Silence and related symptoms in children and adolescents: a network approach to selective mutism

Abstract

Background Silence in certain situations represents the core symptom of selective mutism (SM). However, it is unclear what additional symptoms are part of this disorder. Although knowledge of symptoms is essential for diagnostics and intervention, to date, only scarce research exists on circumscribed symptoms of SM. Given the large overlap between SM and social anxiety disorder (SAD), it remains also unclear which symptoms can differentiate both disorders. Methods A network analysis of potential symptoms of SM was performed based on a mixed sample of N = 899 children and adolescents with and without indication of SM (n = 629 with silence in certain situations). In a preliminary analysis, we demonstrated that children with and without silence in certain situations do not differ with respect to their network structure, justifying an analysis on the entire mixed sample. Possible communities (symptom clusters) within the network and thus potential latent variables were examined, and symptoms were analyzed in terms of their centrality (the extent to which they are associated with other symptoms in the network). To investigate the differentiability of symptoms of the SM network from symptoms of SAD, we computed a network that additionally contains symptoms of SAD. Results In the resulting network on symptoms of SM, silence was, as expected, the symptom with the highest centrality. We identified two communities (symptom cluster): (1) symptoms associated with the fear response of freezing, (2) symptoms associated with speech production and avoidance. SM network symptoms and SAD symptoms largely formed two separate symptom clusters, with only selectivity of speaking behavior (more talkative at home and taciturn or mute outside the home) falling into a common cluster with SAD symptoms. Conclusions Silence appears to have been confirmed by analysis as a core symptom of SM. Additional anxiety-related symptoms, such as avoidance behavior or motor inhibition associated with freezing, seem to co-occur with silence. The two communities of SM potentially indicate different mechanisms of silence. The symptoms of SM appear to be distinguishable from those of SAD, although there seems to be overlap in terms of difficulty speaking in situations outside the home.

Narrative Exposure Therapy for Treating Post-Traumatic Stress Among Transgender Youth of Color With Selective Mutism

“…At the time, only transmasculine clients had presented with comorbid SM and PTSD symptoms. This may be aligned with prior research indicating greater prevalence of anxiety, and social anxiety specifically, among transmasculine individuals (Millet et al, 2017), which may increase likelihood of SM especially among those with higher anxiety and potentially with trauma exposure (Vogel et al, 2022;Wong, 2010). In general, modifications related to the intervention are further detailed in another publication (Julian et al, 2023) and are tailored based on the client's gender identity and experiences of gender-based trauma.…”

“…Selective mutism (SM) is a mental health condition characterized by total absence of speech in specific situations while present in other situations (e.g., absence of speech at school versus home settings). These symptoms must be present for at least 1 month and interfere with academic or occupational achievement and/or social functioning (APA, 2013; Vogel et al, 2022). SM generally presents during childhood and is relatively rare with international studies estimating prevalence between 0.18 and 1.9%, though these estimates are posited to be influenced by immigration status and bilingualism (Viana et al, 2009).…”

Symptoms of Selective Mutism in Middle Childhood: Psychopathological and Temperament Correlates in Non-clinical and Clinically Referred 6- to 12-year-old Children

“…The link between SM and social anxiety has been further substantiated by a recent study of Vogel et al [45] who conducted a network analysis of potential SM symptoms in a mixed sample of children and adolescents with and without an indication of SM (N = 899). These researchers noted that social anxiety symptoms seem to drive the SM symptom of 'selectivity of speaking', implying that socialevaluative fears to a large extent determine children's muteness or taciturnity outdoors (while being talkative at home).…”

“…Obviously, such a test goes beyond the fact that 'pure' psychiatric conditions in clinical practice rarely exist (e.g., a substantial proportion of the children with ASD will also display fear and anxiety symptoms) [51] but could still provide valuable insights in the driving forces of the phenomenon of selective nonspeaking in young people. Another viable method could be ecological momentary assessment: by repeatedly collecting data on children's emotions, thoughts, and behavior in daily life, we could gain more knowledge on the mechanisms underlying selective non-speaking (e.g., fear and anxiety versus social skill deficits/lack of social motivation/social cognitive impairments typically seen in ASD) [45].…”

Correcting for collider bias after conditioning on a sum score in the Ising model

“…In particular, edges were biased to be negative, so that some edges that were initially positive were set to zero, and spurious negative edges were estimated between some variables that were initially unrelated. Since de Ron et al, (2021) warned about the risk of selection bias after sum-score selection, researchers have either avoided using certain selection criteria (e.g., Vogel et al, 2022;Kuckertz et al, 2022) or mentioned selection bias as a possible limitation of their study (e.g., Xu et al, 2022;Wright et al, 2021). In this paper, we provide a more direct solution to this problem in the form of a correction for the case of the Ising model, which is a popular network model for binary data (Ising, 1925;Epskamp, 2017).…”