Comparison of Behavioral Profiles for Anxiety-Related Comorbidities Including Adhd and Selective Mutism in Children

Abstract

Background Elucidating differences in social-behavioral profiles of children with comorbid presentations, utilizing caregiver as well as teacher reports, will refine our understanding of how contextual symptoms vary across anxiety-related disorders. Methods In our pediatric anxiety clinic, the most frequent diagnoses and comorbidities were mixed anxiety (MA; ≥ 1 anxiety disorder; N = 155), anxiety with comorbid attention-deficit hyperactivity disorder (MA/ADHD, N = 47) and selective mutism (SM, N = 48). Behavioral measures (CPRS, CTRS) were analyzed using multiple one-way multivariate analyses of covariance tests. Differences between the three diagnostic groups were examined using completed parent and teacher reports (N = 135, 46 and 48 for MA, MA/ADHD and SM groups, respectively). Results Comparisons across the MA, MA/ADHD and SM groups indicate a significant multivariate main effect of group for caregiver and teacher responses (p < 0.01). Caregivers reported that children with SM are similar in profile to those with MA, and both groups were significantly different from the MA/ADHD group. Teachers reported that children with SM had more problem social behaviors than either the MA or MA/ADHD groups. Further comparison indicates a significant main effect of group (p < 0.001), such that children with SM have the greatest differences in behavior observed by teachers versus caregivers. Conclusions Clinical profiles between MA/ADHD, MA and SM groups varied, illustrating the importance of multi-rater assessment scales to capture subtle distinctions and to inform treatment planning given that comorbidities occur frequently in children who present with anxiety.

Selective Mutism: The Fraternal Twin of Childhood Social Phobia

“…On the item level, adolescents with SM also perceived themselves as significantly more shy than those with SP and as having more deficits in social and communicative skills. These findings at least partially contradict prior studies, which noted similar social anxiety rates in SM and SP or even mixed anxiety groups and healthy controls in parent ratings or self-report [12,16,17,19,20,23]. Our discrepant findings might be in part explained by the fact that previous studies included children with SP in their mixed anxiety groups, hence elevating social anxiety means.…”

“…In line with previous surveys [15,19,23,25], parental report (CBCL) did not indicate enhanced externalizing behavior compared to SP and INT, but compared to the CG children; mean scores were nevertheless in the normal range. Here, we replicate the finding of Alyanak et al [24] of higher but still normal CBCL externalizing behavior scores of children with SM compared to controls.…”

“…In another study, however, children with SM were rated as more socially anxious than those with mixed anxiety and normal controls and as also having more generalized and separation anxiety than normal controls [20]. In a recent study with a wide age range of participants from 3-16 years, children with SM were rated similarly regarding anxiety/shyness as a mixed anxiety group [23], while another study found overall anxiety of children with mixed anxiety disorders to be high compared to children with SM and normal controls [21]. Again, all comparisons with a mixed anxiety group were limited by the variable inclusion of individuals with SP.…”

“…Congruent with these investigations, a number of studies yielded equal parent-reported externalizing behavior of children with SM and community controls [11,20,22] and mixed anxiety groups [11,20], respectively. Levin-Decanini et al [23] found that children with SM had significantly lower parent-rated scores on oppositional behavior than a mixed anxiety group. In another study, Alyanak et al [24] reported higher but still normal CBCL externalizing T values in children with SM compared to controls.…”

Child-centered play therapy with young children who are anxious: A controlled trial

“…Children who have anxiety disorders struggle with academic achievement, sleep, family cohesion, general happiness, self-esteem, and social and peer relationships (Kendall et al, 2010;Weiner, Elkins, Pincus & Comer, 2015). These children typically have an increased risk for future psychiatric disorders, substance abuse, and conduct problems (Levin-Decanini, Connolly, Simpson, Suarez & Jacob, 2013;Oldehinkel & Ormel, 2014).…”