Clinical Distinctions Between Selective Mutism and Social Phobia: An Investigation of Childhood Psychopathology

doi:10.1097/01.CHI.0000070262.24125.23

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 42, Issue 9, September 2003, Pages 1069-1075

https://doi.org/10.1097/01.CHI.0000070262.24125.23 Get rights and content

ABSTRACT

Objective

To investigate the hypothesis that children with selective mutism are more socially anxious than children with social anxiety disorder but who are not selectively mute.

Method

Twenty-three children with comorbid selective mutism and social phobia and 23 age-matched controls with social phobia alone and their parents participated in a comprehensive assessment of social anxiety and related aspects of psychopathology.

Results

The results do not uniformly support previous suggestions that children with selective mutism refuse speech because they are “frozen with fear.” Although clinician and observer ratings for children with selective mutism revealed higher ratings of social distress than for children with social phobia alone, self-report data do not support this conclusion. Furthermore, although there were no group differences on measures of trait anxiety, general fears, or scores on the Child Behavior Checklist broadband Internalizing or Externalizing scales, children with selective mutism scored higher than children with social phobia alone on the Child Behavior Checklist Delinquency subscale, suggesting the presence of a broader clinical syndrome.

Conclusion

It remains unclear whether children with selective mutism have extreme levels of social anxiety. Potential areas that might shed further light on this interesting disorder are discussed.

Section snippets

Participants

The sample consisted of 23 children diagnosed with social phobia matched by age with 23 children diagnosed with social phobia and a comorbid diagnosis of selective mutism (hereafter called the selective mutism group). Data were collected during pretreatment assessments from participants involved in research studies conducted at two separate anxiety centers. Some of the ads used to advertise availability of the treatment programs described symptoms of anxiety disorders and others specifically

RESULTS

Group differences were analyzed with analyses of variance. Because of variable N values, only subjects who completed each particular instrument or assessment were included in the analysis of that variable. No averaging or substitution of group means was used to correct for missing data. Thus, the number of subjects for each variable is slightly different. The number of subjects included in each of the analyses is presented in the tables below. It should be noted that the ratio of statistical

DISCUSSION

Currently, the most common explanation for selective mutism is that these children exhibit such an extreme degree of social anxiety that they are incapable of speech. However, previous studies have only examined the clinical profiles of these children in comparison with a normal control group (Black and Uhde, 1995;Dummit et al., 1997). Thus, to date, conclusions about the relationship between selective mutism and social phobia have been drawn without the benefit of a direct comparison. To our

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Cited by (89)

Similarities and differences between young children with selective mutism and social anxiety disorder
2020, Behaviour Research and Therapy
Citation Excerpt :
Such a reduced language confidence may heighten anxiety in situations where speech is anticipated and/or expected (Manassis et al., 2003) and this may be especially true when there is an audience or the situation is novel. In contrast to speaking situations, some authors have questioned whether children with SM experience anxiety in social situations that do not require speech (Carlson et al., 2008; Yeganeh et al., 2003), in that way pointing to a distinction from children with more general SAD. The DSM-5 guidelines for differential diagnosis of SM and SAD note that “individuals with selective mutism may fail to speak because of fear of negative evaluation, but do not fear negative evaluation in social situations where no speaking is required (e.g. are responsive in non-verbal play)” (American Psychiatric Association (APA), 2013, p. 207).
A growing body of evidence points to a strong overlap between selective mutism (SM) and social anxiety disorder in children, specifically with regard to characteristics such as social reticence and anxiety. Yet few studies have directly compared these populations, especially with young children. This study compared 25 children (aged 3–7 years) with a primary diagnosis of SM, 17 children with a primary diagnosis of social anxiety disorder and 15 non-clinical controls using interviews and questionnaires on expressions of social anxiety and behavioural inhibition. Results showed that children with SM or social anxiety disorder were more anxious than non-clinical controls and did not significantly differ from each other on either non-verbal social anxiety or non-social forms of anxiety. Both children with SM and social anxiety disorder had fewer friends and experienced greater difficulties forming friendships than non-clinical controls. However, children with SM scored higher than children with social anxiety disorder and non-clinical controls on a few measures of inhibition (both verbal and nonverbal). The results support assertions of strong similarities between SM and social anxiety disorder, but suggest that children with SM may show even greater severity in certain symptoms at a young age. These findings point to the need for treatment to include both cognitive behavioural skills to manage social anxiety and structured practice of social skills in order to improve treatment efficacy for children with SM.
Selective mutism
2019, Pediatric Anxiety Disorders
Selective mutism (SM) is a relatively rare condition in childhood characterized by a consistent failure to speak in some social situations where speaking is expected (e.g., kindergarten and school) despite speaking in other situations (e.g., at home). If left untreated, the muteness may last for years with serious consequences academically and socially. The lack of speech in specific situations is currently understood as an expression of anxiety in contrast to previous literature describing the muteness as a deliberate act. Correspondingly, the last decade anxiety treatment programs have been developed for children with SM. However, compared to other anxiety disorders in childhood, the current knowledge base on SM is still sparse. This chapter on SM provides an update on important issues such as prevalence, comorbidity, etiology, assessment, and treatment with an emphasis on how to work clinically with children with SM, their families, and school staff.
Selective mutism in a child with autism spectrum disorder: A case report and an approach to the management in such difficult to treat scenario in children
2018, Asian Journal of Psychiatry
Effects of anxiety, language skills, and cultural adaptation on the development of selective mutism
2018, Journal of Communication Disorders
Citation Excerpt :
Yeganeh and colleagues conducted two studies to examine the association between SM and social anxiety. In both studies, they did not find any significant differences between children with SM and children with isolated social anxiety disorder on self-report measures (Yeganeh, Beidel, Turner, Pina, & Silverman, 2003; Yeganeh, Beidel, & Turner, 2006; see also Manassis et al., 2003). Significant differences were found only for parent and clinician ratings.
Although bilingual children are thought to be at higher risk for selective mutism (SM), little is known about the development of SM in this population. This study investigates the effects of children’s anxiety and language skills and parents’ cultural adaptation on the development of SM. 15 bilingual (11 mute, 4 speaking at the beginning of the study) and 15 monolingual children (7 mute, 8 speaking at the beginning of the study) between the ages of 3 years and 5 years 8 months were assessed longitudinally over a 9-month period. Children’s anxiety and parents’ cultural adaptation were examined via parent questionnaires. Receptive language skills were assessed with a standardized test. Every 3 months, parents and preschool teachers reported on the children’s speaking behavior via questionnaires. Anxiety best predicted the development of mute behavior. There was no effect of bilingual status on its own. The effect of language skills did not reach significance but was considerably higher in preschool settings in comparison with family and public situations. Results also indicated an association between parents’ orientation to the mainstream culture and children’s speaking behavior in preschool. Level of anxiety might function as an early indicator of SM, especially in bilingual children, when information on language proficiency is scarce. There is still a need for intensive research in order to further the understanding of the development of SM in bilingual children.
Phasic Versus Tonic Irritability and Associations with Family Accommodation Among Youth with Selective Mutism: A Latent Profile Analysis
2024, Research on Child and Adolescent Psychopathology
Long-term outcomes of selective mutism: a systematic literature review
2023, BMC Psychiatry

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: This research was supported in part by NIMH grant R01 MH 53703 and MH 60332.

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Journal of the American Academy of Child & Adolescent Psychiatry

ABSTRACT

Objective

Method

Results

Conclusion

Section snippets

Participants

RESULTS

DISCUSSION

REFERENCES (15)

Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification

J Anxiety Disord

Prevalence and description of selective mutism in a school-based sample

J Am Acad Child Adolesc Psychiatry

Psychiatric characteristics of children with selective mutism: a pilot study

J Am Acad Child Adolesc Psychiatry

Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder

J Am Acad Child Adolesc Psychiatry

Reliability and validity of the revised Fear Survey Schedule for Children (FSSC-R)

Behav Res Ther

Elective mutism: an analysis of 100 cases

J Am Acad Child Adolesc Psychiatry

Integrative Guide for the 1991 CBCL/4–18, YSR, and TRF Profiles

Cited by (89)

Similarities and differences between young children with selective mutism and social anxiety disorder

Selective mutism

Selective mutism in a child with autism spectrum disorder: A case report and an approach to the management in such difficult to treat scenario in children

Effects of anxiety, language skills, and cultural adaptation on the development of selective mutism

Phasic Versus Tonic Irritability and Associations with Family Accommodation Among Youth with Selective Mutism: A Latent Profile Analysis

Long-term outcomes of selective mutism: a systematic literature review

ARTICLESClinical Distinctions Between Selective Mutism and Social Phobia: An Investigation of Childhood Psychopathology

ABSTRACT

Objective

Method

Results

Conclusion

Section snippets

Participants

RESULTS

DISCUSSION

J Anxiety Disord

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Behav Res Ther

J Am Acad Child Adolesc Psychiatry

Integrative Guide for the 1991 CBCL/4–18, YSR, and TRF Profiles

ARTICLES
Clinical Distinctions Between Selective Mutism and Social Phobia: An Investigation of Childhood Psychopathology