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

Abstract

Selective Mutism (SM) is an anxiety disorder with predictable and circumscribed situations in which children remain silent while they speak unaffectedly in others. However, core features of anxiety inducing stimuli have rarely been studied so far. Parents of children with elevated SM symptomatology participated in an online-based study and answered open ended questions about specific characteristics of a person, place, and activity that elicit failure to speak in their child. The final sample consisted of n = 91 parents with children aged between 3 and 17 years (M = 8.02 years, SD = 3.94). Answers were analyzed by qualitative content analysis. Characteristics of a person were assigned to five categories with lack of distance as the most frequently reported feature. With respect to a place, the majority of parents mentioned unknown places as a silence trigger. The most frequently mentioned feature of an activity that was designated to be associated to silence was new activity. There were only few associations between the designation of these features, age, and gender. For the first time, anxiety inducing triggers related to person, place, and activity were comprehensively assessed in children with SM. This allows a differentiated and deeper understanding of an understudied disorder. The majority of characteristics can be associated with proposed etiological factors such as increased behavioral inhibition, conditioning processes, social anxiety, and a strong need for control. Implications for effective treatments are discussed.

Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism

“…Because of the assumed biological foundation of the mechanism, freezing might be compared to attentional biases that depend on disordercongruency of stimuli (Pergamin-Hight et al, 2015), less dependent on learning experiences and on the content of the social situation (i.e., whether it has a speech component or not). Consistently, evidence from recent research indicates that eye contact and the presence of strangers per se, induces fear in children with SM (Schwenck et al, 2021) and that children with SM exhibit longer latency to movement, even in social situations where they do not need to speak (Milic et al, 2020).…”

“…Selective mutism (SM) is an anxiety disorder in which affected children are consistently unable to speak in certain social situations, while their speech production is not impaired in other situations, such as with close family and friends (American Psychiatric Association, 2013). Situations typically associated with the inability to speak include, for example, unfamiliar places or the presence of strangers (Schwenck et al, 2021). The disorder typically occurs between 2 and 5 of age (Muris & Ollendick, 2015;Remschmidt et al, 2001;Steinhausen et al, 2006), severely interferes with everyday life functioning (Milic et al, 2020;Schwartz et al, 2006) and is associated with mental and communicative problems in adulthood (Remschmidt et al, 2001;Steinhausen et al, 2006).…”

Betrayed by the nervous system: a comparison group study to investigate the ‘unsafe world’ model of selective mutism

“…Usually they have most difficulty at school, nursery or kindergarten and in unfamiliar social situations. Lack of physical distance to other people has also been found to be an important trigger for SM behaviour (Schwenck et al 2021). The disorder usually begins in transitional situations from parental home to kindergarten and elementary school (Muris and Ollendick 2021).…”

Qualitative methods in child and adolescent psychiatry: the time has come

“…One of us tried to address the shortcomings of the entirely numerical by co-editing two series soliciting qualitative and mixed methods submissions: one focused on the interface between CAP and the COVID-19 pandemic [ 7 ], another on that between psychiatry and medical education [ 8 ]. Qualitative research is sometimes the only available method to study discrete yet impactful phenomena, as exemplified by recent work from our group and others: patient and family perspectives about ADHD, anhedonia, or selective mutism [ 9 – 11 ]; stigma experienced by underrepresented minorities and their obstacles accessing mental health services [ 12 , 13 ]; barriers to science implementation in CAP [ 14 – 16 ]; the individual experience of child and adolescent mental health providers during the early days of the pandemic [ 17 , 18 ], or the experiences of medical students during their clerkship in adolescent psychiatry [ 19 ].…”