Anxiety levels in children with selective mutism and social anxiety disorder

  • Christina SchwenckEmail author
  • Angelika Gensthaler
  • Felix Vogel


DSM-5 classifies Selective Mutism (SM) among anxiety disorders, and a majority of children with SM comply with symptomatology of Social Anxiety Disorder (SAD). It is still discussed whether SM constitutes a discrete disorder entity or merely an extreme form of SAD. Past research that compared anxiety levels in both disorders resulted in conflicting conclusions, which might be due to the adoption of questionnaire measures or experimental designs that comprised in vivo situations. In vivo situations contain the possibility to avoid the feared situations for children with SM by remaining silent, which is not true for children with SAD. Participants aged eight to 18 years (M = 13.30 years, SD = 3.26) with above cut-off symptomatology in SM (n = 52), SAD (n = 18), and typical development (n = 41) participated in an online-based study. They evaluated 21 videos with neutral, embarrassing, or speech-demanding situations with respect to their anxiety elicitation. There was no general difference in anxiety levels between participants with elevated SM and SAD symptomatology, and both groups rated embarrassing situations similarly. However, only children with SM features experienced speech-demanding situations as anxiety eliciting, as embarrassing situations and more so than participants in both other groups. Results of the present study indicate that SM is an anxiety disorder with a specific anxiety pattern rather than an extreme form of SAD. In addition to typical social phobic situations, interventions for children with SM should also address situations involving speech demands.


Selective mutism Social anxiety disorder Cognition Treatment Web-based 


Compliance with Ethical Standards

Conflict of Interest

All authors have no financial relationships to disclose and declare that they have no conflict of interest.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 938–946. Scholar
  3. 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(10), 680–689. Scholar
  4. Biederman, J., Hirshfeld-Becker, D. R., Rosenbaum, J. F., Hérot, C., Friedman, D., Snidman, N., Kagan, J., & Faraone, S. V. (2001). Further evidence of association between behavioral inhibition and social anxiety in children. The American Journal of Psychiatry, 158, 1673–1679. Scholar
  5. Black, B., & Uhde, T. W. (1995). Psychiatric characteristics of children with selective mutism: A pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 847–856. Scholar
  6. Carbone, D., Schmidt, L. A., Cunningham, C. C., McHolm, A. E., Edison, S., St Pierre, J., & Boyle, M. H. (2010). Behavioral and socio-emotional functioning in children with selective Mutism: A comparison with anxious and typically developing children across multiple informants. Journal of Abnormal Child Psychology, 38(8), 1057–1067. Scholar
  7. 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. Scholar
  8. Cohan, S. L., Charira, 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. Scholar
  9. Gensthaler, A., Möhler, E., Resch, F., Paulus, F., Schwenck, C., Freitag, C. M., & Goth, K. (2013). Retrospective assessment of behavioral inhibition in infants and toddlers: Development of a parent report questionnaire. Child Psychiatry & Human Development, 44(1), 152–165. Scholar
  10. Gensthaler, A., Khalaf, S., Ligges, M., Kaess, M., Freitag, C. M., & Schwenck, C. (2016a). Selective mutism and temperament: The silence and behavioral inhibition to the unfamiliar. European Child & Adolescent Psychiatry, 25(10), 1113–1120. Scholar
  11. Gensthaler, A., Maichrowitz, V., Kaess, M., Ligges, M., Freitag, C. M., & Schwenck, C. (2016b). Selective Mutism: The fraternal twin of childhood social phobia. Psychopathology, 49(2), 95–107. Scholar
  12. Gensthaler, A., Dieter, J., Raisig, S., Hartmann, B., Ligges, M., Kaess, M., et al. (2018). Evaluation of a novel parent-rated scale for selective Mutism. Assessment, 107319111878732–9.
  13. 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. Scholar
  14. Levin-Decanini, T., Connolly, S. D., Simpson, D., Suarez, L., & Jacob, S. (2013). Comparison of behavioral profiles for anxiety-related comorbidities including ADHD and selective mutism in children. Depression and Anxiety, 30, 857–864. Scholar
  15. Manassis, K., Fung, D., Tannock, R., Sloman, L., Fiksenbaum, L., & McInnes, A. (2003). Characterizing selective mutism: Is it more than social anxiety? Depression and Anxiety, 18(3), 153–161. Scholar
  16. McInnes, A., Fung, D., Manassis, K., Fiksenbaum, L., & Tannock, R. (2004). Narrative skills in children with selective Mutism: An exploratory study. American Journal of Speech-Language Pathology, 13(4), 304–315. Scholar
  17. Melfsen, S., & Warnke, A. (2001). SPAIK. Sozialphobie und -angstinventar für Kinder. Göttingen: Hogrefe.Google Scholar
  18. 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 Psychology Review, 18, 151–169. Scholar
  19. Muris, P., Hendriks, E., & Bot, S. (2016). Children of few words: Relations among selective Mutism, behavioral inhibition, and (social) anxiety symptoms in 3- to 6-year-olds. Child Psychiatry & Human Development, 47(1), 94–101. Scholar
  20. Sharp, W. G., Sherman, C., & Gross, A. M. (2007). Selective mutism and anxiety: A review of the current conceptualization of the disorder. Journal of Anxiety Disorders, 21(4), 568–579. Scholar
  21. Stein, M. B., Yang, B. Z., Chavira, D. A., Hitchcock, C. A., Sung, S. C., Shipon-Blum, E., & Gelernter, J. (2011). A common genetic variant in the Neurexin superfamily member CNTNAP2 is associated with increased risk for selective Mutism and social anxiety-related traits. BPS, 69(9), 825–831. Scholar
  22. Viana, A. G., Beidel, D. C., & Rabian, B. (2009). Selective mutism: A review and integration of the last 15 years. Clinical Psychology Review, 29(1), 57–67. Scholar
  23. 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 childhood psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 42(9), 1069–1075. Scholar
  24. Yeganeh, R., Beidel, D. C., & Turner, S. M. (2006). Selective mutism: More than social anxiety? Depression and Anxiety, 23(3), 117–123. Scholar
  25. 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. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Special Needs Educational and Clinical Child and Adolescent PsychologyJustus-Liebig-University of GiessenGiessenGermany
  2. 2.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity Hospital Frankfurt am MainFrankfurtGermany

Personalised recommendations