Skip to main content
Log in

Selective Mutism: An Update and Suggestions for Future Research

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Speculation continues regarding the accurate classification of selective mutism and potential etiologic factors. Current research has shed some light on several factors that may predispose some children to this disorder, but conclusions are difficult to draw due to reliance on subjective measures, few comparison groups, and/or limited theoretical grounding. This article provides an update on recent efforts to elucidate the etiologic pathways of selective mutism and on the current debate regarding its strong overlap with anxiety disorders, most notably social phobia. An additional attempt is made to examine findings based on a developmental perspective that accounts for multiple pathways, context, and the developmental stage of the child. Emotion regulation theory is offered as a potential factor in why some children may be more vulnerable to the etiologic factors described. Suggestions for future research are offered based on this integration of information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, edn 4 (DSM-IV). Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, edn 4—text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

    Book  Google Scholar 

  3. Sharp WG, Sherman C, Gross AM. Selective mutism and anxiety: a review of the current conceptualization of the disorder. J Anxiety Disord. 2007;21:568–79.

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association: DSM V development proposed revisions Available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=163. Accessed February 2011.

  5. Anstendig KD. Is selective mutism an anxiety disorder? Rethinking DSM-IV classification. J Anxiety Disord. 1999;13:417–34.

    Article  PubMed  CAS  Google Scholar 

  6. Black B, Uhde TW. Elective mutism as a variant of social phobia. J Am Acad Child Adolesc Psychiatry. 1992;31:1090–4.

    Article  PubMed  CAS  Google Scholar 

  7. Black B, Uhde TW. Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry. 1995;34:847–56.

    Article  PubMed  CAS  Google Scholar 

  8. Beidel DC, Turner SM. Childhood anxiety disorders: a guide to research and treatment. New York: Taylor & Francis Group; 2005.

    Google Scholar 

  9. Krysanski VL. A brief review of selective mutism literature. Journal of Psychology: Interdisciplinary and Applied. 2003;137:29–40.

    Article  Google Scholar 

  10. • Viana AG, Beidel DC, Rabian B: Selective mutism: a review and integration of the last 15 years. Clin Psychol Rev. 2009, 29: 57–67. In this review, the authors discuss the importance of considering SM from a developmental perspective as a way to integrate and organize disparate findings. This theoretical perspective accounts for multiple systems that may influence variations in the development, presentation, and trajectory of SM, providing a better understanding of the behavior and how to shape future research.

  11. Carlson JS, Kratochwill TR, Johnson HF. Sertraline treatment of 5 children diagnosed with selective mutism: a single case research trial. J Child Adolesc Psychopharmacol. 1999;9:293–306.

    Article  PubMed  CAS  Google Scholar 

  12. Yeganeh R, Beidel DC, Turner SM. Selective mutism: more than social anxiety? Depress Anxiety. 2006;23:117–23.

    Article  PubMed  Google Scholar 

  13. Yeganeh R, Beidel DC, Turner SM, et al. Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology. J Am Acad Child Adolesc Psychiatry. 2003;42:1069–75.

    Article  PubMed  Google Scholar 

  14. • Bogels SM, Alden L, Beidel DC, et al.: Social anxiety disorder: questions and answers for the DSM-V, Depress Anxiety 2010, 27: 168–189. This article reviews the DSM-IV criteria for social anxiety disorder and offers a unique perspective for considering SM as a developmentally related avoidance behavior for young children with social anxiety.

  15. Davidson RJ. Affective style and affective disorders: perspectives from affective neuroscience. Cognition and Emotion. 1998;12:307–30.

    Article  Google Scholar 

  16. • Cisler JM, Olatunji BO, Feldner MT, Forsyth JP: Emotion regulation and the anxiety disorders: an integrative review, J Psychopathol Behav Assess. 2010, 32: 6882. In this review, the authors suggest that emotion regulation may be one reason for variations in fear responses, and discuss the relationship demonstrated between emotion regulation and anxiety disorders. They suggest that anxious children may have a lessened ability to regulate their emotions and use avoidance as a maladaptive emotion regulation strategy in response to perceived fear.

  17. Gross JJ, Thompson RA: Emotion regulation: conceptual foundations. In Handbook of Emotion Regulation. Edited by Gross JJ. New York: Guilford Press; 2007: 3–24.

  18. Cohan SL, Price JM, Stein MB. Suffering in silence: why a developmental psychopathology perspective on selective mutism is needed. J Dev Behav Pediatr. 2006;27:341–55.

    Article  PubMed  Google Scholar 

  19. Beidel DC, Turner SM. Shy children, phobic adults: nature and treatment of social anxiety disorder. 2nd ed. Washington, D.C: American Psychological Association; 2007.

    Book  Google Scholar 

  20. Remschmidt H, Poller M, Herpertz-Dahlmann B, et al. A follow-up study of 45 patients with elective mutism. Eur Arch Psychiatry Clin Neurosci. 2001;251:284–96.

    Article  PubMed  CAS  Google Scholar 

  21. Kristensen H, Torgersen S. MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case-control study. J Abnorm Psychol. 2001;110:648–52.

    Article  PubMed  CAS  Google Scholar 

  22. Chavira DA, Shipon-Blum E, Hitchcock C, et al. Selective mutism and social anxiety disorder: all in the family? J Am Acad Child Adolesc Psychiatry. 2007;46:1464–72.

    Article  PubMed  Google Scholar 

  23. Johnson PL, Flake EM. Maternal depression and child outcomes. Psychiatric Annals. 2007;37:404–10.

    Google Scholar 

  24. Contreras J, Kerns KA, Weimer BL, et al. Emotion regulation as a mediator of associations between mother-child attachment and peer relationships in middle childhood. Journal of Family Psychology. 2000;14:111–24.

    Article  PubMed  CAS  Google Scholar 

  25. Garcia-Coll C, Kagan J, Reznick S. Behavioral inhibition in young children. Child Dev. 1984;55:1005–19.

    Article  Google Scholar 

  26. Kagan J: Temperamental contributions to affective and behavioral profiles in children. In from social anxiety to social phobia: multiple perspectives. Edited by Hofmann SG, DiBartolo, PM. Needham Heights, Massachusetts: Allyn & Bacon; 2001: 216–234.

  27. Biederman J, Hirshfeld-Becker DR, Rosenbaum JF, et al. Further evidence of the association between behavioral inhibition and social anxiety in children. Am J Psychiatry. 2001;158:1673–9.

    Article  PubMed  CAS  Google Scholar 

  28. Hirshfeld-Becker DR, Biederman J, Henin A, et al. 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. 2007;28:225–33.

    Article  PubMed  Google Scholar 

  29. Nowakowski ME, Schmidt LA: Temperamental antecedents of social phobia: the case of behavioral inhibition. In social phobia: etiology, diagnosis and treatment. Edited by Axelby, CP. New York: Nova Biomedical Books; 2009: 191–208.

  30. Rotge J, Grabot D, Aouizerate B, et al. Childhood history of behavioral inhibition and comorbidity status in 256 adults with social phobia. Journal of Affective Disorders. 2010;129:338–41.

    Article  PubMed  Google Scholar 

  31. Moehler E, Kagan J, Parzer P, et al. Childhood behavioral inhibition and maternal symptoms of depression. Psychopathology. 2007;40:446–52.

    Article  PubMed  CAS  Google Scholar 

  32. Kagan J. Behavioral inhibition as a temperamental category. In: Davidson RJ, Scherer KR, Goldsmith HH, editors. Handbook of affective sciences. New York: Oxford University Press; 2009. p. 320–31.

    Google Scholar 

  33. Cunningham CE, McHolm A, Boyle MH, Patel S. Behavioral and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism. J Child Psychol Psychiatry. 2004;45:1363–72.

    Article  PubMed  Google Scholar 

  34. Manassis K, Fung D, Tannock R, et al. Characterizing selective mutism: is it more than social anxiety? Depress Anxiety. 2003;18:153–61.

    Article  PubMed  Google Scholar 

  35. • Carbone D, Schmidt LA, Cunningham CC, et al.: Behavioral and socio-emotional functioning in children with selective mutism: a comparison with anxious and typically developing children across multiple informants. J Abnorm Child Psychol. 2010, 38: 1057–1067. This comparison study of children with SM, children with mixed anxiety, and controls provides further evidence that children with SM exhibit similar anxiety symptoms and social skills deficits demonstrated by children with other anxiety disorders, particularly those with social anxiety.

  36. Joseph PR. Selective mutism: the child who doesn’t speak at school. Pediatrics. 1999;104:308–10.

    Article  PubMed  CAS  Google Scholar 

  37. Amstadter A. Emotion regulation and anxiety disorders. J Anxiety Disord. 2008;22:211–21.

    Article  PubMed  Google Scholar 

  38. Wilson EJ, MacLeod C, Mathews A, Rutherford EM. The causal role of interpretive bias in anxiety reactivity. J Abnorm Psychol. 2006;115:103–11.

    Article  PubMed  Google Scholar 

  39. Bogels SM, Zigterman D. Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized anxiety disorder. J Abnorm Child Psychol. 2000;28:205–16.

    Article  PubMed  CAS  Google Scholar 

  40. • Carthy T, Horesh N, Apter A, et al.: Emotional reactivity and cognitive regulation in anxious children. Behav Res Ther. 2010, 48: 384393. The authors discuss emotional hyperreactivity for individuals with anxiety and examine this hypothesis in children and adolescents with a variety of anxiety disorders. Their results suggest that children and adolescents with anxiety are hypersensitive emotionally to negative images and utilize cognitive emotion regulation strategies less frequently than controls. This suggests that children with anxiety also may use other emotion regulation strategies in maladaptive ways.

  41. Calkins SD. Origins and outcomes of individual differences in emotion regulation. Monogr Soc Res Child Dev. 1994;59(2/3):53–72.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah C. Beidel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scott, S., Beidel, D.C. Selective Mutism: An Update and Suggestions for Future Research. Curr Psychiatry Rep 13, 251–257 (2011). https://doi.org/10.1007/s11920-011-0201-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-011-0201-7

Keywords

Navigation