Evaluation of a Novel Parent-Rated Scale for Selective Mutism

Abstract

Assessment of selective mutism (SM) is hampered by the lack of diagnostic measures. The Frankfurt Scale of Selective Mutism was developed for kindergarteners, schoolchildren, and adolescents, including the diagnostic scale (DS) and the severity scale (SS). The objective of this study was to evaluate this novel, parent-rated questionnaire among individuals aged 3 to 18 years ( n = 334) with SM, social phobia, internalizing disorders, and a control group. Item analysis resulted in high item-total correlations, and internal consistency in both scales was excellent with Cronbach's α = .90-.98. Exploratory factor analysis of the SS consistently yielded a one-factor solution. Mean sum scores of the DS differed significantly between the diagnostic groups, and the receiver operating characteristic analysis resulted in optimal cutoffs for distinguishing SM from all other groups with the area under the curves of 0.94-1.00. The SS sum scores correlated significantly with SM's clinician-rated symptom severity.

The Selective Mutism Questionnaire: Data from typically developing children and children with selective mutism

“…Our mean score findings in the TDs are quite similar to previous findings from the small group ( n = 18) of referred children diagnosed with anxiety disorders other than SM, where a total SMQ score >2.5 was reported ( Bergman et al, 2008 ). The relatively comparable parent-rated scores between children with anxiety disorders in the Bergman study ( Bergman et al, 2008 ) and the TDs in this study have also been reported on the more recently developed parent-rated FSSM ( Gensthaler et al, 2018 ). In the FSSM study, it was demonstrated that children with social phobia had scores about twice as high as those for the TDs and children with other anxiety disorders, and about half as high as the scores for children with SM, thus adding important information on speaking behavior as reported by parents in this diagnostic group ( Gensthaler et al, 2018 ).…”

“…Children with SAD may also show speech problems, such as longer speech latency, inappropriate tone or low voice volume, and reduced spontaneous speech ( Beidel et al, 2019 ). Whether speaking behavior differentiates the two conditions has not been evaluated until the recent publication of the Frankfurt Scale of Selective Mutism (FSSM; Gensthaler et al, 2018 ). The parent-rated FSSM is a validated, age-adjusted measure of SM for both research and clinical practice and includes a diagnostic scale (DS) and a severity scale for three age groups (3–18 years).…”

“…The parent-rated FSSM is a validated, age-adjusted measure of SM for both research and clinical practice and includes a diagnostic scale (DS) and a severity scale for three age groups (3–18 years). In a study including children and adolescents with SM, SAD, or internalizing disorders, and a control group ( n = 334), the mean DS sum scores differed significantly between the diagnostic groups, and the receiver operating characteristic analysis gave optimal cutoffs for distinguishing SM from the other groups with the area under the curves of 0.94–1.00 ( Gensthaler et al, 2018 ).…”

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

“…Because a social situation is usually influenced by all three factors an interaction between the three components can be assumed and children are usually confronted with more than one anxiety eliciting stimuli [25]. The three factors were confirmed by a factor analysis of a screening questionnaire [26] although another screening tool has found only one factor on which all items loaded [27]. Empirical data on talking patterns of children with SM are sparse yet, but there are some single research results that indicate proof for the existence of such factors that have an influence on the speaking behavior of children with SM.…”

Symptoms of Selective Mutism in Non-clinical 3- to 6-Year-Old Children: Relations With Social Anxiety, Autistic Features, and Behavioral Inhibition

“…Children showing SM in its extreme form (i.e., <1%; Bergman et al, 2002;Karakaya et al, 2008) are usually referred to a clinical facility for treatment because the persistent non-speaking behavior obviously hinders them in performing adequately in school and establishing friendships with other children (Manassis, 2009). It is good to bear in mind, however, that SM is a dimensional phenomenon as there are also young children who are not totally silent in certain social situations, but clearly use less spoken language as they would do in other settings (Gensthaler et al, 2020). This means that SM, just like other psychiatric conditions, is better conceptualized as a continuum rather than as a categorical diagnostic entity, and this justifies that its scientific inquiry should not only be conducted in clinical samples but also in non-clinical populations.…”