Mutyzm wybiórczy – Epidemiologia

Mutyzm wybiórczy
Epidemiologia

Mutyzm wybiórczy (MW) to zaburzenie lękowe charakteryzujące się trwałą niemożnością mówienia w określonych sytuacjach społecznych, pomimo zachowanej zdolności komunikacji werbalnej w innych kontekstach. Częstość występowania MW w populacji dziecięcej szacuje się na 0,2-2%, z bardziej precyzyjnymi danymi wskazującymi na 0,47-0,76% w badaniach z Europy Zachodniej, USA i Izraela, a także około 0,7% (1 na 140 dzieci) w wieku szkolnym. Zaburzenie częściej dotyka dziewczęta (stosunek płci 1,5:1 do 2,6:1), dzieci dwujęzyczne, z mniejszości etnicznych oraz z opóźnieniami mowy i języka. Pierwsze objawy pojawiają się zwykle między 2 a 5 rokiem życia, a diagnoza jest najczęściej stawiana między 5 a 8 rokiem życia, gdy dziecko rozpoczyna edukację szkolną. MW współwystępuje często z innymi zaburzeniami, zwłaszcza fobią społeczną (około 90% przypadków), zaburzeniami lękowymi, ASD, depresją, OCD i opóźnieniami rozwojowymi. Czynniki ryzyka obejmują trudności w mowie, cechy osobowości (np. nieśmiałość, perfekcjonizm), rodzinne występowanie zaburzeń psychicznych oraz nadwrażliwość sensoryczną.

Mutyzm wybiórczy: Epidemiologia i nadzór

Rozpowszechnienie mutyzmem wybiórczym

Mutyzm wybiórczy (MW) jest zaburzeniem lękowym charakteryzującym się stałą niezdolnością do mówienia w określonych sytuacjach społecznych, mimo zdolności do normalnej komunikacji werbalnej w innych okolicznościach. Badania wskazują na różne oszacowania częstotliwości występowania tego zaburzenia, co wynika z różnorodności metod badawczych, kryteriów diagnostycznych oraz badanych populacji.¹²

Większość szacunków dotyczących częstości występowania mutyzmowi wybiórczego wskazuje na zakres od 0,2% do 2% populacji dziecięcej. W badaniach z Europy Zachodniej, Stanów Zjednoczonych i Izraela, częstość występowania oszacowano na poziomie od 0,47% do 0,76% populacji.¹² Nowsze badania sugerują, że MW dotyka około 1 na 140 dzieci (około 0,7%) w wieku szkolnym, choć wielu badaczy zgadza się, że te wskaźniki mogą być niedoszacowane ze względu na ograniczoną wiedzę na temat tego zaburzenia.¹²

W szwedzkim badaniu Kopp i Gillberg (1997) stwierdzono częstość występowania wśród dzieci szkolnych na poziomie 0,18%.¹ Z kolei inne badania wskazują na częstość występowania od 0,03% do 1% w populacji ogólnej oraz około 1% w instytucjach zajmujących się zdrowiem psychicznym.¹²

Charakterystyka demograficzna

Badania wskazują na nierównomierny rozkład płci wśród osób z mutyzmem wybiórczym. Większość badań sugeruje, że zaburzenie to występuje częściej u dziewcząt niż u chłopców, w stosunku od 1,5:1 do 2,6:1.¹² Niektóre źródła podają jednak, że może dotyczyć częściej chłopców w stosunku 1,3:1 lub że nie ma różnicy między płciami.¹

Mutyzm wybiórczy jest częstszy wśród dzieci pochodzących z rodzin imigrantów, dzieci dwujęzycznych oraz dzieci z mniejszości etnicznych.¹² Badania wykazały również wyższe wskaźniki występowania wśród dzieci z opóźnieniami mowy i języka.¹

Wiek wystąpienia i diagnozowania

Pierwsze objawy mutyzmowi wybiórczego zwykle pojawiają się między 2 a 5 rokiem życia, jednak formalna diagnoza następuje najczęściej między 5 a 8 rokiem życia, gdy dziecko rozpoczyna edukację szkolną.¹² Zaburzenie zazwyczaj ujawnia się w przedszkolu, ale jest najczęściej identyfikowane jako problem dopiero po rozpoczęciu nauki w szkole podstawowej, prawdopodobnie ze względu na zwiększone wymagania dotyczące występów i interakcji społecznych w tym okresie.¹

Średni wiek wystąpienia to około 5 lat, choć rodzice lub nauczyciele często zauważają pierwsze oznaki już w wieku 3-4 lat.¹ Mutyzm wybiórczy występuje głównie u dzieci między 3 a 8 rokiem życia, ale możliwe jest również wystąpienie u nastolatków i dorosłych, choć jest to znacznie rzadsze.¹

Czynniki ryzyka i zaburzenia współistniejące

Ze względu na rzadkość występowania mutyzmowi wybiórczego, czynniki ryzyka nie są w pełni zrozumiane.¹ Badania wskazują jednak na kilka potencjalnych czynników predysponujących. Mutyzm wybiórczy częściej występuje u dzieci:¹

z trudnościami w mowie i języku
dwujęzycznych
pochodzących z mniejszości etnicznych
z trudnościami w przetwarzaniu sensorycznym (np. nadwrażliwością na hałas)
z rodzinną historią zaburzeń lękowych lub depresji
z określonymi cechami osobowości (np. wrażliwością, nieśmiałością, lękiem lub perfekcjonizmem)
z trudnościami psychologicznymi, takimi jak niskie poczucie własnej wartości lub depresja

Badanie przeprowadzone w oparciu o wywiady z rodzicami dzieci z diagnozą MW wykazało, że 16% rodzeństwa tych dzieci miało zaburzenia psychiczne, podczas gdy w grupie kontrolnej odsetek ten wynosił jedynie 4,9%.¹ Sugeruje to, że MW może mieć komponenty genetyczne lub środowiskowe związane z rodzinnymi wzorcami zdrowia psychicznego.

Bardzo często mutyzm wybiórczy współwystępuje z innymi zaburzeniami, zwłaszcza z zaburzeniami lękowymi. Około 90% dzieci z MW ma również fobię społeczną.¹ Inne częste współistniejące zaburzenia to:¹

Zaburzenia lękowe
Zaburzenia ze spektrum autyzmu (ASD)
Depresja
Opóźnienia rozwojowe
Problemy językowe
Zaburzenia obsesyjno-kompulsyjne (OCD)
Zaburzenia paniczne

Badanie kliniczne wykazało, że 63% z grupy klinicznej z MW (n=97) otrzymało również diagnozę autyzmu/zaburzeń ze spektrum autyzmu, gdy przeprowadzono odpowiednie badania.¹ Podobnie badanie Kristensena z 2000 roku również opisuje zwiększone ryzyko autyzmu w przypadkach MW.¹

Przebieg i rokowanie

Przebieg mutyzmowi wybiórczego może być różny u różnych osób. Zaburzenie może trwać kilka miesięcy lub utrzymywać się przez kilka lat.¹ W wielu przypadkach MW trwa tylko kilka miesięcy, jednak objawy mogą utrzymywać się do kilku lat.¹

Większość dzieci z mutyzmem wybiórczym ma tendencję do spontanicznego przezwyciężenia zaburzenia z nieznanych przyczyn.¹ Jednak pomimo pozornej remisji, zachowania związane z mówieniem pozostają z czasem niższe niż przeciętne, a fobia społeczna i inne zaburzenia lękowe mogą się utrzymywać.¹

Badania długoterminowe pokazują, że chociaż objawy MW mają tendencję do zmniejszania się z czasem, trudności komunikacyjne i lęk społeczny często utrzymują się w wieku dziecięcym.¹ Jeśli MW pozostaje nieleczony, może utrzymywać się w okresie dojrzewania i dorosłości, prowadząc do izolacji, niskiego poczucia własnej wartości i zaburzeń lękowych.¹

Badania sugerują, że rokowanie dla MW jest dobre, szczególnie przy wczesnej diagnozie i leczeniu. Według badań, dzieci, które zaczynają mówić przed 8 rokiem życia w uprzednio „niemych” sytuacjach, zwykle stają się werbalne w innych sytuacjach w ciągu jednego roku.¹ Gdy MW jest diagnozowany i leczony we wczesnym dzieciństwie, większość osób może go przezwyciężyć lub nauczyć się z nim radzić, dzięki czemu nie wpływa on tak znacząco na ich życie.¹

Wyzwania w badaniach nad mutyzmem wybiórczym

Literatura dotycząca mutyzmowi wybiórczego składa się głównie z małych populacji badanych i raportów przypadków.¹ Do tej pory nie przeprowadzono badań porównujących wyniki różnych metod leczenia, choć podejmowane są kroki w tym kierunku.¹

Ponieważ charakterystykę obecnych badań nad farmakoterapią w mutyzmie wybiórczym stanowią izolowane raporty przypadków i małe próbki, trudno jest wyciągnąć kliniczne wnioski, ponieważ do tej pory nie przeprowadzono zakrojonych na szeroką skalę badań farmakoterapeutycznych.¹

Przegląd przeprowadzony przez badaczy ujawnił, że większość badań opublikowanych w ostatniej dekadzie wykorzystywała jedno lub więcej standaryzowanych lub skwantyfikowanych miar. Co ciekawe, 38% badań nie używało żadnego standaryzowanego narzędzia diagnostycznego dla MW.¹² Ogranicza to możliwość replikacji tych badań oraz psychometryczne podstawy narzędzi, które mają być stosowane w praktyce klinicznej.¹

Do klasyfikacji MW w praktyce klinicznej lub potwierdzenia diagnozy w celu włączenia do badań stosowane są kwestionariusze i wywiady kliniczne. Najczęściej stosowaną miarą w badaniach jest SMQ (Selective Mutism Questionnaire). To narzędzie jest krótkie i zawiera skalę ciężkości badającą mówienie w trzech różnych kontekstach oraz skalę do badania wpływu objawów na funkcjonowanie dziecka i rodziny.¹

Wywiad kliniczny najczęściej stosowany do badania obecności i ciężkości MW, a także współistniejących zaburzeń, to ADIS (Anxiety Disorders Interview Schedule). ADIS był najczęściej używany do włączania do badań. Ocena ciężkości była również używana w siedmiu badaniach jako miara wyników i okazała się wrażliwa na zmiany.¹

Międzynarodowe perspektywy i nadzór

Badania nad mutyzmem wybiórczym prowadzone są w różnych krajach, co zapewnia globalną perspektywę tego zaburzenia. Badanie w Chinach wykazało, że tylko 51,2% przypadków MW zostało zdiagnozowanych przez specjalistę, a 31,1% przypadków MW, które otrzymały leczenie, było prowadzonych przez specjalistę.¹ Wyniki sugerują, że wiele dzieci z MW w Chinach nie otrzymało profesjonalnego leczenia lub interwencji. Czynniki dziedziczne i środowiskowe społeczne mogą przyczyniać się do wystąpienia MW w dzieciństwie w Chinach.¹

Badanie przeprowadzone przez dr Beate Ørbeck i Hanne Kristensen w Oslo University Hospital i Centre for Child and Adolescent Mental Health (wschodnia południowa Norwegia) podkreśliło znaczenie wczesnej interwencji w mutyzmie wybiórczym.¹ Badacze zauważyli, że częstość występowania wynosi około jeden procent, co jest prawie takie same jak w przypadku autyzmu, i podkreślili potrzebę zwiększenia świadomości i poziomu wiedzy opiekunów i nauczycieli.¹

W Europie przewodnik ESCAP (European Society for Child and Adolescent Psychiatry) przedstawia przegląd mutyzmowi wybiórczego w dziesięciu krajach, co podkreśla międzynarodowe zainteresowanie tym zaburzeniem.¹

Warto zauważyć, że mutyzm wybiórczy jest obecnie rozumiany jako zaburzenie lękowe według DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), ale wiedza na temat skutecznych interwencji i długoterminowych wyników jest nadal ograniczona.¹

Wpływ na zdrowie publiczne i współczesne tendencje

Mutyzm wybiórczy, pomimo stosunkowo niskiej częstości występowania w porównaniu z innymi zaburzeniami komunikacyjnymi (1-7 przypadków na 1000 dzieci), może mieć znaczący wpływ na dzieci, które cierpią na to zaburzenie, oraz ich rodziny.¹ Nadal wiele pozostaje do nauczenia o mutyzmie wybiórczym, ale często jest on związany z lękiem lub innymi schorzeniami wymagającymi leczenia przez personel zajmujący się zdrowiem psychicznym.¹

W ciągu ostatnich 10 lat Department of Communication Sciences and Disorders (COMD) USC Speech and Hearing Research Center nie tylko skutecznie leczył pacjentów z mutyzmem wybiórczym, ale stał się również uznanym autorytetem w zrozumieniu tego schorzenia i szkoleniu nowego pokolenia logopedów i badaczy w jego niuansach.¹ Z czasem klinicyści z całego regionu i stanu konsultowali się z wykładowcami w Centrum, gdy natrafili na pacjentów podejrzewanych o mutyzm wybiórczy.¹

Długoterminowym celem każdego leczenia zapewnianego przez Centrum jest pomoc pacjentom w uzyskaniu komfortu i zdolności do interakcji z innymi w większości sytuacji w takim stopniu, aby osiągnęli oni funkcjonalne umiejętności komunikacyjne.¹

Dane pokazują, że pacjenci, którzy otrzymują sesje kliniczne, szkolne i społeczne, wykazują zwiększoną pewność siebie, mniejsze zahamowania oraz ogólną znaczącą poprawę w zachowaniu werbalnym i interakcji społecznej.¹

Wczesna, dokładna diagnoza i interwencja są kluczowe dla przezwyciężenia mutyzmowi wybiórczego, niezależnie od rodzaju programu leczenia.¹ Badania sugerują, że leczenie tego zaburzenia jest najbardziej skuteczne, jeśli zaczyna się, gdy tylko objawy zaburzenia stają się widoczne, minimalizując w ten sposób ilość negatywnego wzmocnienia dla tych zachowań.¹

Shipon-Blum (2007) ostrzega, że jeśli mutyzm wybiórczy pozostaje nieleczony, akademickie, społeczne i emocjonalne reperkusje mogą obejmować depresję, izolację społeczną, słabe wyniki w nauce, samoleczenie narkotykami i alkoholem oraz samobójstwo.¹

Personel szkolny, zwłaszcza nauczyciele, odgrywa kluczową rolę w leczeniu mutyzmowi wybiórczego. Badania wykazały, że zaangażowanie nauczycieli w proces leczenia jest niezbędne dla pozytywnych wyników leczenia.¹

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Materiały źródłowe

#1 Diagnosing selective mutism: a critical review of measures for clinical practice and research
https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
Selective mutism (SM) is an anxiety disorder (prevalence 12%), characterized by the consistent absence of speaking in specific situations (e.g., in school), while adequately speaking in other situations (e.g., at home). SM can have a debilitating impact on the psychosocial and academic functioning in childhood. The use of psychometrically sound and cross-culturally valid instruments is urgently needed. […] SM is not as rare as once believed, with reported prevalence rates between 0.7 and 2%. The broad prevalence range may be attributed to differences in sampling strategies, such as the inclusion of clinical or community samples, sample characteristics such as age range or immigrant status, or to the diagnostic methods used. SM usually has an onset between 2 and 4 years, but often remains unrecognized until the child enters school. If left untreated, SM can take a chronic course and affect social communicative capacity, mental health and quality of life in adolescence and adulthood.
#1 Selective Mutism
https://pmc.ncbi.nlm.nih.gov/articles/PMC2861522/
Selective mutism is a rare childhood disorder characterized by the persistent failure to speak in specific contexts where speech is typically expected, despite hearing and speaking in other contexts. […] The prevalence of social mutism ranges from 0.47 to 0.76 percent of the population based on pooled case studies from Western Europe, the United States, and Israel. […] The onset of selective mutism typically occurs between ages three and six, and diagnosis occurs between ages five and eight, most often discovered after the child enters school. […] The disorder can occur over a few months or persist for several years, although the majority of selectively mute children tend to outgrow the disorder spontaneously for unknown reasons. […] However, despite apparent remission, talking behaviors over time remain lower than average, and residual social phobia and other anxiety disorders may persist.
#1 What Is Selective Mutism? – Selective Mutism Association
https://www.selectivemutism.org/resources/archive/online-library/what-is-selective-mutism/
Selective Mutism (SM) is an anxiety disorder characterized by an individualâs inability to speak in one or more social settings (e.g., at school, in public places, with peers) despite the ability to speak comfortably in other settings (e.g., at home with immediate family). […] Several studies examining the prevalence of SM suggest that it impacts about 0.7% (approximately 1 in 140) of school-aged children. It is slightly more common among girls than boys. It is more common in multilingual youth.
#1 Selective mutism | University of Gothenburg
https://www.gu.se/en/gnc/selective-mutism
SM tends to initially manifest in preschool, but is typically only identified as a problem upon entering elementary school, most likely due to the increased demands placed on performance and social interaction at that time. Prevalence numbers shift between 0.11 and 2 percent depending on the population studied and the criteria used. In a Swedish study by Kopp and Gillberg (1997), the prevalence among school children was found to be 0.18 percent. […] Research has indicated a somewhat uneven gender distribution, with a higher proportion of girls than boys. The estimated gender distribution (girl:boy) varies between 2.6:1 and 1.5:1. […] A medical record study we did found that 63 percent of a clinical SM group (n=97) had also been diagnosed with autism/autism spectrum disorders when examined for such conditions (Steffenburg, Steffenburg, Gillberg, Billstedt et al. 2018). Kristensens study from 2000 also describes an increased risk of autism in cases of SM. […] The few long-term follow-ups that have been done show that although the SM symptoms tend to lessen over time, communication difficulties and social anxiety often linger into childhood.
#1 Selective Mutism (313.23) – Abnormal Psychology
https://fscj.pressbooks.pub/abnormalpsychology/chapter/selective-mutism-313-23/
90% of children with Selective Mutism also have a social phobia. In many cases Selective Mutism lasts for only a few months, however, the symptoms may last up to several years. […] Selective Mutism is very rare, with rates of 0.1% to 0.7% in the general population and 1% in mental health institutes being reported. These extremely low rates are due, in part, to limited research.
#1 Selective Mutism
https://www.asha.org/practice-portal/clinical-topics/selective-mutism/?srsltid=AfmBOor0GTDlxEtV8ifx2-Cv6pQpj0gUatRubbemB2jty0pqDrr3B6GW
There is currently a lack of consensus regarding the incidence and prevalence of selective mutism and gender assigned at birth. While most studies report that selective mutism affects more females than males by a ratio of about 1.5-2.5:1.0, some studies report that it affects more males than females with a ratio of about 1.3:1.0 or that there is no difference between genders.
#1 Selective mutism – NHS
https://www.nhs.uk/mental-health/conditions/selective-mutism/
Selective mutism affects about 1 in 140 young children. It’s more common in girls and children who have recently migrated from their country of birth. […] Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder. It can continue into adolescence and adulthood if not managed. […] Selective mutism is diagnosed according to specific guidelines. These include observations about the person concerned as outlined: they do not speak in specific situations, such as during school lessons or when they can be overheard in public; they can speak normally in situations where they feel comfortable, such as when they’re alone with parents at home, or in their empty classroom or bedroom; their inability to speak to certain people has lasted for at least 1 month (2 months in a new setting); their inability to speak interferes with their ability to function in that setting; their inability to speak is not better explained by another behavioural, mental or communication disorder. […] With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.
#1 Selective Mutism
https://www.asha.org/practice-portal/clinical-topics/selective-mutism/?srsltid=AfmBOor0GTDlxEtV8ifx2-Cv6pQpj0gUatRubbemB2jty0pqDrr3B6GW
The incidence of selective mutism refers to the number of new cases identified in a specified time period. Prevalence is the number of individuals who are living with selective mutism in a given time period. […] Accurate population estimates of selective mutism are difficult to ascertain due to the relative rarity of the condition, differences in sampled populations, variations in diagnostic procedures (e.g., chart review, standardized assessment), and the use of different diagnostic criteria. […] Most prevalence estimates for selective mutism range between 0.2% and 1.6%. Prevalence can be somewhat higher among immigrant children, language-minority children, and children with speech and language delays. […] However, it is important to note that selective mutism must exist in all languages to confirm an accurate diagnosis in these populations.
#1 Selective Mutism | The Child and Family Institute
https://childfamilyinstitute.com/factsheets/selective-mutism/
Roughly 7 per 1,000 children; or 1 out of 140 elementary-aged children. […] Average age of onset is age 5, though parents or teachers often notice signs as early as ages 3-4. […] Slightly more prevalent among girls than boys. […] Due to poor understanding of the disorder, most SM cases are not treated. […] As a result, children and adolescents can go years without speaking and, because their mutism is ingrained, it becomes harder to overcome. […] When SM therapy begins early, the response is quicker and greater. […] According to research, those speaking before age 8 in previously mute settings typically become verbal in other settings within one year. […] A comprehensive neuropsychological assessment and diagnosis by experienced professionals are key to assembling the team and forming an early intervention plan.
#1 Selective Mutism: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/selective-mutism
SM is fairly rare. It affects less than 1% of people (across all age groups). It almost always begins in childhood around age 5, often coming to attention soon after a child starts preschool, kindergarten or grade school. Its less common but still possible in teenagers and adults. […] SM seems to affect women about twice as often as men. However, that number may be skewed because of bias or stereotypes about how talkative people should be based on their sex. More research is necessary to determine if the disparity is accurate. […] SM is rare overall, but its especially rare in adults. You might recognize the symptoms of it in yourself, or you might recognize them in your child (or a child you care for). Everyone with a diagnosis can benefit from treatment, regardless of age. […] A mental health provider, like a psychiatrist or psychologist, will usually diagnose SM. Other providers, especially speech-language pathologists or speech therapists, may rule out other conditions to help with the diagnosis.
#1 Selective Mutism: Definition, Traits, Causes, Treatment
https://www.verywellmind.com/what-is-selective-mutism-3024702
Selective mutism affects children. […] It is estimated that less than 1% of children have selective mutism. […] The primary criterion for a diagnosis of selective mutism is a consistent failure to speak in specific social situations in which there is an expectation of speaking (e.g., school), despite speaking in other situations. […] In order to be diagnosed with selective mutism as an adult, the following criteria are usually present: Symptoms of selective mutism must have been present for at least one month. […] Because the condition tends to be quite rare, risk factors for the condition are not fully understood. […] Selective mutism also often co-occurs with other disorders including: Anxiety, Autism spectrum disorder (ASD), Depression, Developmental delays, Language problems, Obsessive-compulsive disorder (OCD), Panic disorder. […] In general, there is a good prognosis for selective mutism. […] Although it is possible for this disorder to continue through to adulthood, it is rare and more likely that social anxiety disorder would develop.
#1
https://www2.hse.ie/conditions/selective-mutism/causes/
Selective mutism affects about 1 in 140 young children and is more common in girls. […] It is more common in children: with speech and language difficulties, who are bilingual, from ethnic or minority backgrounds, who have sensory processing difficulties – for example, are overly sensitive to noise, with a family history of anxiety disorders or depression, with certain personality traits – for example, they are sensitive, shy, anxious or a perfectionist, who have psychological difficulties, such as low self-esteem or depression.
#1
https://link.springer.com/article/10.1007/s00787-022-02114-3
Given the limited understanding of the etiology of SM, there are three specific research areas that are of particular interest when examining the risk of psychopathology transmission in these individuals. […] A study that carried out interviews with the parents of children diagnosed with SM reported that 16% of the children’s siblings had mental disorders. […] The rate was only 4.9% in the control group siblings in that study. […] In contrast, another case-control study, which was based on interviews with parents, found no associations between children with a clinical diagnosis of SM and a history of mental disorders in their siblings. […] The associations between SM and neurodevelopmental disorders have been investigated by a few studies and these showed that 30-40% of subjects with SM also had learning and coordination disorders.
#1 Selective Mutism: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/selective-mutism
The outlook for SM is good overall, especially with early diagnosis and treatment. When diagnosed and treated in early childhood, most people with SM can overcome or learn to cope with it, so it doesnt affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isnt dangerous, but the negative effects can be significant. People with SM often experience anxiety and depression. Some struggle with social situations and feel lonely or isolated. It can also affect their education, career and other important parts of their lives.
#1 Selective Mutism
https://pmc.ncbi.nlm.nih.gov/articles/PMC2861522/
The literature on selective mutism consists primarily of small sample populations and case reports. […] The wide range reflects the lack of uniformity in establishing the diagnosis from chart review and the infrequent use of standardized assessments. […] To date, no studies have contrasted outcomes for different treatments but steps are being taken in that direction. […] Since isolated case reports and small sample sizes characterize the current research on pharmacotherapy in selective mutism, it is difficult to draw clinical conclusions, as no large-scale pharmacotherapy trials have been performed to date. […] Despite these limitations, much attention has been given to the etiology and comorbidities of selective mutism.
#1 Diagnosing selective mutism: a critical review of measures for clinical practice and research
https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
Given the interference with social, communicational and academic development and wellbeing, it is important to identify and treat SM timely and accurately. Valid and reliable diagnostic instruments are needed to further advance research into the behavioral characteristics, possible subgroups, treatment efficacy and long-term outcome of individuals with SM. […] Our review revealed that the majority of studies published in the last decade, used one or more standardized or quantified measures. Interestingly, 38% of studies did not use any standardized diagnostic instrument for SM. […] To classify SM in clinical practice or to confirm the diagnosis for the purpose of inclusion in research, questionnaires and clinical interviews have been used. The measure used most often in research is the SMQ. This measure is short and comprises a severity scale investigating speaking in three different contexts and a scale to investigate interference of the symptoms on the child’s and family functioning.
#1 Diagnosing selective mutism: a critical review of measures for clinical practice and research
https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
The clinical interview most often used to investigate the presence and severity of SM, as well as comorbid disorders, is the ADIS. The ADIS has most often been used for inclusion in studies. The severity rating has also been used in seven studies as an outcome measure and was found to be sensitive to change. […] This review showed an important shortcoming that over a third of studies (38%) did not report any objective measure to classify SM. This limits the replicability of these studies and psychometrically sound foundation of instruments to be used in clinical practice.
#1 Selective mutism in China: a nationwide survey and case-control study | medRxiv
https://www.medrxiv.org/content/10.1101/2022.10.19.22281244v1
Selective mutism (SM) is an anxiety disorder characterized by a consistent failure to speak in particular public settings despite speaking normally in other situations. However, quantitative SM research from China remains scanty at best. […] This case-control mixed-methods study was composed of 172 cases with SM and 179 controls, recruited by online surveys. Multilevel logistic regression was performed to examine the association between potential correlates and SM. […] Only 51.2% of SM cases were diagnosed by a professional, and 31.1% of SM cases that received treatment were guided by a professional. […] Findings suggest that many children with SM in China have not received professional treatment or interventions. Hereditary and social environmental factors may be contributing to childhood onset of SM in China. Novel policies such as access to special education resources, SM-training for therapists, and school support are needed to enhance the early detection and treatment of SM in China.
#1 Early detection and treatment of selective mutism | ESCAP
https://www.escap.eu/resources/resource-centre-disorders/early-detection-and-treatment-of-selective-mutism
Children who do speak at home but exercise complete silence at school and elsewhere: selective mutism (SM) seems often hard to detect. Meanwhile, early intervention has proven to be important to live a happy (adult) life in our predominantly verbal society. A recent study by Dr Beate rbeck and Hanne Kristensen at the Oslo University Hospital and Centre for Child and Adolescent Mental Health (Eastern Southern Norway) underlined the importance of an early intervention in selective mutism. […] The prevalence is about one per cent, which is nearly the same as in autism. Increasing the awareness and knowledge level of caregivers and teachers is essential. […] Your study shows that treatment preferably early treatment can be effective. Yes, we found a steady increase of speaking behaviour in our Norwegian study.
#1 Early detection and treatment of selective mutism | ESCAP
https://www.escap.eu/resources/resource-centre-disorders/early-detection-and-treatment-of-selective-mutism
Selective mutism (SM) describes children who consistently do not speak in certain social situations, while they talk freely in other situations. SM is now understood as an anxiety disorder (DSM-5), but knowledge is still sparse on effective interventions, and long-term outcome. […] This issue presents an overview of Selective Mutism in ten countries, and remarkably in their own languages, with the framework still in German and summaries in English.
#1 USC Speech and Hearing Research Center provides individualized care, addressing uncommon disorders like selective mutism – Arnold School of Public Health | University of South Carolina
https://sc.edu/study/colleges_schools/public_health/about/news/2015/mcleod_selective_mutism.php
USC Speech and Hearing Research Center provides individualized care, addressing uncommon disorders like selective mutism. […] Though it is considered a low-incidence condition (i.e., 1-7 cases per 1,000 children) compared to other communication disorders, selective mutism can have a significant impact on the children it affects and their families. […] There is still much to be learned about selective mutism, but it is often tied to anxiety or other conditions that require treatment from mental health personnel. […] During the past 10 years of its 45-year history, the Department of Communication Sciences and Disorders (COMD) USC Speech and Hearing Research Center has not only successfully treated patients with selective mutism, but it has also become a recognized authority in understanding the condition and training the next generation of speech-language pathologists and researchers in its nuances.
#1 USC Speech and Hearing Research Center provides individualized care, addressing uncommon disorders like selective mutism – Arnold School of Public Health | University of South Carolina
https://sc.edu/study/colleges_schools/public_health/about/news/2015/mcleod_selective_mutism.php
Over time, clinicians throughout the region and state have consulted with faculty at the Center when they have encountered patients suspected of having selective mutism. […] The long-term goal of any treatment provided by the Center is to help patients become comfortable and capable of interacting with others in most situations to the extent that they achieve functional communication skills. […] McLeod also stays up-to-date on the literature on the various disorders that affect Center patients and has amassed a meaningful knowledge base pertaining to selective mutism along the way. […] During her eight years at the Arnold School, McLeod has worked with graduate students to provide evaluations, treatment and referrals for other services for five different patients with selective mutism. […] I am constantly reviewing research articles on the topic to stay informed of current practices and interventions, says McLeod.
#1 Selective Mutism | Advanced Therapeutic Solutions for Anxiety
https://www.advancedtherapeuticsolutions.org/selectivemutism
Selective Mutism is the fear of speaking in specific social situations, despite the ability to speak, and affects 1 of 140 children. […] Experts now recognize selective mutism as an anxiety disorder, and 2013 it was moved from the now retired Early Childhood Disorders to the Anxiety Disorders category in the 5th edition of the DSM. […] Selective mutism is usually first recognized when the child starts preschool. […] Parent education and early intervention is pivotal in the trajectory of this disorder. Selective mutism can be successfully treated, but don’t wait – early intervention yields best results. There is no evidence that children grow out of selective mutism. […] Patients who receive selective mutism treatment at ATSA average about one year of services when following the clinicians treatment recommendations, before they can graduate from specialty services. […] Our data show that patients who receive clinic, school, and community sessions show increased self-confidence, less inhibition, and overall significant improvement in verbal behavior and social interaction.
#1 Silent Suffering: Children with Selective Mutism – The Professional Counselor
https://tpcjournal.nbcc.org/silent-suffering-children-with-selective-mutism/
Despite increasing awareness, the childhood disorder of selective mutism is under-researched and commonly misdiagnosed. […] The lack of quality research and general awareness of selective mutism are serious barriers to helping children who suffer from this disorder. […] Recent studies suggest that selective mutism may occur in .7 to 2% of early elementary students, although many researchers agree that these prevalence rates may be underrepresented due to the lack of knowledge of the disorder. […] Symptoms of selective mutism are usually present by the age of three, but this disorder is frequently not identified until the child enters school where there is an increased expectation to speak within social settings. […] Early, accurate diagnosis and intervention are crucial to overcoming selective mutism regardless of the type of treatment program.
#1 Silent Suffering: Children with Selective Mutism – The Professional Counselor
https://tpcjournal.nbcc.org/silent-suffering-children-with-selective-mutism/
Research suggests that treatment for this disorder is most effective if it begins as soon as symptoms of the disorder become apparent, thus minimizing the amount of negative reinforcement for these behaviors. […] Shipon-Blum (2007) warns that if selective mutism is left untreated, the academic, social, and emotional repercussions may include depression, social isolation, poor academic performance, self-medication with drugs and alcohol, and suicide. […] School personnel, especially teachers, play crucial roles in the treatment of selective mutism. […] Research has shown that teachers involvement in the treatment process is vital to positive treatment outcomes.
#2 Selective Mutism
https://www.asha.org/practice-portal/clinical-topics/selective-mutism/?srsltid=AfmBOor0GTDlxEtV8ifx2-Cv6pQpj0gUatRubbemB2jty0pqDrr3B6GW
The incidence of selective mutism refers to the number of new cases identified in a specified time period. Prevalence is the number of individuals who are living with selective mutism in a given time period. […] Accurate population estimates of selective mutism are difficult to ascertain due to the relative rarity of the condition, differences in sampled populations, variations in diagnostic procedures (e.g., chart review, standardized assessment), and the use of different diagnostic criteria. […] Most prevalence estimates for selective mutism range between 0.2% and 1.6%. Prevalence can be somewhat higher among immigrant children, language-minority children, and children with speech and language delays. […] However, it is important to note that selective mutism must exist in all languages to confirm an accurate diagnosis in these populations.
#2 Selective Mutism As It Develops Over Time: A General Overview | OxJournal
https://www.oxjournal.org/selective-mutism-as-it-develops-over-time-a-general-overview/
Selective mutism predominantly occurs in children between the ages of 4 and 10 and is more commonly diagnosed in girls than boys. […] Keen et al. (2016) conducted a retrospective case-note review and estimated the prevalence of selective mutism to be between 0.47% and 0.76% among children, with varying rates depending on demographic and cultural factors. […] The development of selective mutism is influenced by a complex interplay of genetic, temperamental, environmental, and familial factors, with familial history of anxiety disorders and social influences playing a significant role. […] Many children with selective mutism have a family history of anxiety disorders, indicating a possible genetic predisposition. […] The presence of a family history of anxiety disorders suggests a genetic component, which may predispose children to anxiety-related conditions.
#2 Silent Suffering: Children with Selective Mutism – The Professional Counselor
https://tpcjournal.nbcc.org/silent-suffering-children-with-selective-mutism/
Despite increasing awareness, the childhood disorder of selective mutism is under-researched and commonly misdiagnosed. […] The lack of quality research and general awareness of selective mutism are serious barriers to helping children who suffer from this disorder. […] Recent studies suggest that selective mutism may occur in .7 to 2% of early elementary students, although many researchers agree that these prevalence rates may be underrepresented due to the lack of knowledge of the disorder. […] Symptoms of selective mutism are usually present by the age of three, but this disorder is frequently not identified until the child enters school where there is an increased expectation to speak within social settings. […] Early, accurate diagnosis and intervention are crucial to overcoming selective mutism regardless of the type of treatment program.
#2 Selective mutism – wikidoc
https://www.wikidoc.org/index.php/Selective_mutism
The prevalence of selective mutism is 30-1,000 per 100,000 (0.03%-1%) of the overall population.[1] […] Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. […] Selective mutism is usually characterised by the following: […] The disturbance is not better explained by a communication disorder (e.g., childhood onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder. […] If it is not addressed, selective mutism tends to be self-reinforcing: the expectation that one suffering from selective mutism will not speak causes those around them to stop trying to initiate verbal contact, thus making the prospect of talking seem increasingly difficult or foreign. […] Some practitioners advocate the use of antidepressants such as fluoxetine (prozac) as treatment for children with selective mutism.
#2 Selective Mutism
https://www.asha.org/practice-portal/clinical-topics/selective-mutism/?srsltid=AfmBOor0GTDlxEtV8ifx2-Cv6pQpj0gUatRubbemB2jty0pqDrr3B6GW
There is currently a lack of consensus regarding the incidence and prevalence of selective mutism and gender assigned at birth. While most studies report that selective mutism affects more females than males by a ratio of about 1.5-2.5:1.0, some studies report that it affects more males than females with a ratio of about 1.3:1.0 or that there is no difference between genders.
#2 About Selective Mutism – SMIRA
https://www.selectivemutism.org.uk/about-selective-mutism/
Selective Mutism, sometimes called Situational Mutism, is an anxiety-based mental health disorder which usually commences in early childhood. […] For unknown reasons, Selective Mutism appears to be more prevalent amongst girls and more cases are reported from migrant and multi-lingual families.
#2 What is selective mutism? And is it a lifelong condition?
https://theconversation.com/what-is-selective-mutism-and-is-it-a-lifelong-condition-219930
Belle has selective mutism, which affects about one in 140 children under the age of eight years. […] Selective mutism usually starts between two to five years. Although the condition becomes less common in adolescence and adulthood, if left untreated, it has a significant effect on the persons mental health, wellbeing and life opportunities as an adult. […] Studies have also shown a high occurrence of communication difficulties, autism and developmental delays in the people with selective mutism. […] My colleagues and I systematically reviewed the literature on selective mutism treatments without medication. We found that children who received treatments using a combined systems and behavioural approach, similar to Belles experience, made significant improvements in their speaking behaviour than those who had no treatment.
#2 Diagnosing selective mutism: a critical review of measures for clinical practice and research
https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
The clinical interview most often used to investigate the presence and severity of SM, as well as comorbid disorders, is the ADIS. The ADIS has most often been used for inclusion in studies. The severity rating has also been used in seven studies as an outcome measure and was found to be sensitive to change. […] This review showed an important shortcoming that over a third of studies (38%) did not report any objective measure to classify SM. This limits the replicability of these studies and psychometrically sound foundation of instruments to be used in clinical practice.