2002) Prevalence and description of selective mutism in a school-based sample. J Am Acad Child Adolesc Psychiatry 41:938–946CrossRefPubMedGoogle Scholar
Black B, Uhde TW (1995) Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry 34:847–856CrossRefPubMedGoogle Scholar
Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M (2010) Social anxiety disorder: questions and answers for the DSM‐V. Depress Anxiety 27:168–189CrossRefPubMedGoogle Scholar
Chorpita BF (2007) Modular cognitive-behavioral therapy for childhood anxiety disorders. Guilford Press, New YorkGoogle Scholar
Chorpita BF, Taylor AA, Francis SE, Moffitt C, Austin AA (2004) Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behav Ther 35:263–287CrossRefGoogle Scholar
Cohan SL, Chavira DA, Stein MB (2006) Practitioner review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005. J Child Psychol Psychiatry 47:1085–1097CrossRefPubMedGoogle Scholar
Guy W (1976) Clinical global impression scale. The ECDEU Assessment Manual for Psychopharmacology-Revised Volume DHEW Publ No ADM 76 338:218–222Google Scholar
Kolvin I, Fundudis T (1981) Elective mute children: psychological development and background factors. J Child Psychol Psychiatry 22:219–232CrossRefPubMedGoogle Scholar
Kristensen H (2000) Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39:249–256CrossRefPubMedGoogle Scholar
Kristensen H, Torgersen S (2001) MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case–control study. J Abnorm Psychol 110:648CrossRefPubMedGoogle Scholar
Krohn DD, Weckstein SM, Wright HL (1992) A study of the effectiveness of a specific treatment for elective mutism. J Am Acad Child Adolesc Psychiatry 31:711–718CrossRefPubMedGoogle Scholar
Kumpulainen K, Räsänen E, Raaska H, Somppi V (1998) Selective mutism among second-graders in elementary school. Eur Child Adolesc Psychiatry 7:24–29CrossRefPubMedGoogle Scholar
Manassis K, Tannock R, Garland E, Minde K, McINNES A, Clark S (2007) The sounds of silence: language, cognition, and anxiety in selective mutism. J Am Acad Child Adolesc Psychiatry 46:1187–1195CrossRefPubMedGoogle Scholar
Mitchell AD, Kratochwill TR (2013) Treatment of selective mutism: applications in the clinic and school through conjoint consultation. J Educ Psychol Consult 23:36–62CrossRefGoogle Scholar
Monga S, Young A, Owens M (2009) Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depress Anxiety 26:243–250CrossRefPubMedGoogle Scholar
Oerbeck B, Stein MB, Pripp AH, Kristensen H (2014) Selective mutism: follow-up study 1 year after end of treatment. Eur Child Adolesc Psychiatry 24:1–10Google Scholar
Remschmidt H, Poller M, Herpertz-Dahlmann B, Hennighausen K, Gutenbrunner C (2001) A follow-up study of 45 patients with elective mutism. Eur Arch Psychiatry Clin Neurosci 251:284–296CrossRefPubMedGoogle Scholar
Reuther ET, Davis TE III, Moree BN, Matson JL (2011) Treating selective mutism using modular CBT for child anxiety: a case study. J Clin Child Adolesc Psychol 40:156–163CrossRefPubMedGoogle Scholar
Schwartz RH, Freedy AS, Sheridan MJ (2006) Selective mutism: are primary care physicians missing the silence? Clin Pediatr 45:43–48CrossRefGoogle Scholar