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.
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, edn 4 (DSM-IV). Washington, DC: American Psychiatric Association; 1994.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, edn 4—text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.
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.
American Psychiatric Association: DSM V development proposed revisions Available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=163. Accessed February 2011.
Anstendig KD. Is selective mutism an anxiety disorder? Rethinking DSM-IV classification. J Anxiety Disord. 1999;13:417–34.
Black B, Uhde TW. Elective mutism as a variant of social phobia. J Am Acad Child Adolesc Psychiatry. 1992;31:1090–4.
Black B, Uhde TW. Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry. 1995;34:847–56.
Beidel DC, Turner SM. Childhood anxiety disorders: a guide to research and treatment. New York: Taylor & Francis Group; 2005.
Krysanski VL. A brief review of selective mutism literature. Journal of Psychology: Interdisciplinary and Applied. 2003;137:29–40.
• 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.
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.
Yeganeh R, Beidel DC, Turner SM. Selective mutism: more than social anxiety? Depress Anxiety. 2006;23:117–23.
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.
• 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.
Davidson RJ. Affective style and affective disorders: perspectives from affective neuroscience. Cognition and Emotion. 1998;12:307–30.
• Cisler JM, Olatunji BO, Feldner MT, Forsyth JP: Emotion regulation and the anxiety disorders: an integrative review, J Psychopathol Behav Assess. 2010, 32: 68–82. 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.
Gross JJ, Thompson RA: Emotion regulation: conceptual foundations. In Handbook of Emotion Regulation. Edited by Gross JJ. New York: Guilford Press; 2007: 3–24.
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.
Beidel DC, Turner SM. Shy children, phobic adults: nature and treatment of social anxiety disorder. 2nd ed. Washington, D.C: American Psychological Association; 2007.
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.
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.
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.
Johnson PL, Flake EM. Maternal depression and child outcomes. Psychiatric Annals. 2007;37:404–10.
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.
Garcia-Coll C, Kagan J, Reznick S. Behavioral inhibition in young children. Child Dev. 1984;55:1005–19.
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.
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.
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.
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.
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.
Moehler E, Kagan J, Parzer P, et al. Childhood behavioral inhibition and maternal symptoms of depression. Psychopathology. 2007;40:446–52.
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.
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.
Manassis K, Fung D, Tannock R, et al. Characterizing selective mutism: is it more than social anxiety? Depress Anxiety. 2003;18:153–61.
• 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.
Joseph PR. Selective mutism: the child who doesn’t speak at school. Pediatrics. 1999;104:308–10.
Amstadter A. Emotion regulation and anxiety disorders. J Anxiety Disord. 2008;22:211–21.
Wilson EJ, MacLeod C, Mathews A, Rutherford EM. The causal role of interpretive bias in anxiety reactivity. J Abnorm Psychol. 2006;115:103–11.
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.
• Carthy T, Horesh N, Apter A, et al.: Emotional reactivity and cognitive regulation in anxious children. Behav Res Ther. 2010, 48: 384–393. 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.
Calkins SD. Origins and outcomes of individual differences in emotion regulation. Monogr Soc Res Child Dev. 1994;59(2/3):53–72.
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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
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DOI: https://doi.org/10.1007/s11920-011-0201-7