Skip to main content
SpringerLink
Log in
Book cover

Pediatric Anxiety Disorders pp 209–227Cite as

Selective Mutism

  • Chapter
  • First Online:

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Selective mutism (SM) is an impairing behavioral disorder of childhood characterized by persistent failure to speak in specific social situations despite the ability to speak in other situations. SM typically begins during the preschool years but is usually not identified until the early school years. The disorder occurs in 0.11–2 % of children and persists for most children if untreated. SM is most often conceptualized as an anxiety disorder and is considered by many to be an early-onset or developmental variant of social phobia. The treatment literature is dominated by case reports and a few controlled studies. The most common treatments are those that are also used for pediatric anxiety, namely, cognitive, behavioral, and pharmacological interventions. Cognitive and behavioral strategies are recommended as the first-line treatment. Selective serotonin reuptake inhibitors are suggested in cases of treatment resistance and/or high symptom severity or impairment. It is often necessary to involve the child’s teacher or other school personnel in the treatment plan.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. World Health Organization. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2007.

    Google Scholar 

  2. Ford MA, Sladeczek IE, Carlson J, Kratochwill TR. Selective mutism: phenomenological characteristics. Sch Psychol Q. 1998;13(3):192–227.

    Article  Google Scholar 

  3. Steinhausen H-C, Juzi C. Elective mutism: an analysis of 100 cases. J Am Acad Child Adolesc Psychiatry. 1996;35(5):606–14.

    Article  PubMed  CAS  Google Scholar 

  4. Dow SP, Sonies BC, Scheib D, Moss SE. Practical guidelines for the assessment and treatment of selective mutism. J Am Acad Child Adolesc Psychiatry. 1995;34(7):836–46.

    Article  PubMed  CAS  Google Scholar 

  5. Schwartz RH, Freedy AS, Sheridan MJ. Selective mutism: are primary care physicians missing the silence? Clin Pediatr (Phila). 2006;45(1):43–8.

    Article  Google Scholar 

  6. Dummit ES, Klein RG, Tancer NK, Asche B. Systematic assessment of 50 children with selective mutism. J Am Acad Child Adolesc Psychiatry. 1997;36(5):653–60.

    Article  PubMed  Google Scholar 

  7. 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 Psychiatr. 2004;45(8):1363–72.

    Article  Google Scholar 

  8. Cunningham CE, McHolm AE, Boyle MH. Social phobia, anxiety, oppositional behavior, social skills, and self-concept in children with specific selective mutism, generalized selective mutism, and community controls. Eur Child Adolesc Psychiatry. 2006;15(5):245–55.

    Article  PubMed  Google Scholar 

  9. Yeganeh R, Beidel DC, Turner SM, Pina AA, Silverman WK. Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology. J Am Acad Child Adolesc Psychiatry. 2003;42(9):1069–75.

    Article  PubMed  Google Scholar 

  10. Carbone D, Schmidt LA, Cunningham CC, McHolm AE, Edison S, St Pierre J, 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(8):1057–67.

    Article  PubMed  Google Scholar 

  11. Anstendig KD. Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification. J Anxiety Disord. 1999;13(4):417–34.

    Article  PubMed  CAS  Google Scholar 

  12. Rye MS, Ullman D. The successful treatment of long-term selective mutism: a case study. J Behav Ther Exp Psychiatry. 1999;30(4):313–23.

    Article  PubMed  CAS  Google Scholar 

  13. Manassis K. Silent suffering: understanding and treating children with selective mutism. Expert Rev Neurother. 2009;9(2):235–43.

    Article  PubMed  Google Scholar 

  14. Bergman RL, Piacentini J, McCracken JT. Prevalence and description of selective mutism in a school-based sample. J Am Acad Child Adolesc Psychiatry. 2002;41(8):938–46.

    Article  PubMed  Google Scholar 

  15. Standart S, Le Couteur A. The quiet child: a literature review of selective mutism. Child Adolescent Mental Health. 2003;8(4):154–60.

    Article  Google Scholar 

  16. McLnnes A, Manassis K. When silence is not golden: an integrated approach to selective mutism. Semin Speech Lang. 2005;26(3):201–10.

    Article  Google Scholar 

  17. Bar-Haim Y, Henkin Y, Ari-Even-Roth D, Tetin-Schneider S, Hildesheimer M, Muchnik C. Reduced auditory efferent activity in childhood selective mutism. Biol Psychiatry. 2004;55(11):1061–8.

    Article  PubMed  Google Scholar 

  18. Arie M, Henkin Y, Lamy D, Tetin-Schneider S, Apter A, Sadeh A, et al. Reduced auditory processing capacity during vocalization in children with selective mutism. Biol Psychiatry. 2007;61(3):419–21.

    Article  PubMed  Google Scholar 

  19. Young BJ, Bunnell BE, Beidel DC. Evaluation of children with selective mutism and social phobia: a comparison of psychological and psychophysiological arousal. Behav Modif. 2012;36(4):525–44.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  21. Carlson JS, Kratochwill TR, Johnston H. Prevalence and treatment of selective mutism in clinical practice: a survey of child and adolescent psychiatrists. J Child Adolesc Psychopharmacol. 1994;4(4):281–91.

    Article  Google Scholar 

  22. Chavira DA, Stein MB, Bailey K, Stein MT. Child anxiety in primary care: prevalent but untreated. Depress Anxiety. 2004;20(4):155–64.

    Article  PubMed  Google Scholar 

  23. Elizur Y, Perednik R. Prevalence and description of selective mutism in immigrant and native families: a controlled study. J Am Acad Child Adolesc Psychiatry. 2003;42(12):1451–9.

    Article  PubMed  Google Scholar 

  24. Kumpulainen K, Rãsãnen E, Raaska H, Somppi V. Selective mutism among second-graders in elementary school. Eur Child Adolesc Psychiatry. 1998;7(1):24–9.

    Article  PubMed  CAS  Google Scholar 

  25. Kristensen H. Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry. 2000;39(2):249–56.

    Article  PubMed  CAS  Google Scholar 

  26. Viana AG, Beidel DC, Rabian B. Selective mutism: a review and integration of the last 15 years. Clin Psychol Rev. 2009;29(1):57–67.

    Article  PubMed  Google Scholar 

  27. Anyfantakis D, Botzakis E, Mplevrakis E, Symvoulakis E, Arbiros I. Selective mutism due to a dog bit trauma in a 4-year-old girl: a case report. J Med Case Rep. 2009;3:100.

    Google Scholar 

  28. Wong P. Selective mutism: a review of etiology, comorbidities, and treatment. Psychiatry (Edgemont). 2010;7(3):23–31.

    Google Scholar 

  29. Bradley S, Sloman L. Elective mutism in immigrant families. J Am Acad Child Psychiatry. 1975;14:510–4.

    Article  PubMed  CAS  Google Scholar 

  30. Kolvin I, Fundudis T. Elective mute children: psychological development and background factors. J Child Psychol Psychiatr. 1981;22(3):219–32.

    Article  CAS  Google Scholar 

  31. Bogels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, et al. Social anxiety disorder: questions and answers for the DSM-V. Depress Anxiety. 2010;27(2):168–89.

    Article  PubMed  Google Scholar 

  32. Remschmidt H, Poller M, Herpertz-Dahlmann B, Hennighausen K, Gutenbrunner C. A follow-up study of 45 patients with elective mutism. Eur Arch Psychiatry Clin Neurosci. 2001;251(6):284–96.

    Article  PubMed  CAS  Google Scholar 

  33. Steinhausen H-C, Wachter M, Laimbock K, Winkler MC. A long-term outcome study of selective mutism in childhood. J Child Psychol Psychiatr. 2006;47(7):751–6.

    Article  Google Scholar 

  34. Manassis K, Tannock R. Comparing interventions for selective mutism: a pilot study. Can J Psychiatr/La Revue canadienne de psychiatrie. 2008;53(10):700–3.

    Google Scholar 

  35. Vecchio J, Kearney CA. Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management. Behav Ther. 2009;40(4):380–92.

    Article  PubMed  Google Scholar 

  36. Manassis K, Tannock R, Garland EJ, Minde K, McInnes A, Clark S. The sounds of silence: language, cognition and anxiety in selective mutism. J Am Acad Child Adolesc Psychiatry. 2007;46(9):1187–95.

    Article  PubMed  Google Scholar 

  37. Buzzella BA, Ehrenreich-May J, Pincus DB. Comorbidity and family factors associated with selective mutism. Child Develop Res. 2011;9.

    Google Scholar 

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

    Article  CAS  Google Scholar 

  39. Chavira DA, Shipon-Blum E, Hitchcock C, Cohan S, Stein MB. Selective mutism and social anxiety disorder: all in the family? J Am Acad Child Adolesc Psychiatry. 2007;46(11):1464–72.

    Article  PubMed  Google Scholar 

  40. Krohn DD, Weckstein SM, Wright HL. A study of the effectiveness of a specific treatment for elective mutism. J Am Acad Child Adolesc Psychiatry. 1992;31(4):711–8.

    Article  PubMed  CAS  Google Scholar 

  41. Cohan SL, Chavira DA, Shipon-Blum E, Hitchcock C, Roesch SC, Stein MB. Refining the classification of children with selective mutism: a latent profile analysis. J Clin Child Adolesc Psychol. 2008;37(4):770–84.

    Article  PubMed  Google Scholar 

  42. Vecchio JL, Kearney CA. Selective mutism in children: comparison to youths with and without anxiety disorders. J Psychopathol Behav Assess. 2005;27(1):31–7.

    Article  Google Scholar 

  43. Yeganeh R, Beidel DC, Turner SM. Selective mutism: more than social anxiety? Depress Anxiety. 2006;23(3):117–23.

    Article  PubMed  Google Scholar 

  44. Beidel DC, Turner SM. Shy children, phobic adults: nature and treatment of social phobia. Washington: American Psychological Association; 1998.

    Book  Google Scholar 

  45. Andersson CB, Thomsen PH. Electively mute children: an analysis of 37 Danish cases. Nord J Psychiatry. 1998;52(3):231–8.

    Article  Google Scholar 

  46. Manassis K, Fung D, Tannock R, Sloman L, Fiksenbaum L, McInnes A. Characterizing selective mutism: is it more than social anxiety? Depress Anxiety. 2003;18(3):153–61.

    Article  PubMed  Google Scholar 

  47. Subak ME, West M, Carlin M. Elective mutism: an expression of family psychopathology. Int J Family Psychiatr. 1982;3(3):335–44.

    Google Scholar 

  48. Browne E, Wilson V, Laybourne P. Diagnosis and treatment of elective mutism in children. J Am Acad Child Psychiatry. 1963;(2):605–17.

    Google Scholar 

  49. Goll K. Role structure and subculture in families of elective mutists. Adv Family Psychiatr. 1980;2:141–61.

    Google Scholar 

  50. Hayden TL. Classification of elective mutism. J Am Acad Child Psychiatry. 1980;19(1):118–33.

    Article  PubMed  CAS  Google Scholar 

  51. Kagan J, Reznick JS, Snidman N. The physiology and psychology of behavioral inhibition in children. Child Dev. 1987;58(6):1459–73.

    Article  PubMed  CAS  Google Scholar 

  52. Scott S, Beidel DC. Selective mutism: an update and suggestions for future research. Curr Psychiatry Rep. 2011;13(4):251–7.

    Article  PubMed  Google Scholar 

  53. Pionek Stone B, Kratochwill TR, Sladezcek I, Serlin RC. Treatment of selective mutism: a best-evidence synthesis. Sch Psychol Q. 2002;17(2):168–90.

    Article  Google Scholar 

  54. Fisak Jr BJ, Oliveros A, Ehrenreich JT. Assessment and behavioral treatment of selective mutism. Clin Case Stud. 2006;5(5):382–402.

    Article  Google Scholar 

  55. Reuther ET, Davis III TE, Moree BN, Matson JL. Treating selective mutism using modular CBT for child anxiety: a case study. J Clin Child Adolesc Psychol. 2011;40(1):156–63.

    Article  PubMed  Google Scholar 

  56. Stein MB, Yang B-Z, Chavira DA, Hitchcock CA, Sung SC, Shipon-Blum E, et al. A common genetic variant in the neurexin superfamily member CNTNAP2 is associated with increased risk for selective mutism and social anxiety-related traits. Biol Psychiatry. 2010;69(9):825–31.

    Article  PubMed  Google Scholar 

  57. Edison SC, Evans MA, McHolm AE, Cunningham CE, Nowakowski ME, Boyle M, et al. An investigation of control among parents of selectively mute, anxious, and non-anxious children. Child Psychiatry Hum Dev. 2011;42(3):270–90.

    Article  PubMed  Google Scholar 

  58. Silverman WK, Albano AM. The anxiety disorders interview schedule for DSM-IV-child and parent versions. San Antonio: Graywind Publications, A Division of The Psychological Corporation; 1996.

    Google Scholar 

  59. Egger H, Angold A. The Preschool Age Psychiatric Assessment (PAPA): a structured parent interview for diagnosing psychiatric disorders in preschool children. In: DelCarmen-Wiggins R, Carter A, editors. Handbook of infant, toddler, and preschool mental assessment. New York: Oxford University Press; 2004. p. 223–43.

    Google Scholar 

  60. Bergman RL, Keller ML, Piacentini J, Bergman AJ. The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychol. 2008;37(2):456–64.

    Article  PubMed  Google Scholar 

  61. Letamendi AM, Chavira DA, Hitchcock CA, Roesch SC, Shipon-Blum E, Stein MB. Selective Mutism Questionnaire: measurement structure and validity. J Am Acad Child Adolesc Psychiatry. 2008;47(10):1197–204.

    Article  PubMed  Google Scholar 

  62. Sharkey L, Mc Nicholas F, Barry E, Begley M, Ahern S. Group therapy for selective mutism—a parents’ and children’s treatment group. J Behav Ther Exp Psychiatry. 2008;39(4):538–45.

    Article  PubMed  Google Scholar 

  63. Oerbeck B, Johansen J, Lundahl K, Kristensen H. Selective mutism: a home-and kindergarten-based intervention for children 3–5 years: a pilot study. Clin Child Psychol Psychiatry. 2012;17(3):370–83.

    Google Scholar 

  64. Dunn LM, Dunn DM. Peabody picture vocabulary test. 4th ed. Circle Pines: American Guidance Service; 2007.

    Google Scholar 

  65. Bishop DVM. The children’s communication checklist–2. London: Psychological Corporation; 2003.

    Google Scholar 

  66. Cohan SL, Chavira DA, Stein MB. Practitioner review: psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005. J Child Psychol Psychiatr. 2006;47(11):1085–97.

    Article  Google Scholar 

  67. Kearney CA. Helping children with selective mutism and their parents: a guide for school-based professionals. New York: Oxford University Press; 2007.

    Google Scholar 

  68. McHolm AE, Cunningham CE, Vanier MK. Helping your child with selective mutism: practical steps to overcome a fear of speaking. Oakland: New Harbinger Publications; 2005.

    Google Scholar 

  69. Watson TS, Kramer JJ. Multimethod behavioral treatment of long-term selective mutism. Psychol Sch. 1992;29(4):359–66.

    Article  Google Scholar 

  70. Masten WG, Stacks JR, Caldwell-Colbert AT, Jackson JS. Behavioral treatment of a selective mute Mexican-American boy. Psychol Sch. 1996;33(1):56–60.

    Article  Google Scholar 

  71. Blum NJ, Kell RS, Starr HL, Lender WL, Bradley-Klug KL, Osborne ML, et al. Case study: audio feedforward treatment of selective mutism. J Am Acad Child Adolesc Psychiatry. 1998;37(1):40–3.

    Article  PubMed  CAS  Google Scholar 

  72. Kehle TJ, Madaus MR, Baratta VS, Bray MA. Augmented self-modeling as a treatment for children with selective mutism. J Sch Psychol. 1998;36(3):247–60.

    Article  Google Scholar 

  73. Grover RL, Hughes AA, Bergman RL, Kingery JN. Treatment modifications based on childhood anxiety diagnosis: demonstrating the flexibility in manualized treatment. J Cogn Psychother. 2006;20(3):275–86.

    Article  Google Scholar 

  74. Beidel DC, Turner SM, Young BJ. Social effectiveness therapy for children: five years later. Behav Ther. 2006;37(4):416–25.

    Article  PubMed  Google Scholar 

  75. Kendall PC, Hedtke KA, Ardmore PA. Cognitive-behavioral therapy for anxious children: therapist manual. 3rd ed. Workbook Publishing; 2006.

    Google Scholar 

  76. Chorpita BF, Taylor AA, Francis SE, Moffitt C, Austin AA. Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behav Ther. 2004;35(2):263–87.

    Article  Google Scholar 

  77. Hudson JL, Krain AL, Kendall PC. Expanding horizons: adapting manual-based treatments for anxious children with comorbid diagnoses. Cogn Behav Pract. 2001;8(4):338–45.

    Article  Google Scholar 

  78. Keen D, Fonseca S, Wintgens A. Selective mutism: a consensus based care pathway of good practice. Arch Dis Child. 2008;93:838–44.

    Article  PubMed  CAS  Google Scholar 

  79. Fung DSS, Manassis K, Kenny A, Fiksenbaum L. Web-based CBT for selective mutism. J Am Acad Child Adolesc Psychiatry. 2002;41(2):112–3.

    Article  PubMed  Google Scholar 

  80. Monga S, Mendlowitz S. Group cognitive-behavioral therapy for selective mutism: getting the chatter started. Paper presented at the 32nd ADAA annual conference, Arlington, April 12–15, 2012.

    Google Scholar 

  81. Kurtz S. Brave buddies: an intensive group treatment for SM in an analog classroom setting. Paper presented at the 32nd ADAA annual conference, Arlington, April 12–15, 2012.

    Google Scholar 

  82. Kaakeh YS, Janice L. Treatment of selective mutism: focus on selective serotonin reuptake inhibitors. Pharmacotherapy. 2008;28(2):214–24.

    Article  PubMed  CAS  Google Scholar 

  83. Black B, Uhde TW. Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study. J Am Acad Child Adolesc Psychiatry. 1994;33(7):1000–6.

    Article  PubMed  CAS  Google Scholar 

  84. Dummit III ES, Klein RG, Tancer NK, Asche B. Fluoxetine treatment of children with selective mutism: an open trial. J Am Acad Child Adolesc Psychiatry. 1996;35(5):615–21.

    Article  PubMed  Google Scholar 

  85. Carlson JS, Kratochwill TR, Johnston HF. Sertraline treatment of 5 children diagnosed with selective mutism: a single-case research trial. J Child Adolesc Psychopharmacol. 1999;9(4):293–306.

    Article  PubMed  CAS  Google Scholar 

  86. Lehman RB. Rapid resolution of social anxiety disorder, selective mutism, and separation anxiety with paroxetine in an 8-year-old girl. J Psychiatry Neurosci. 2002;27(2):124–5.

    PubMed  Google Scholar 

  87. Golwyn DH, Sevlie CP. Phenelzine treatment of selective mutism in four prepubertal children. J Child Adolesc Psychopharmacol. 1999;9(2):109–13.

    Article  PubMed  CAS  Google Scholar 

  88. Golwyn D. Phenelzine treatment of elective mutism: a case report. J Clin Psychiatry. 1990;51(9):384–5.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institution, Baltimore, MD, USA

    Courtney P. Keeton

Authors
  1. Courtney P. Keeton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Courtney P. Keeton .

Editor information

Editors and Affiliations

  1. , Education and Training, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, 21211, Maryland, USA

    Roma A. Vasa

  2. Fordham University, East Fordham Road 441, Bronx, 10458, New York, USA

    Amy Krain Roy

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Keeton, C.P. (2013). Selective Mutism. In: Vasa, R., Roy, A. (eds) Pediatric Anxiety Disorders. Current Clinical Psychiatry. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-6599-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6599-7_11

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4614-6598-0

  • Online ISBN: 978-1-4614-6599-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation