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Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar

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Abstract

Behavioral inhibition (BI) is a suspected precursor of selective mutism. However, investigations on early behavioral inhibition of children with selective mutism are lacking. Children aged 3–18 with lifetime selective mutism (n = 109), social phobia (n = 61), internalizing behavior (n = 46) and healthy controls (n = 118) were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire. Analyses showed that children with lifetime selective mutism and social phobia were more inhibited as infants and toddlers than children of the internalizing and healthy control groups, who displayed similar low levels of behavioral inhibition. Moreover, behavioral inhibition was higher in infants with lifetime selective mutism than in participants with social phobia according to the Total BI score (p = 0.012) and the Shyness subscale (p < 0.001). Infant behavioral inhibition, particularly towards social stimuli, is a temperamental feature associated with a lifetime diagnosis of selective mutism. Results yield first evidence of the recently hypothesized temperamental origin of selective mutism. Children at risk should be screened for this debilitating child psychiatric condition.

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References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). American Psychiatric Association, Washington, DC

    Google Scholar 

  2. Muris P, Ollendick TH (2015) Children who are anxious in silence: on the DSM-5 classification of selective mutism as an anxiety disorder. Clin Child Fam Psychol Rev 18(2):151–169. doi:10.1007/s10567-015-0181-y

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3th edition, text revised. American Psychiatric Association, Washington, DC

    Google Scholar 

  4. Black B, Uhde TW (1995) Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry 34:847–855. doi:10.1097/00004583-199507000-00007

    Article  CAS  PubMed  Google Scholar 

  5. Dummit ES, Klein RG, Tancer NK, Asche B, Martin J, Fairbanks JA (1997) Systematic assessment of 50 children with selective mutism. J Am Acad Child Adolesc Psychiatry 36:653–660. doi:10.1097/00004583-199705000-00016

    Article  PubMed  Google Scholar 

  6. 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 Ment Health 19(3):192–198. doi:10.1111/camh.12045

    Google Scholar 

  7. Veccio JL, Kearney CA (2005) Selective mutism in children: comparison to youths with and without anxiety disorders. J Psychopathol Behav Assess 27:31–37. doi:10.1007/s10862-005-3263-1

    Article  Google Scholar 

  8. Yeganeh R, Beidel DC, Turner SM (2006) Selective Mutism: more than social anxiety? Depress Anxiety 23:117–123. doi:10.1002/da.20139

    Article  PubMed  Google Scholar 

  9. Kopp S, Gillberg C (1997) Selective mutism: a population-based study: a research note. J Child Psychol Psychiatry 38:257–262. doi:10.1111/j.1469-7610.1997.tb01859.x

    Article  CAS  PubMed  Google Scholar 

  10. Kumpulainen K, Rasanen R, Raaska H, Samppi V (1998) Selective mutism among second-graders in an elementary school. Eur Child Adolesc Psychiatry 7:24–29. doi:10.1007/s007870050041

    Article  CAS  PubMed  Google Scholar 

  11. Elizur Y, Perednik R (2003) Prevalence and description of selective mutism in immigrant and nonimmigrant families: a controlled study. J Am Acad Child Adolesc Psychiatry 42:1451–1459. doi:10.1097/00004583-200312000-00012

    Article  PubMed  Google Scholar 

  12. Steinhausen HC, Juzi C (1996) Elective mutism: an analysis of 100 cases. J Am Acad Child Adolesc Psychiatry 35:606–614. doi:10.1097/00004583-199605000-00015

    Article  CAS  PubMed  Google Scholar 

  13. Kristensen H (2000) Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39:249–256. doi:10.1097/00004583-200002000-00026

    Article  CAS  PubMed  Google Scholar 

  14. Manassis K, Tannock R, Garland J, Minde K, McInnes A, Clark S (2007) The sounds of silence: language, cognition, and anxiety in selective mutism. J Am Acad Child Adolesc Psychiatry 46:1187–1195. doi:10.1097/CHI.0b013e318076b7ab

    Article  PubMed  Google Scholar 

  15. McInnes A, Fung D, Manassis K, Tannock R (2004) Narrative skills in children with selective mutism: an exploratory study. Am J Speech Lang Pathol 13:304–315. doi:10.1044/1058-0360(2004/031)

    Article  PubMed  Google Scholar 

  16. Nowakowski ME, Cunningham CE, McHolm A, Evans MA, Edison S, Pierre JS, Boyle MH, Schmidt LA (2009) Language and academic abilities in children with selective mutism. Infant Child Dev 18:271–290. doi:10.1002/icd.624

    Article  Google Scholar 

  17. Klin A, Volkmar F (1993) Elective mutism and mental retardation. J Am Acad Child Adolesc Psychiatry 32:860–864

    Article  CAS  PubMed  Google Scholar 

  18. Lesser-Katz M (1988) The treatment of elective mutism as stranger reaction. Psychotherapy 25:305–313

    Article  Google Scholar 

  19. Shreeve D (1991) Elective Mutism: origins in stranger anxiety and selective attention. Bull Menninger Clin 55:491–504

    CAS  PubMed  Google Scholar 

  20. Wright H, Cuccaro M (1994) Selective Mutism continued. J Am Acad Child Adolesc Psychiatry 33:593–594. doi:10.1097/00004583-199405000-00024

    Article  CAS  PubMed  Google Scholar 

  21. Hill L, Scull J (1985) Elective Mutism associated with selective inactivity. J Commun Disord 18:161–167. doi:10.1016/0021-9924(85)90018-8

    Article  CAS  PubMed  Google Scholar 

  22. Kagan J, Reznick JS, Snidman N (1987) The physiology and Psychology of behavioural inhibition in children. Child Dev 58:1459–1473. doi:10.2307/1130685

    Article  CAS  PubMed  Google Scholar 

  23. Kagan J, Reznick S, Snidman N, Johnson M, Gibbons J, Gersten M (1990) Origins of panic disorder. In: Ballenger JC (ed) Neurobiology of panic disorder: frontiers of clinical neuroscience, vol. 8. New York: Wiley-Liss, pp 71–87

  24. Garcia Coll C, Kagan J, Reznick JS (1984) Behavioral inhibition in young children. Child Dev 55:1005–1019. doi:10.2307/1130152

    Article  Google Scholar 

  25. Asendorpf JB (1990) Development of inhibition during childhood: evidence for situational specifity and a two-factor model. Dev Psychol 26:721–730. doi:10.1037/0012-1649.26.5.721

    Article  Google Scholar 

  26. Kerr M, Lambert WW, Stattin H, Klackenberg-Larsson I (1994) Stability of inhibition in a Swedish longitudinal sample. Child Dev 65:138–146. doi:10.1111/j.1467-8624.1994.tb00740.x

    Article  Google Scholar 

  27. Biederman J, Hirshfeld-Becker DR, Rosenbaum JF, Herot C, Friedman D, Snidman N, Kagan J, Faraone SV (2001) Further evidence of association between behavioural inhibition and social anxiety in children. Am J Psychiatry 158:1673–1679. doi:10.1176/appi.ajp.158.10.1673

    Article  CAS  PubMed  Google Scholar 

  28. Hirshfeld-Becker DR, Biederman J, Henin A, Faraone SV, Davis S, Harrington K, Rosenbaum JF (2007) Behavioral inhibition in preschool children at risk is a specific predictor of middle childhood social anxiety: a five year follow-up. J Dev Behav Pediatr 28:225–233. doi:10.1097/01.DBP.0000268559.34463.d0

    Article  PubMed  Google Scholar 

  29. Schwartz C, Snidman N, Kagan J (1999) Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry 38:1008–1015. doi:10.1097/00004583-199908000-00017

    Article  CAS  PubMed  Google Scholar 

  30. Clauss JA, Blackford JU (2012) Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. J Am Acad Child Adolesc Psychiatry 51(10):1066–1075. doi:10.1016/j.jaac.2012.08.002

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schmidt LA, Buss A (2010) Understanding shyness. four questions and four decades of research. In: Rubin KH, Coplan RJ (ed) The development of shyness and social withdrawal. NY: Guildford Press, pp 23

  32. Kochanska G, Radke-Yarrow M (1992) Inhibition in toddlerhood and the dynamics of the child’s interaction with an unfamiliar peer at age five. Child Dev 63:325–335. doi:10.1111/j.1467-8624.1992.tb01630.x

    Article  CAS  PubMed  Google Scholar 

  33. Van Ameringen M, Mancini C, Oakman JM (1998) The relationship of behavioral inhibition and shyness to anxiety disorder. J Nervous Mental Dis 186:425–431. doi:10.1097/00005053-199807000-00007

    Article  Google Scholar 

  34. Anstendig KD (1999) Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification. J Anxiety Disord 13(4):417–434. doi:10.1016/S0887-6185(99)00012-2

    Article  CAS  PubMed  Google Scholar 

  35. Bergman RL, Piacentini J, McCracken JT (2002) Prevalence and description of selective mutism in a school-based sample. J Am Acad Child Adolesc Psychiatry 41:938–946. doi:10.1097/00004583-200208000-00012

    Article  PubMed  Google Scholar 

  36. Johnson M, Wintgens A (2001) The selective mutism resource manual. Speech Mark Publishing Limited, Bicester

    Google Scholar 

  37. Young BJ, Bunnell BE, Beidel DC (2012) Evaluation of children with selective mutism and social phobia: a comparison of psychological and psychophysiological arousal. Behav Modif 36:525–544. doi:10.1177/0145445512443980

    Article  PubMed  Google Scholar 

  38. Heilman KJ, Connolly SD, Padilla WO, Wrzosek MI, Graczyk PA, Porges SW (2012) Sluggish vagal brake reactivity to physical exercise challenge in children with selective mutism. Dev Psychopath 24:241–250. doi:10.1017/S0954579411000800

    Article  Google Scholar 

  39. 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 55:1061–1068. doi:10.1016/j.biopsych.2004.02.02

    Article  PubMed  Google Scholar 

  40. Muris P, Hendriks E, Bot S (2016) Children of few words: relation among selective mutism, behavioral inhibition, and (social) anxiety symptoms in 3- to 6-year-olds. Child Psychiatry and Hum Dev 47(1):94–101. doi:10.1007/s10578-015-0547-x

    Article  Google Scholar 

  41. Manassis K, Fung D, Tannock R, Sloman L, Fiksenbaum L, McInnes A (2003) Characterizing selective mutism: is it more than social anxiety? Depress Anxiety 18:153–161. doi:10.1002/da.10125

    Article  PubMed  Google Scholar 

  42. Cohan SL, Price JM, Stein MB (2006) Suffering in silence: why a developmental psychopathology perspective on selective mutism is needed. J Dev Behav Pediatr 27(4):341–355. doi:10.1097/00004703-200608000-00011

    Article  PubMed  Google Scholar 

  43. Toppelberg CO, Tabors P, Coggins A et al (2005) Differential diagnosis of selective mutism in bilingual children. J Am Acad Child Adolesc Psychiatry 44:592–595. doi:10.1097/01.chi.0000157549.87078.f8

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ganzeboom HBG, Treiman DJ (1996) Internationally comparable measures of occupational status for the 1988 international standard classification of occupations. Soc Sci Res 25:201–239

    Article  Google Scholar 

  45. Adornetto C, In-Albon T, Schneider S (2008) Diagnostik im Kindes- und Jugendalter anhand strukturierter Interviews: Anwendung und Durchführung des Kinder-Dips. Klinische Diagnostik und Evaluation 1(4):363–377

    Google Scholar 

  46. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV-TR). Am Psychiatr Assoc, Washington DC

    Google Scholar 

  47. Gensthaler A, Möhler E, Resch F, Paulus F, Schwenck C, Freitag CM, Goth K (2013) Retrospective assessment of behavioral inhibition in infants and toddlers: development of a parent report questionnaire. Child Psychiatry Hum Dev 44(1):152–165. doi:10.1007/s10578-012-0316-z

    Article  CAS  PubMed  Google Scholar 

  48. Hayward C, Killen JD, Kraemer HC, Taylor CB (1998) Linking self-reported childhood behavioral inhibition to adolescent social phobia. J Am Acad Child Adolesc Psychiatry 37(12):1308–1316. doi:10.1097/00004583-199812000-00015

    Article  CAS  PubMed  Google Scholar 

  49. Knappe S, Beesdo-Baum K, Fehmb L, Stein MB, Lieb R, Wittchen HU (2011) Social fear and social phobia types among community youth: Differential clinical features and vulnerability factors. J Psychiatr Res 45:111–120. doi:10.1016/j.jpsychires.2010.05.002

    Article  PubMed  Google Scholar 

  50. Hayward C, Wilson KA, Lagle K, Kraemer HC, Killen JD, Taylor CB (2008) The developmental psychopathology of social anxiety in adolescents. Depress Anxiety 25:200–206. doi:10.1002/da.20289

    Article  PubMed  Google Scholar 

  51. Cunningham CE, McHolm A, Boyle MH (2004) Behavioural and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism. J Child Psychol Psychiatry 45:1363–1372. doi:10.1111/j.1469-7610.2004.00327.x

    Article  PubMed  Google Scholar 

  52. Alyanak B, Kılınçaslan A, Harmancı HS, Demirkaya SK, Yurtbay T, Vehid HE (2013) Parental adjustment, parenting attitudes and emotional and behavioral problems in children with selective mutism. J Anxiety Disord 27(1):9–15. doi:10.1016/j.janxdis.2012.10.001

    Article  PubMed  Google Scholar 

  53. Perez-Edgar KE, Guyer AE (2014) Behavioral inhibition: temperament or prodrome? Curr Behav Neurosci Rep 1(3):182–190. doi:10.1007/s40473-014-0019-9

    Article  PubMed  PubMed Central  Google Scholar 

  54. Task Force on Research Diagnostic Criteria (2003) Infancy and Preschool. Research diagnostic criteria for infants and preschool children: process and empirical support. J Am Acad Child Adolesc Psychiatry 42:1504–1512. doi:10.1097/00004583-200312000-00018

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany

    Angelika Gensthaler, Sally Khalaf, Christine M. Freitag & Christina Schwenck

  2. Department of Child and Adolescent Psychiatry, University Hospital Jena, Jena, Germany

    Marc Ligges

  3. Department of Child and Adolescent Psychiatry, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany

    Michael Kaess

  4. Department of Psychology, University of Gießen, Gießen, Germany

    Christina Schwenck

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  1. Angelika Gensthaler
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  2. Sally Khalaf
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  3. Marc Ligges
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Correspondence to Angelika Gensthaler.

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Gensthaler, A., Khalaf, S., Ligges, M. et al. Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar. Eur Child Adolesc Psychiatry 25, 1113–1120 (2016). https://doi.org/10.1007/s00787-016-0835-4

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