Case Study: Elective Mutism as a Variant of Social Phobia

doi:10.1097/00004583-199211000-00015

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 31, Issue 6, November 1992, Pages 1090-1094

https://doi.org/10.1097/00004583-199211000-00015 Get rights and content

Abstract

To examine the relationship between the syndromes of elective mutism and social phobia, a case of elective mutism associated with social phobia in a 12-year-old girl is presented, and the clinical literature regarding the syndrome of elective mutism is reviewed. Elective mutism or reluctance to speak in unfamiliar social situations may be a symptom of social phobia. Social anxiety is a nearly universal characteristic of children manifesting the syndrome of elective mutism. Elective mutism may respond to treatment with medications that also are effective in the treatment of social phobia. Elective mutism may be a manifestation of social phobia rather than a separate diagnostic syndrome. Pharmacologic treatment may be effective.

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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.
An auditory-neuroscience perspective on the development of selective mutism
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Citation Excerpt :
We assumed that the ability to speak and process incoming sounds simultaneously may thus be compromised in children with SM leading to adaptation in the form of whispering, restricted vocalization, and even complete speech avoidance in situations that require highly efficient sound processing (Bar-Haim et al., 2004). Self-report of children with SM describing peculiarity in the perception of their own voice such as ‘my voice sounds funny and I don’t want others to hear it’ (Black and Uhde, 1992) or ‘my brain won’t let me speak because my voice sounds strange’ (Boon, 1994) provided initial anecdotal support to our conjecture. In an attempt to test these assumptions Bar-Haim et al. (2004) studied auditory efferent and afferent function in a group of 16 children with SM compared to a group of 16 normally speaking, healthy children.
Selective mutism (SM) is a relatively rare psychiatric disorder of childhood characterized by consistent inability to speak in specific social situations despite the ability to speak normally in others. SM typically involves severe impairments in social and academic functioning. Common complications include school failure, social difficulties in the peer group, and aggravated intra-familial relationships. Although SM has been described in the medical and psychological literatures for many years, the potential underlying neural basis of the disorder has only recently been explored. Here we explore the potential role of specific auditory neural mechanisms in the psychopathology of SM and discuss possible implications for treatment.
A theoretical framework for the use of music therapy in the treatment of selective mutism in young children: Multiple case study research
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ORIGINAL ARTICLECase Study: Elective Mutism as a Variant of Social Phobia

Abstract

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Psychiatry

J. Am. Acad. Child Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Psychiatry

Discussion of child panic revisited

J. Am. Acad. Child Adolesc. Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Fluoxetine for treatment of social phobia

J. Clin. Psychopharmacol.

A controlled study of children not speaking at school

J. Assoc. Workers Maladjusted Child

Parent symptom questionnaire

Psychopharmacol. Bull.

Teacher questionnaire

Psychopharmacol. Bull.

Follow-up study of childhood elective mutism

Arch. Gen. Psychiatry

Phenelzine treatment of elective mutism

J. Clin. Psychiatry

Elective mutism in children 1877–1981

Acta Paedopsychiatr.

ORIGINAL ARTICLE
Case Study: Elective Mutism as a Variant of Social Phobia