Mutyzm wybiórczy
Rokowania, prognozy i postęp choroby

Mutyzm wybiórczy (MW) to zaburzenie lękowe charakteryzujące się niemożnością werbalnej komunikacji w określonych sytuacjach społecznych przy zachowanej zdolności mówienia w innych kontekstach. Rokowanie jest generalnie dobre, zwłaszcza przy wczesnej diagnozie i terapii, z wskaźnikami poprawy sięgającymi 78% w badaniach klinicznych. W 5-letnim follow-up po terapii poznawczo-behawioralnej (CBT) 70% pacjentów nie spełniało już kryteriów MW, a 17% było w częściowej remisji. Negatywne czynniki prognostyczne obejmują starszy wiek w momencie diagnozy, większe nasilenie objawów, psychopatologię rodzicielską oraz rodzinne występowanie MW, które obniża wskaźnik pełnej remisji do 45% w porównaniu do 89% u dzieci bez rodzinnego obciążenia. Kompleksowa ocena neuropsychologiczna oraz stosowanie standaryzowanych narzędzi diagnostycznych, takich jak Kwestionariusz Mutyzmu Wybiórczego (SMQ), są kluczowe dla precyzyjnej diagnozy i planowania leczenia.

  1. Prognoza w mutyzmie wybiórczym
    1. Wskaźniki poprawy i remisji
    2. Czynniki prognostyczne
    3. Ryzyko rozwoju innych zaburzeń
    4. Znaczenie wczesnej interwencji
    5. Wyzwania diagnostyczne a prognoza
    6. Wielomodalne podejście do interwencji
  2. Podsumowanie prognozy w mutyzmie wybiórczym
    1. Kolejne rozdziały

Prognoza w mutyzmie wybiórczym

Mutyzm wybiórczy (MW) to zaburzenie lękowe charakteryzujące się stałą niezdolnością do komunikowania się werbalnego w określonych sytuacjach społecznych (np. w szkole), przy jednoczesnej zdolności do adekwatnego mówienia w innych sytuacjach (np. w domu). 1 Przebieg i rokowanie w mutyzmie wybiórczym ma istotne znaczenie dla praktyki klinicznej, pozwalając lekarzom odpowiednio planować długość wizyt kontrolnych i strategię leczenia. 2

Wskaźniki poprawy i remisji

Analiza długoterminowych badań obserwacyjnych wskazuje na stosunkowo dobre rokowanie w kontekście ustępowania objawów mutyzmu wybiórczego. W badaniach kohortowych i kliniczno-kontrolnych wskaźniki poprawy wahały się od 46% do 100%. 3 Przegląd systematyczny wykazał, że zdecydowana większość (190 z 243, czyli 78%) osób objętych badaniami wykazała umiarkowaną lub całkowitą poprawę objawów MW do końca okresu obserwacji. 4 W 5-letnim badaniu follow-up po terapii poznawczo-behawioralnej (CBT) 70% pacjentów nie spełniało już kryteriów diagnostycznych MW, a 17% było w częściowej remisji. 5

Obserwacje kliniczne potwierdzają, że większość osób z mutyzmem wybiórczym osiąga poprawę w okresie dojrzewania. 67 Wczesna identyfikacja i właściwe leczenie są kluczowymi czynnikami poprawiającymi rokowanie – przy wczesnym rozpoznaniu i terapii w dzieciństwie, większość pacjentów może przezwyciężyć zaburzenie lub nauczyć się z nim radzić, minimalizując jego wpływ na funkcjonowanie. 8

Czynniki prognostyczne

Wyniki badań wskazują na kilka istotnych czynników prognostycznych w mutyzmie wybiórczym:

  • Wiek w momencie diagnozy – starszy wiek w momencie rozpoznania może przewidywać większe upośledzenie funkcjonowania i gorsze rokowanie. 910
  • Nasilenie objawów – większa ciężkość objawów na początku leczenia koreluje z gorszym rokowaniem. 11
  • Psychopatologia rodzicielska – problemy psychiczne u rodziców mogą negatywnie wpływać na rokowanie. 1213
  • Mutyzm wybiórczy w rodzinie – rodzinne występowanie MW jest znaczącym negatywnym predyktorem długoterminowego wyniku leczenia. Badania wykazały, że tylko 45% dzieci z rodzinnym występowaniem MW osiągnęło pełną remisję, w porównaniu do 89% dzieci bez rodzinnego obciążenia. 14
  • Milkliwość w rodzinie – małomówność w środowisku rodzinnym może być negatywnym predyktorem wyniku leczenia i późniejszej psychopatologii. 15

Ryzyko rozwoju innych zaburzeń

Mimo stosunkowo dobrych wskaźników remisji samego mutyzmu wybiórczego, badania długoterminowe wskazują na podwyższone ryzyko rozwoju innych zaburzeń psychicznych w późniejszym życiu. Pięć z sześciu badań kohortowych i kliniczno-kontrolnych, które badały występowanie innych zaburzeń psychicznych w okresie obserwacji, wykazało umiarkowane wskaźniki zaburzeń lękowych. 16

Nieleczony mutyzm wybiórczy może przyjmować przewlekły przebieg i wpływać na zdolności społeczno-komunikacyjne, zdrowie psychiczne i jakość życia w okresie dojrzewania i dorosłości. 17 Osoby z nieleczonym MW często doświadczają uporczywych zaburzeń lękowych, depresji, trudności w sytuacjach społecznych oraz poczucia osamotnienia lub izolacji. 18 Może to również negatywnie wpływać na edukację, karierę zawodową i inne istotne obszary życia. 19

Znaczenie wczesnej interwencji

Wczesne wykrycie i leczenie mutyzmu wybiórczego jest niezbędne, aby zapobiec utrzymywaniu się objawów i rozwojowi innych zaburzeń psychicznych. 20 Kompleksowa ocena neuropsychologiczna ma kluczowe znaczenie dla zrozumienia poznawczych i emocjonalnych podstaw MW oraz identyfikacji współwystępujących zaburzeń lub specyficznych wyzwań, które mogą utrwalać to zaburzenie. 21

Wyniki badań wskazują na długoterminową skuteczność terapii poznawczo-behawioralnej (CBT) w leczeniu mutyzmu wybiórczego. Badanie 5-letnie wykazało, że efekty szkolnej terapii CBT dla MW są w dużej mierze utrzymane 5 lat po zakończeniu leczenia u dzieci z MW w wieku 3-9 lat. 22 Jednocześnie badania podkreślają potrzebę opracowania skuteczniejszych interwencji dla podgrupy dzieci z utrzymującymi się objawami. 23

Wyzwania diagnostyczne a prognoza

Istnieją istotne wyzwania związane z diagnostyką MW, które mogą wpływać na rokowanie. Przegląd diagnostyczny wykazał, że 38% badań opublikowanych w ostatniej dekadzie nie wykorzystywało żadnego standaryzowanego narzędzia diagnostycznego dla MW. 24 Większość instrumentów stosowanych w różnych badaniach była używana tylko raz, co utrudnia porównywalność wyników między badaniami. 25

Dla poprawy prognozy konieczne jest stosowanie rzetelnych i trafnych narzędzi diagnostycznych. Kwestionariusz Mutyzmu Wybiórczego (SMQ) może być wykorzystywany do różnicowania między dziećmi z MW i bez tego zaburzenia, chociaż potrzebne są dalsze badania nad wartościami odcięcia w większych próbach. 26

Wielomodalne podejście do interwencji

Na rokowanie w mutyzmie wybiórczym wpływają różne czynniki, w tym wczesna diagnoza i dostosowana interwencja, obecność innych zaburzeń, wsparcie rodzinne oraz współpraca między różnymi kontekstami życia dziecka. 27 W opisywanych przypadkach klinicznych głównym celem programów interwencyjnych jest często redukcja uogólnionego lęku. 28

Wielowymiarowa ocena kliniczna, obejmująca nie tylko objawy mutyzmu, ale także funkcjonowanie poznawcze, emocjonalne i społeczne, pozwala na bardziej precyzyjną diagnozę i lepsze ukierunkowanie leczenia, co przekłada się na lepsze rokowanie długoterminowe. 29

Podsumowanie prognozy w mutyzmie wybiórczym

Ogólne rokowanie w mutyzmie wybiórczym jest dobre, szczególnie w przypadku wczesnej diagnozy i leczenia. 30 Większość osób z MW wykazuje poprawę w okresie dojrzewania, a wskaźniki poprawy w badaniach klinicznych wynoszą około 78%. 3132 Pomimo ustępowania objawów mutyzmu, istnieje podwyższone ryzyko występowania innych zaburzeń lękowych w późniejszym życiu. 33

Negatywnymi czynnikami prognostycznymi są: starszy wiek w momencie diagnozy, większe nasilenie objawów, psychopatologia rodzicielska oraz występowanie MW w rodzinie. 343536 Terapia poznawczo-behawioralna wykazuje długotrwałą skuteczność, a jej efekty utrzymują się nawet 5 lat po zakończeniu leczenia. 37

Wczesna interwencja ma kluczowe znaczenie dla poprawy rokowania, zapobiegając rozwinięciu się przewlekłej formy zaburzenia i późniejszych problemów psychicznych, społecznych i edukacyjnych. 3839 Dokładna diagnostyka i wielowymiarowa ocena kliniczna pozwalają na lepsze ukierunkowanie leczenia i poprawę długoterminowych wyników. 40

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

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). […] If left untreated, SM can take a chronic course and affect social-communicative capacity, mental health and quality of life in adolescence and adulthood. […] 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.
  • #2 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Investigating the long-term outcomes of SM is important because it could help clinicians to plan the length of follow-up visits and treatment. […] The aim of this review was to address the lack of evidence on the long-term outcomes of SM by performing a systematic literature review that identified all the long-term follow-up studies that explored the psychiatric outcomes of SM.
  • #3 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    The recovery rates in the cohort and case-control studies, which all had clinical based samples, ranged from 46% to 100%. […] The majority (190/243, 78%) of the subjects in these studies had shown moderate or total improvements in SM symptoms by the end of the follow-up periods. […] Five of the six cohort and case-control studies that examined other psychiatric disorders at follow up found moderate rates of anxiety disorders. […] The long-term recovery rates for SM were relatively good in the reviewed studies, but other disorders, mainly anxiety disorders, were common later in life.
  • #4 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    The recovery rates in the cohort and case-control studies, which all had clinical based samples, ranged from 46% to 100%. […] The majority (190/243, 78%) of the subjects in these studies had shown moderate or total improvements in SM symptoms by the end of the follow-up periods. […] Five of the six cohort and case-control studies that examined other psychiatric disorders at follow up found moderate rates of anxiety disorders. […] The long-term recovery rates for SM were relatively good in the reviewed studies, but other disorders, mainly anxiety disorders, were common later in life.
  • #5
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #6 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Investigating the long-term outcomes of SM is important because it could help clinicians to plan the length of follow-up visits and treatment. […] The aim of this review was to address the lack of evidence on the long-term outcomes of SM by performing a systematic literature review that identified all the long-term follow-up studies that explored the psychiatric outcomes of SM.
  • #7 Long-term outcomes of selective mutism: a systematic literature review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10598940/
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
  • #8 Selective Mutism: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/selective-mutism
    Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood. […] 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 doesn’t affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isn’t 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.
  • #9 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Investigating the long-term outcomes of SM is important because it could help clinicians to plan the length of follow-up visits and treatment. […] The aim of this review was to address the lack of evidence on the long-term outcomes of SM by performing a systematic literature review that identified all the long-term follow-up studies that explored the psychiatric outcomes of SM.
  • #10
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. […] Older age and severity at baseline and familial SM were significant negative predictors of outcome. […] These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms. […] Based on the existing literature on pediatric anxiety disorders, where factors such as bilingualism, and comorbid anxiety disorders, especially social phobia are found to be negative predictors of treatment outcome one could hypothesize a poor long-term outcome in children with SM, where these factors are overrepresented. […] However, based on the favorable results in our previous follow-up studies conducted 1 year after end of treatment, we hypothesized that treatment gains would be maintained in the present 5-year follow-up study.
  • #11
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. […] Older age and severity at baseline and familial SM were significant negative predictors of outcome. […] These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms. […] Based on the existing literature on pediatric anxiety disorders, where factors such as bilingualism, and comorbid anxiety disorders, especially social phobia are found to be negative predictors of treatment outcome one could hypothesize a poor long-term outcome in children with SM, where these factors are overrepresented. […] However, based on the favorable results in our previous follow-up studies conducted 1 year after end of treatment, we hypothesized that treatment gains would be maintained in the present 5-year follow-up study.
  • #12 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Investigating the long-term outcomes of SM is important because it could help clinicians to plan the length of follow-up visits and treatment. […] The aim of this review was to address the lack of evidence on the long-term outcomes of SM by performing a systematic literature review that identified all the long-term follow-up studies that explored the psychiatric outcomes of SM.
  • #13 Long-term outcomes of selective mutism: a systematic literature review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10598940/
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
  • #14
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #15
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #16 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    The recovery rates in the cohort and case-control studies, which all had clinical based samples, ranged from 46% to 100%. […] The majority (190/243, 78%) of the subjects in these studies had shown moderate or total improvements in SM symptoms by the end of the follow-up periods. […] Five of the six cohort and case-control studies that examined other psychiatric disorders at follow up found moderate rates of anxiety disorders. […] The long-term recovery rates for SM were relatively good in the reviewed studies, but other disorders, mainly anxiety disorders, were common later in life.
  • #17 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). […] If left untreated, SM can take a chronic course and affect social-communicative capacity, mental health and quality of life in adolescence and adulthood. […] 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.
  • #18 Selective Mutism: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/selective-mutism
    Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood. […] 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 doesn’t affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isn’t 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.
  • #19 Selective Mutism: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/selective-mutism
    Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood. […] 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 doesn’t affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isn’t 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.
  • #20 Long-term outcomes of selective mutism: a systematic literature review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10598940/
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
  • #21 Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age
    https://www.mdpi.com/2227-9067/11/6/746
    Selective mutism (SM) is an anxiety disorder that is characterized by a child’s persistent inability to communicate verbally in some or all contexts of social life. […] The prognosis is influenced by various factors, including early diagnosis and tailored intervention, the presence of other disorders, family support, and collaboration across different contexts of the child’s life (Mercado, 2024) [15]. […] The primary aim of the intervention program for G. centered on reducing generalized anxiety. […] By age 11 (T1), in the fifth grade, it became possible to conduct a comprehensive neuropsychological assessment of her school learning, leading to a clearer and more complete clinical diagnosis. […] This report underscores the significance of early diagnosis and thorough neuropsychological assessment, essential for understanding the cognitive and emotional underpinnings of SM and identifying comorbidities or specific challenges that may perpetuate the disorder.
  • #22
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #23
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. […] Older age and severity at baseline and familial SM were significant negative predictors of outcome. […] These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms. […] Based on the existing literature on pediatric anxiety disorders, where factors such as bilingualism, and comorbid anxiety disorders, especially social phobia are found to be negative predictors of treatment outcome one could hypothesize a poor long-term outcome in children with SM, where these factors are overrepresented. […] However, based on the favorable results in our previous follow-up studies conducted 1 year after end of treatment, we hypothesized that treatment gains would be maintained in the present 5-year follow-up study.
  • #24 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). […] If left untreated, SM can take a chronic course and affect social-communicative capacity, mental health and quality of life in adolescence and adulthood. […] 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.
  • #25 Diagnosing selective mutism: a critical review of measures for clinical practice and research
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
    The SMQ can be used to differentiate between children with and without SM. […] The use of cut-off scores, and the use of the SMQ in typically developing children (TDs) can be investigated in larger samples. […] 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. […] The vast majority of instruments used in different studies were used only once, hampering comparability of findings over studies.
  • #26 Diagnosing selective mutism: a critical review of measures for clinical practice and research
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10533577/
    The SMQ can be used to differentiate between children with and without SM. […] The use of cut-off scores, and the use of the SMQ in typically developing children (TDs) can be investigated in larger samples. […] 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. […] The vast majority of instruments used in different studies were used only once, hampering comparability of findings over studies.
  • #27 Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age
    https://www.mdpi.com/2227-9067/11/6/746
    Selective mutism (SM) is an anxiety disorder that is characterized by a child’s persistent inability to communicate verbally in some or all contexts of social life. […] The prognosis is influenced by various factors, including early diagnosis and tailored intervention, the presence of other disorders, family support, and collaboration across different contexts of the child’s life (Mercado, 2024) [15]. […] The primary aim of the intervention program for G. centered on reducing generalized anxiety. […] By age 11 (T1), in the fifth grade, it became possible to conduct a comprehensive neuropsychological assessment of her school learning, leading to a clearer and more complete clinical diagnosis. […] This report underscores the significance of early diagnosis and thorough neuropsychological assessment, essential for understanding the cognitive and emotional underpinnings of SM and identifying comorbidities or specific challenges that may perpetuate the disorder.
  • #28 Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age
    https://www.mdpi.com/2227-9067/11/6/746
    Selective mutism (SM) is an anxiety disorder that is characterized by a child’s persistent inability to communicate verbally in some or all contexts of social life. […] The prognosis is influenced by various factors, including early diagnosis and tailored intervention, the presence of other disorders, family support, and collaboration across different contexts of the child’s life (Mercado, 2024) [15]. […] The primary aim of the intervention program for G. centered on reducing generalized anxiety. […] By age 11 (T1), in the fifth grade, it became possible to conduct a comprehensive neuropsychological assessment of her school learning, leading to a clearer and more complete clinical diagnosis. […] This report underscores the significance of early diagnosis and thorough neuropsychological assessment, essential for understanding the cognitive and emotional underpinnings of SM and identifying comorbidities or specific challenges that may perpetuate the disorder.
  • #29 Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age
    https://www.mdpi.com/2227-9067/11/6/746
    Selective mutism (SM) is an anxiety disorder that is characterized by a child’s persistent inability to communicate verbally in some or all contexts of social life. […] The prognosis is influenced by various factors, including early diagnosis and tailored intervention, the presence of other disorders, family support, and collaboration across different contexts of the child’s life (Mercado, 2024) [15]. […] The primary aim of the intervention program for G. centered on reducing generalized anxiety. […] By age 11 (T1), in the fifth grade, it became possible to conduct a comprehensive neuropsychological assessment of her school learning, leading to a clearer and more complete clinical diagnosis. […] This report underscores the significance of early diagnosis and thorough neuropsychological assessment, essential for understanding the cognitive and emotional underpinnings of SM and identifying comorbidities or specific challenges that may perpetuate the disorder.
  • #30 Selective Mutism: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/selective-mutism
    Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood. […] 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 doesn’t affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isn’t 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.
  • #31 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    The recovery rates in the cohort and case-control studies, which all had clinical based samples, ranged from 46% to 100%. […] The majority (190/243, 78%) of the subjects in these studies had shown moderate or total improvements in SM symptoms by the end of the follow-up periods. […] Five of the six cohort and case-control studies that examined other psychiatric disorders at follow up found moderate rates of anxiety disorders. […] The long-term recovery rates for SM were relatively good in the reviewed studies, but other disorders, mainly anxiety disorders, were common later in life.
  • #32 Long-term outcomes of selective mutism: a systematic literature review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10598940/
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
  • #33 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    The recovery rates in the cohort and case-control studies, which all had clinical based samples, ranged from 46% to 100%. […] The majority (190/243, 78%) of the subjects in these studies had shown moderate or total improvements in SM symptoms by the end of the follow-up periods. […] Five of the six cohort and case-control studies that examined other psychiatric disorders at follow up found moderate rates of anxiety disorders. […] The long-term recovery rates for SM were relatively good in the reviewed studies, but other disorders, mainly anxiety disorders, were common later in life.
  • #34 Long-term outcomes of selective mutism: a systematic literature review | BMC Psychiatry | Full Text
    https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05279-6
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Investigating the long-term outcomes of SM is important because it could help clinicians to plan the length of follow-up visits and treatment. […] The aim of this review was to address the lack of evidence on the long-term outcomes of SM by performing a systematic literature review that identified all the long-term follow-up studies that explored the psychiatric outcomes of SM.
  • #35
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. […] Older age and severity at baseline and familial SM were significant negative predictors of outcome. […] These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms. […] Based on the existing literature on pediatric anxiety disorders, where factors such as bilingualism, and comorbid anxiety disorders, especially social phobia are found to be negative predictors of treatment outcome one could hypothesize a poor long-term outcome in children with SM, where these factors are overrepresented. […] However, based on the favorable results in our previous follow-up studies conducted 1 year after end of treatment, we hypothesized that treatment gains would be maintained in the present 5-year follow-up study.
  • #36
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #37
    https://link.springer.com/article/10.1007/s00787-018-1110-7
    As 70% no longer were diagnosed with SM at the 5-year follow-up, and 17% were in partial remission, this supports provision of CBT treatment for children with SM. […] The present study found that having SM in the family (11 of 30 children) was a significant negative predictor of long-term outcome, as only 45% of the children did not have SM, compared to 89% in children without familial SM. […] This finding is also in line with the controlled study of long-term outcome of children with SM followed up into young adulthood, showing taciturnity in the family as a negative predictor on psychopathology and symptomatic outcome. […] The present study demonstrates that the effect of a school-based CBT for SM is largely upheld 5 years after end of treatment in children with SM aged 3-9 years at baseline.
  • #38 Long-term outcomes of selective mutism: a systematic literature review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10598940/
    Most subjects with SM recovered from this disorder during adolescence, but anxiety disorders were common in later life. […] The review found that 190 of the 243 subjects in the studies that reported recovery rates showed moderate or total improvement from SM during follow up. […] Older age at baseline and parental psychopathology might predict greater impairment, but further studies are needed to confirm these results. […] Early detection and treatment are needed to prevent symptoms from persisting and other psychiatric disorders from developing.
  • #39 Selective Mutism: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/selective-mutism
    Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood. […] 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 doesn’t affect their lives as much (or at all). […] When SM goes undetected or untreated, the outlook is less positive. It isn’t 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.
  • #40 Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age
    https://www.mdpi.com/2227-9067/11/6/746
    Selective mutism (SM) is an anxiety disorder that is characterized by a child’s persistent inability to communicate verbally in some or all contexts of social life. […] The prognosis is influenced by various factors, including early diagnosis and tailored intervention, the presence of other disorders, family support, and collaboration across different contexts of the child’s life (Mercado, 2024) [15]. […] The primary aim of the intervention program for G. centered on reducing generalized anxiety. […] By age 11 (T1), in the fifth grade, it became possible to conduct a comprehensive neuropsychological assessment of her school learning, leading to a clearer and more complete clinical diagnosis. […] This report underscores the significance of early diagnosis and thorough neuropsychological assessment, essential for understanding the cognitive and emotional underpinnings of SM and identifying comorbidities or specific challenges that may perpetuate the disorder.

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