Anxiety in Children with Selective Mutism: A Meta-analysis

Abstract

This study evaluates the current conceptualization of selective mutism (SM) as an anxiety disorder in the DSM-5 using a meta-analytic approach. In the absence of any systematic assessment of anxiety in the field of SM, we pooled prevalence data of comorbid anxiety disorders in a random-effects meta-analysis. On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%). However, considerable heterogeneity was present, which remained unexplained by a priori specified moderators. The finding that SM is often diagnosed in combination with anxiety disorders, indicates that these disorders are not discrete, separable categories. Moreover, this finding does not help to elucidate the relation between SM and anxiety as an etiological mechanism or symptomatic feature. Broadening our research strategies regarding the assessment of anxiety is paramount to clarify the role of anxiety in SM, and allow for proper classification.

Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder

“…While the role of anxiety in SM is clear (e.g., Driessen et al 2020;Muris and Ollendick 2015;Sharp et al 2007;Viana et al 2009), the purpose of the present review is to suggest that-in some children with SM-ASD seems to be present as well. We have pointed out that on a categorical and dimensional level-relations among SM, SAD, and ASD are substantial and they can be considered to be a unified trinity of social disorders.…”

“…Ibi and Leo were referred to an outpatient facility specialized in the treatment of childhood anxiety disorders. These referrals seemed appropriate given the prominent role of anxiety, and in particular social anxiety, in the clinical picture of this psychiatric disorder (e.g., Driessen et al 2020 ; Muris and Ollendick 2015 ), which has resulted in its allocation to the category of anxiety disorders in current versions of classification systems including the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA 2013 ) and the International Classification of Diseases (ICD-11; World Health Organization [WHO] 2018 ). A standardized questionnaire taken at the clinic confirmed the presence of anxiety problems and revealed clinically elevated scores, not only for social anxiety (both boys), but also for a number of other anxiety problems such as separation anxiety (Ibi), generalized anxiety (Leo), and specific phobias (both boys).…”

Characteristics of person, place, and activity that trigger failure to speak in children with selective mutism

“…This decision was based on a significant number of studies indicating anxiety as a central phenomenon of SM, a common etiology between SM and other anxiety disorders, and results from initial treatment studies [4,8,9]. High comorbidity rates between SM and other anxiety disorders, in particular with social anxiety disorders (SAD), have been found [9][10][11]. Etiologically, behavioral inhibition (BI) was found to display a significant role for anxiety disorders in general and for SM in particular.…”

Current Challenges in the Diagnosis and Management of Selective Mutism in Children

“…A recently published meta-analysis nicely summarizes the results of 22 studies in which clinical interviews were conducted in children with SM to establish the co-occurrence of other anxiety disorders. 9 The results showed that 80% of the children with SM also fulfilled the diagnostic criteria for at least one other anxiety disorder, and in the vast majority of cases (69%) this involved social anxiety disorder (SAD). A second line of inquiry has focused on the content of the fears and fear-related cognitions of children with SM.…”