ARTICLES
Selective Mutism and Social Anxiety Disorder: All in the Family?

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ABSTRACT

Objective

To examine the history of lifetime psychiatric disorders in the parents of children with selective mutism (SM) compared to parents of children in a control group.

Method

Seventy parent dyads (n = 140) of children with lifetime SM and 31 parent dyads (n = 62) of children without SM were interviewed with the Structured Clinical Interview for DSM-IV (IV and II) anxiety disorders, mood disorders, avoidant personality disorder, and schizoid personality disorder modules via telephone. Interviewers were blind to proband status. The NEO Personality Inventory was also administered.

Results

Lifetime generalized social phobia was present in 37.0% of SM parents compared to 14.1% of control parents (χ2 = 10.98; p < .001; odds ratio 3.6, 95% confidence interval 1.6-7.9). Avoidant personality disorder was present in 17.5% of the SM parents compared to 4.7% of control parents (χ2 = 6.18; p < .05; odds ratio 4.3, 95% confidence interval 1.3-14.9). The proportion of parents with other psychiatric disorders was not different between groups. SM parents had higher neuroticism and lower openness scores on the NEO Personality Inventory than control parents.

Conclusions

These results support earlier uncontrolled findings of a familial relationship between generalized social phobia and SM.

Section snippets

Purpose of the Study

The present study builds on past findings in its assessment of personality traits and psychiatric disorders among parents of children with and without an SM diagnosis. In this study, we address some of the methodological limitations of previous research in this area by including a control group to provide appropriate comparisons; well-established semistructured diagnostic interviews rather than informal assessments; and multiple clinicians, blind to proband status to minimize diagnostic bias.

Design and Procedures

This study is part of a larger project that includes the collection of DNA samples from families of children with SM. A nationwide sample was recruited by means of two sources: a Web site sponsored by a nonprofit organization for children with SM (the Selective Mutism Group-Child Anxiety Network), and parent-oriented conferences organized by this same nonprofit group. The Selective Mutism Group Web site receives approximately 500,000 hits per month from parents, professionals, and educators

Parent and Child Demographics

The geographic distribution of the SM families was as follows: 24% were from the west, 26% were from the midwest, 20% were from the south, and 40% were from the northeast. The majority of controls were from the west (84%). As shown in Table 1, there were no significant differences in age of parent, education, or ethnicity across the SM and control groups. Among children, there were also no sex or age differences across groups: There were 9 boys and 22 girls in the control sample and 26 boys and

DISCUSSION

Our data support a familial relationship between SM and SP. In this study parental GSP and AVPD were three- to fourfold more common among parents of SM children than control children. Furthermore, child SM severity predicted parent SP (generalized type). GSP has often been characterized as a more severe form of social anxiety, and it is possible that SM may be an early onset form of the disorder. Although there were not more lifetime diagnoses of SM in the parents of SM children when compared

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  • Cited by (0)

    This study was supported in part by an unrestricted research grant from GlaxoSmithKline and a research grant fromNIMHto Dr. Stein (MH64122). Preparation of this manuscript was also supported by a research grant fromNIMHto Dr. Chavira (K01 MH072952). Many thanks to our interviewers and interview schedulers: Kelly Bailey, M.S., Bonnie Bethel, M.A., Laura Campbell-Sills, Ph.D., Adrienne Means Christensen, Ph.D., Shadha Hami, M.S., Teresa Marcotte, B.A., Jack Maser, Ph.D., Sonya Norman, Ph.D., Ryan Pepin, B.A. Also many thanks to the Selective Mutism Group-Child Anxiety Network and all of the families who participated in this study.

    Disclosure: Dr. Stein has received research support from Eli Lilly, Forest, Novartis, GlaxoSmithKline, and UCB Pharma and has been a consultant to AstraZeneca, Avera Pharmaceuticals, Bristol-Myers Squibb, Cephalon, Eli Lilly, Forest, GlaxoSmithKline, Hoffmann-La Roche, Jazz, Johnson & Johnson, Pfizer, UCB Pharma, and Wyeth. The other authors have no financial relationships to disclose.

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