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Distinguishing selective mutism and social anxiety in children: a multi-method study

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Abstract

Selective mutism (SM) is an anxiety disorder in which a child fails to speak in some situations (e.g., school) despite the ability to speak in other situations (e.g., home). Some work has conceptualized SM as a variant of social anxiety disorder (SAD) characterized by higher levels of social anxiety. Here, we empirically tested this hypothesis to see whether there were differences in social anxiety (SA) between SM and SAD across behavioral, psychophysiological, self-, parent-, and teacher-report measures. Participants included 158 children (Mage = 8.76 years, SD = 3.23) who were classified into three groups: children with SM and who were also highly socially anxious (SM + HSA; n = 48), highly socially anxious children without SM (HSA; n = 48), and control children (n = 62). Children participated in a videotaped self-presentation task, following which observed SA behaviors were coded, and salivary cortisol reactivity was measured. We also collected child, parent, and teacher reports of children’s trait SA symptoms. The SM + HSA and HSA groups had similar observed non-verbal SA behavior, cortisol reactivity, and trait SA symptom levels according to parent and child reports, but SM + HSA children had significantly higher SA according to teacher report and observer-rated verbal SA behavior relative to the HSA group. As expected, control children had lower cortisol reactivity and SA across all measures relative to the other groups. Although SM and SAD in children share many similarities, SM may be characterized by greater SA in certain social contexts (e.g., school) and is distinguishable from SAD on behavioral measures of verbal SA.

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Notes

  1. There were two additional children who met diagnostic criteria for SM, without HSA. However, given the small number of children in this group, we were not able to compare this group of children to the other children in the study. Therefore, these two children were not considered further in our analyses.

  2. There were two children who did not speak at all during the self-presentation task. Therefore, their verbal socially anxious behavior includes only type of speech.

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Acknowledgements

This research was supported by funding from the Ontario Mental Health Foundation (OMHF). We would like to thank the many children and their primary caregivers for their participation in the study. We would also like to thank Lindsay Bennett, Diana Carbone, Sue McKee, Renee Nossal, and Matilda Nowakowski for their help with data collection and coordinating the visits, and Alexander Greenberg, Annie Mills, Jhanahan Sriranjan, and Anna Swain for their assistance with video coding.

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Authors and Affiliations

  1. Department of Psychology, Neuroscience and Behaviour, McMaster University, Room 130, Psychology Building, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Kristie L. Poole & Louis A. Schmidt

  2. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada

    Charles E. Cunningham & Angela E. McHolm

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  1. Kristie L. Poole
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  2. Charles E. Cunningham
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  3. Angela E. McHolm
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  4. Louis A. Schmidt
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Correspondence to Kristie L. Poole.

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CEC receives salary support and is a shareholder in BCFPI Inc., which provides children’s mental health intake and outcome measures.

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Hamilton Integrated Research Ethics Board (HIREB), 04-222, McMaster Early Social Anxiety Project.

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Poole, K.L., Cunningham, C.E., McHolm, A.E. et al. Distinguishing selective mutism and social anxiety in children: a multi-method study. Eur Child Adolesc Psychiatry 30, 1059–1069 (2021). https://doi.org/10.1007/s00787-020-01588-3

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  • DOI: https://doi.org/10.1007/s00787-020-01588-3

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