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European Child & Adolescent Psychiatry

, Volume 25, Issue 6, pp 571–578 | Cite as

The use of medication in selective mutism: a systematic review

  • Katharina Manassis
  • Beate Oerbeck
  • Kristin Romvig Overgaard
Review

Abstract

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.

Keywords

Selective mutism Pharmacotherapy Selective serotonin reuptake inhibitors Review 

Notes

Acknowledgments

We thank librarian Ellen Bjoernstad, Oslo University Hospital, for the literary searches.

Compliance with ethical standards

Financial disclosure

Katharina Manassis receives royalties for books related to child mental health from Barron’s Educational, Guilford, and Routledge; she has received one unrestricted educational honorarium from Shire Pharmaceuticals. Beate Oerbeck and Kristin Overgaard have no relevant financial relationships to disclose.

Conflict of interest

Katharina Manassis has no potential conflicts of interest apart from the financial disclosures above. Beate Oerbeck and Kristin Overgaard have no potential conflicts of interest to disclose.

References

  1. 1.
    Muris P, Hendriks E, Bot S (2015) Children of few words: relations among selective mutism, behavioral inhibition, and (social) anxiety symptoms in 3- to 6-year-olds. Child Psychiatry Hum Dev 18(2):151–169. doi: 10.1007/s10578-015-0547-x Google Scholar
  2. 2.
    American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, Washington, DCCrossRefGoogle Scholar
  3. 3.
    Compton SN, Peris TS, Almirall D, Birmaher B, Sherrill J, Kendall PC, March JS, Gosch EA, Ginsburg GS, Rynn MA, Piacentini JC, McCracken JT, Keeton CP, Suveg CM, Aschenbrand SG, Sakolsky D, Iyengar S, Walkup JT, Albano AM (2014) Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. J Consult Clin Psychol 82(2):212–224. doi: 10.1037/a0035458 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    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(6):284–296. doi: 10.1007/PL00007547 CrossRefPubMedGoogle Scholar
  5. 5.
    Steinhausen H-C, Wachter M, Laimbock K, Winkler Metzke C (2006) A long-term outcome study of selective mutism in childhood. J Child Psychol Psychiatry 47(7):751–756. doi: 10.1111/j.1469-7610.2005.01560.x CrossRefPubMedGoogle Scholar
  6. 6.
    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(9):1187–1195. doi: 10.1097/CHI.0b013e318076b7ab CrossRefPubMedGoogle Scholar
  7. 7.
    Bar-Haim Y, Henkin Y, Ari-Even-Roth D, Tetin-Schneider S, Hildesheimer M, Muchnik C (2004) Reduced auditory efferent activity in childhood selective mutism. Biol Psychiatry 55(11):1061–1068. doi: 10.1016/j.biopsych.2004.02.021 CrossRefPubMedGoogle Scholar
  8. 8.
    Kristensen H (2000) Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39(2):249–256. doi: 10.1097/00004583-200002000-00026 CrossRefPubMedGoogle Scholar
  9. 9.
    Elizur Y, Perednik R (2003) Prevalence and description of selective mutism in immigrant and native families: a controlled study. J Am Acad Child Adolesc Psychiatry 42(12):1451–1459. doi: 10.1097/00004583-200312000-00012 CrossRefPubMedGoogle Scholar
  10. 10.
    Kendall PC, Hedtke KA (2006) Coping cat workbook, 2nd edn. Workbook Publishing, ArdmoreGoogle Scholar
  11. 11.
    Bergman RL, Gonzalez A, Piacentini J, Keller ML (2013) Integrated behavior therapy for selective mutism: a randomized controlled pilot study. Behav Res Ther 51(10):680–689. doi: 10.1016/j.brat.2013.07.003 CrossRefPubMedGoogle Scholar
  12. 12.
    Oerbeck B, Stein MB, Wentzel-Larsen T, Langsrud Ø, Kristensen H (2014) A randomized controlled trial of a home and school-based intervention for selective mutism—defocused communication and behavioural techniques. Child Adolesc Mental Health 19(3):192–198. doi: 10.1111/camh.12045 Google Scholar
  13. 13.
    Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA (2007) Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 297(15):1683–1696. doi: 10.1001/jama.297.15.1683 CrossRefPubMedGoogle Scholar
  14. 14.
    Oerbeck B, Stein MB, Pripp AH, Kristensen H (2014) Selective mutism: follow-up study 1 year after end of treatment. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-014-0620-1 Google Scholar
  15. 15.
    Jones E, Manassis K, Arnold P, Ickowicz A, Mendlowitz S, Nowrouzi B, Wilansky-Traynor P, Bennett K, Schmidt F (2015) Translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry. Community Ment Health J. doi: 10.1007/s10597-015-9882-4 Google Scholar
  16. 16.
    Shields PG (2000) Publication bias is a scientific problem with adverse ethical outcomes: the case for a section for null results. Cancer Epidemiol Biomarkers Prev 9(8):771–772PubMedGoogle Scholar
  17. 17.
    Black B, Uhde TW (1994) Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry 33(7):1000–1006. doi: 10.1097/00004583-199409000-00010 CrossRefPubMedGoogle Scholar
  18. 18.
    Carlson JS, Kratochwill TR, Johnston HF (1999) Sertraline treatment of 5 children diagnosed with selective mutism: a single-case research trial. J Child Adolesc Psychopharmacol 9(4):293–306. doi: 10.1089/cap.1999.9.293 CrossRefPubMedGoogle Scholar
  19. 19.
    Manassis K, Tannock R (2008) Comparing interventions for selective mutism: a pilot study. Can J Psychiatry 53(10):700–703PubMedGoogle Scholar
  20. 20.
    Dummit E, Klein RG, Tancer NK, Asche B et al (1996) Fluoxetine treatment of children with selective mutism: an open trial. J Am Acad Child Adolesc Psychiatry 35(5):615–621. doi: 10.1097/00004583-199605000-00016 CrossRefPubMedGoogle Scholar
  21. 21.
    Ooi YP, Raja M, Sung SC, Fung DS, Koh JB (2012) Application of a web-based cognitive-behavioural therapy programme for the treatment of selective mutism in Singapore: a case series study. Singap Med J 53(7):446–450Google Scholar
  22. 22.
    Eke AD (2002) Pharmacopsychosocial treatment of selective mutism: a research investigation. Dissertation Abstracts International: Section B: The Sciences and Engineering 62 (7-B):3368Google Scholar
  23. 23.
    Moreno J, Pedreira J (1998) Treatment of elective mutism in children with fluoxetine. Rev Psiquiatr Infanto Juv 3:180–186Google Scholar
  24. 24.
    Copur M, Gorker I, Demir T (2012) Selective serotonin reuptake inhibitors for treatment of selective mutism. Balk Med J 29:99–102. doi: 10.5174/tutfd.2010.04056.1 Google Scholar
  25. 25.
    Golwyn DH, Sevlie CP (1999) Phenelzine treatment of selective mutism in four prepubertal children. J Child Adolesc Psychopharmacol 9(2):109–113CrossRefPubMedGoogle Scholar
  26. 26.
    Schwartz RH, Freedy AS, Sheridan MJ (2006) Selective mutism: are primary care physicians missing the silence? Clin Pediatr (Phila) 45(1):43–48. doi: 10.1177/000992280604500107 CrossRefGoogle Scholar
  27. 27.
    National Institute of Mental Health (1985) CGI (Clinical Global Impression) Scale side effect ratings. Psychopharmacol Bull 21:839–843Google Scholar
  28. 28.
    Zaider T, Heimberg RG, Fresco D, Schneier F, Liebowitz M (2003) Evaluation of the Clinical Global Impression Scale among individuals with social anxiety disorder. Psychol Med 33(4):611–622. doi: 10.1017/S0033291703007414 CrossRefPubMedGoogle Scholar
  29. 29.
    Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatry 40(11):1228–1231CrossRefPubMedGoogle Scholar
  30. 30.
    Bergman LR, Keller ML, Piacentini J, Bergman AJ (2008) The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychol 37(2):456–464. doi: 10.1080/15374410801955805 CrossRefPubMedGoogle Scholar
  31. 31.
    Liebowitz MR (1987) Social phobia. Mod Probl Pharmacopsychiatry 22:141–173CrossRefPubMedGoogle Scholar
  32. 32.
    Goyette CH, Conners CK, Ulrich RF (1978) Normative data on revised Conners Parent and Teacher Rating Scales. J Abnorm Child Psychol 6(2):221–236CrossRefPubMedGoogle Scholar
  33. 33.
    Beck N, Warnke A (2003) Day care treatment of 2 siblings with elective mutism. Z Kinder Jugendpsychiatr Psychother 31(1):59–68. doi: 10.1024/1422-4917.31.1.59 CrossRefPubMedGoogle Scholar
  34. 34.
    Berger I, Jaworowski S, Gross-Tsur V (2002) Selective mutism: a review of the concept and treatment. Isr Med Assoc J 4(12):1135–1137PubMedGoogle Scholar
  35. 35.
    Black B, Uhde TW (1992) Elective mutism as a variant of social phobia. J Am Acad Child Adolesc Psychiatry 31(6):1090–1094CrossRefPubMedGoogle Scholar
  36. 36.
    Boon F (1994) The selective mutism controversy (continued). J Am Acad Child Adolesc Psychiatry 33(2):283. doi: 10.1097/00004583-199402000-00023 CrossRefPubMedGoogle Scholar
  37. 37.
    Eskeland B, Albrigtsen V (2011) The ties of silence: a pair of twins with selective mutism. Paper presented at the 14th International Congress of ESCAP European Society for Child and Adolescent Psychiatry Helsinki Finland, Helsinki, FinlandGoogle Scholar
  38. 38.
    Guna-Dumitrescu L, Pelletier G (1996) Successful multimodal treatment of a child with selective mutism: a case report. Can J Psychiatry 41(6):417PubMedGoogle Scholar
  39. 39.
    Hagerman RJ, Hills J, Scharfenaker S, Lewis H (1999) Fragile X syndrome and selective mutism. Am J Med Genet 83(4):313–317CrossRefPubMedGoogle Scholar
  40. 40.
    Herdener-Pinnekamp K, Gundelfinger R, Steinhausen H-C (2010) Outpatient treatment of selective mutism: long-standing selective mutism in a 17-year-old male. Z Kinder Jugendpsychiatr Psychother 38(1):29–36. doi: 10.1024/1422-4917.a000004 CrossRefPubMedGoogle Scholar
  41. 41.
    Kaur D, Dere S, Ajinkya S, Ghildyal R, Y S (2014) Selective mutism with premorbid speech delay in a 6-year-old anemic child with abnormal EEG tracings. Paper presented at the 66th Annual National Conference of the Indian Psychiatric Society, ANCIPS, Pune, India, JanuaryGoogle Scholar
  42. 42.
    Kehle TJ, Madaus MR, Baratta VS, Bray MA (1998) Augmented self-modeling as a treatment for children with selective mutism. J Sch Psychol 36(3):247–260. doi: 10.1016/S0022-4405%2898%2900013-2 CrossRefGoogle Scholar
  43. 43.
    Manassis K, Avery D (2013) SSRIs in a case of selective mutism. J Psychiatry Neurosci 38(1):E1–E2. doi: 10.1503/jpn.120194 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Motavalli N (1995) Fluoxetine for (s)elective mutism. J Am Acad Child Adolesc Psychiatry 34(6):701–702. doi: 10.1097/00004583-199506000-00007 CrossRefPubMedGoogle Scholar
  45. 45.
    Plener P, Gatz A, Schuetz C, Ludolph A, Kolch M (2012) A case of selective mutism in an 8-year-old girl with thalassaemia major after bone marrow transplantation. Pharmacopsychiatry 45(1):37–39. doi: 10.1055/s-0031-1287776 CrossRefPubMedGoogle Scholar
  46. 46.
    Rupp SN (1999) Haloperidol for Tourette’s disorder plus selective mutism. J Am Acad Child Adolesc Psychiatry 38(1):7. doi: 10.1097/00004583-199901000-00012 CrossRefPubMedGoogle Scholar
  47. 47.
    Russell PS, Raj SE, John JK (1998) Multimodal intervention for selective mutism in mentally retarded children. J Am Acad Child Adolesc Psychiatry 37(9):903–904CrossRefPubMedGoogle Scholar
  48. 48.
    Segal NL (2003) ‘Two’ quiet: monozygotic female twins with selective mutism. Clinical Child Psychol Psychiatry 8(4):473–488. doi: 10.1177/13591045030084005 CrossRefGoogle Scholar
  49. 49.
    Sharkey L, Mc Nicholas F (2006) Female monozygotic twins with selective mutism–a case report. J Dev Behav Pediatr 27(2):129–133CrossRefPubMedGoogle Scholar
  50. 50.
    Silveira R, Jainer AK, Bates G (2004) Fluoxetine treatment of selective mutism in pervasive developmental disorder. Int J Psychiatry Clin Pract 8(3):179–180. doi: 10.1080/13651500410006143 CrossRefPubMedGoogle Scholar
  51. 51.
    Tsitsi P, Roboti P, Voura N, Papanikolaou K, Gerodimou M, Angelidis GF (2010) Selective mutism: Comparing case reports of two 6-year-old children. In: 18th European Congress of Psychiatry Munich Germany, European Psychiatry, p 25Google Scholar
  52. 52.
    Wright HH, Cuccaro ML, Leonhardt TV, Kendall DF et al (1995) Case study: fluoxetine in the multimodal treatment of a preschool child with selective mutism. J Am Acad Child Adolesc Psychiatry 34(7):857–862. doi: 10.1097/00004583-199507000-00008 CrossRefPubMedGoogle Scholar
  53. 53.
    Black B (2009) Chatterbox at home: selective mutism. In: Galanter CA, Jensen PS (eds) DSM-IV-TR casebook and treatment guide for child mental health, 6 edn. American Psychiatric Publishing, Inc, Arlington, pp 59–75Google Scholar
  54. 54.
    Thomsen PH, Rasmussen G, Andersson CB (1999) Elective mutism: a 17-year-old girl treated successfully with citalopram. Nord J Psychiatry 53(6):427–429. doi: 10.1080/080394899427656 CrossRefGoogle Scholar
  55. 55.
    Golwyn DH, Weinstock RC (1990) Phenelzine treatment of elective mutism: a case report. J Clin Psychiatry 51(9):384–385PubMedGoogle Scholar
  56. 56.
    Lafferty JE, Constantino JN (1998) Fluvoxamine in selective mutism. J Am Acad Child Adolesc Psychiatry 37(1):12–13. doi: 10.1097/00004583-199801000-00008 CrossRefPubMedGoogle Scholar
  57. 57.
    Lehman RB (2002) Rapid resolution of social anxiety disorder, selective mutism, and separation anxiety with paroxetine in an 8-year-old girl. J Psychiatry Neurosci 27(2):124–125PubMedPubMedCentralGoogle Scholar
  58. 58.
    Maskey S (2001) Selective mutism, social phobia and mocobemide. A case report. Clini Child Psychol Psychiatry 6(3):3363–3369Google Scholar
  59. 59.
    Turkiewicz G, Castro LL, Morikawa M, da Costa CZG, Asbahr FR (2008) Selective mutism and the anxiety spectrum-A long-term case report. Rev Bras Psiquiatr 30(2):172–173. doi: 10.1590/S1516-44462008000200019 CrossRefPubMedGoogle Scholar
  60. 60.
    Bergman LR, Piacentini J, McCracken JT (2002) Prevalence and description of selective mutism in a school-based sample. J Am Acad Child Adolesc Psychiatry 41(8):938–946. doi: 10.1097/00004583-200208000-00012 CrossRefPubMedGoogle Scholar
  61. 61.
    Kazdin AE, Tuma AH (1982) Single-case research designs. Jossey-Bass Publishers, San FranciscoGoogle Scholar
  62. 62.
    Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, den Boer JA, Fineberg NA, Knapp M, Scott J, Wittchen HU (2005) Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxf, Engl) 19(6):567–596. doi: 10.1177/0269881105059253
  63. 63.
    Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O’Neill C, Scott J, van der Wee N, Wittchen HU (2014) Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol (Oxf, Engl) 28(5):403–439. doi: 10.1177/0269881114525674
  64. 64.
    Manassis K, Bradley S (1994) Fluoxetine in anxiety disorders. J Am Acad Child Adolesc Psychiatry 33(5):761–762. doi: 10.1097/00004583-199406000-00025 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Katharina Manassis
    • 1
  • Beate Oerbeck
    • 2
  • Kristin Romvig Overgaard
    • 2
  1. 1.Department of PsychiatryUniversity of TorontoTorontoCanada
  2. 2.Division of Mental Health and AddictionOslo University HospitalOsloNorway

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