Prevalence and Treatment of Selective Mutism in Clinical Practice: A Survey of Child and Adolescent Psychiatrists

Abstract

This study investigates the use of medications by child and adolescent psychiatrists for treating selective mutism. In 1993, a one-page survey was mailed to 962 child and adolescent psychiatrists selected at random from approximately 2500 active members of the American Academy of Child and Adolescent Psychiatry. Of the 962 questionnaires sent, 411 were returned (return rate 43%) and 308 were completed (sample participation rate 32%). A prevalence estimate of selective mutism within a clinical sample was calculated to be 1 case of selective mutism per 936 new patients (0.11 %). Less than two-thirds (199/308) of the responding psychiatrists reported having treated a child with selective mutism in their practice. Of those who had treated a child with selective mutism, 36% (n = 71) reported having prescribed medication for this disorder. Antidepressants were the most frequently endorsed medication for being potentially beneficial in treating a hypothetical case example and, in addition, for being actually used by child psychiatrists in clinical practice for children diagnosed with selective mutism. Antianxiety agents were reported, at much lower rates, to be potentially useful in a hypothetical case and actually used in clinical practice for treating children with this disorder. These findings suggest that child psychiatrists may view selective mutism as being related to, having symptoms similar to, or often presenting comorbidly with depressive or anxiety disorders. However, a therapeutic program that includes pharmacotherapy was endorsed as the most effective treatment modality for selective mutism by only 14% of the reporting psychiatrists. Psychiatrists' impressions and observations cannot, even collectively, be used to make clinical inferences about the usefulness of treatments. This study did not examine treatment efficacy, since the outcomes of these open clinical trials were not judged by independent observers but were reported as observed and recollected by the clinicians involved. Moreover, these data on the treatment practices of sampled members of the American Academy of Child and Adolescent Psychiatry may not reflect the practices of other psychiatrists or pediatricians. The results indicate that child and adolescent psychiatrists are prescribing a variety of medications for selective mutism without the benefit of adequate efficacy studies. There is a significant need for further research and dissemination of information in this area.There is a paucity of research that has examined the actual or potential benefits of psychotropic medications as a treatment modality for selective mutism. Only three studies on the pharmacotherapy of

Social Phobia and Selective Mutism

“…60 -62 The Kiddie Schedule for Affective Disorders and Schizophrenia and Diagnostic Interview for Children and Adolescents do not assess SM, but investigators have added questions to do so. 63,6 Rating Scales…”

Sertraline Treatment of 5 Children Diagnosed with Selective Mutism: A Single-Case Research Trial

“…Deficits in academic performance and social communication are associated with this understudied and rare disorder (Ford et al 1998; Leonard and Dow 1995). Prevalence within psychiatric referrals have been estimated at less than 1% (Carlson et al 1994). Information has been obtained on the potential benefits of psychosocial treatments for SM, particularly behavioral treatments such as stimulus fading Departments of Psychology and Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin. procedures (Kehle et al 1997).…”

“…A variety of drugs are being used to treat SM despite a paucity of research in this area (Carlson et al 1994). Approximately two-thirds (n = 199) of survey respondents (i.e., child and adolescent psychiatrists) reported treating a case of SM, and a third of those reported using treatments involving psychotropic medications (n = 71).…”

Selective mutism

“…on the population studied and the diagnostic criteria that were applied [15][16][17]. A 2002 study examining the prevalence of selective mutism in kindergarten, first, and second-grade students in a school district in Los Angeles, yielded a prevalence rate of 0.71% [18].…”