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01-04-2016 | Original Article

The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study

Authors: Claudia Lang, Ziv Nir, Ayelet Gothelf, Shoshi Domachevsky, Lee Ginton, Jonathan Kushnir, Doron Gothelf

Published in: European Journal of Pediatrics | Issue 4/2016

Abstract

Selective mutism (SM) is a relatively rare childhood disorder and is underdiagnosed and undertreated. The purpose of the retrospective naturalistic study was to examine the long-term outcome of children with SM who were treated with specifically designed modular cognitive behavioral therapy (MCBT). Parents of 36 children who met diagnostic criteria of SM that received MCBT treatment were invited for a follow-up evaluation. Parents were interviewed using structured scales and completed questionnaires regarding the child, including the Selective Mutism Questionnaire (SMQ). Twenty-four subjects were identified and evaluated. Their mean age ± SD of onset of SM symptoms, beginning of treatment, and age at follow-up were 3.4 ± 1.4, 6.4 ± 3.1, and 9.3 ± 3.4 years, respectively. There was robust improvement from beginning of treatment to follow-up evaluation in SM, social anxiety disorder, and specific phobia symptoms. The recovery rate from SM was 84.2 %.

Conclusion: SM-focused MCBT is feasible in children and possibly effective in inducing long-term reduction of SM and comorbid anxiety symptoms.

What is Known:

• There are limited empirical data on selective mutism (SM) treatment outcome and specifically on cognitive-behavioral therapy, with the majority of studies being uncontrolled case reports of 1 to 2 cases each.

• There is also limited data on the long-term outcome of children with SM following treatment.

What is New:

• Modular cognitive behavioral treatment is a feasible and possibly effective treatment for SM. Intervention at a younger age is more effective comparing to an older age.

• Treatment for SM also decreases the rate of psychiatric comorbidities, including separation anxiety disorder and specific phobia.

Anstendig KD (1999) Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification. J Anxiety Disord 13:417–434CrossRefPubMed

Arie M, Henkin Y, Lamy D, Tetin-Schneider S, Apter A, Sadeh A, Bar-Haim Y (2007) Reduced auditory processing capacity during vocalization in children with selective mutism. Biol Psychiatry 61:419–421CrossRefPubMed

Association AP (2013) The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUS

Bergman RL, Gonzalez A, Piacentini J, Keller ML (2013) Integrated behavior therapy for selective mutism: a randomized controlled pilot study. Behav Res Ther 51:680–689CrossRefPubMed

Bergman RL, Keller ML, Piacentini J, Bergman AJ (2008) The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychol 37:456–464CrossRefPubMed

Bergman RL, Piacentini J, McCracken JT (2002) Prevalence and description of selective mutism in a school-based sample. J Am Acad Child Adolesc Psychiatry 41:938–946CrossRefPubMed

Black B, Uhde TW (1995) Psychiatric characteristics of children with selective mutism: a pilot study. J Am Acad Child Adolesc Psychiatry 34:847–856CrossRefPubMed

Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB, Voncken M (2010) Social anxiety disorder: questions and answers for the DSM‐V. Depress Anxiety 27:168–189CrossRefPubMed

Chorpita BF (2007) Modular cognitive-behavioral therapy for childhood anxiety disorders. Guilford Press, New York

10.

Chorpita BF, Taylor AA, Francis SE, Moffitt C, Austin AA (2004) Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behav Ther 35:263–287CrossRef

11.

Cohan SL, Chavira DA, Stein MB (2006) Practitioner review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005. J Child Psychol Psychiatry 47:1085–1097CrossRefPubMed

12.

Guy W (1976) Clinical global impression scale. The ECDEU Assessment Manual for Psychopharmacology-Revised Volume DHEW Publ No ADM 76 338:218–222

13.

Kolvin I, Fundudis T (1981) Elective mute children: psychological development and background factors. J Child Psychol Psychiatry 22:219–232CrossRefPubMed

14.

Kristensen H (2000) Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry 39:249–256CrossRefPubMed

15.

Kristensen H, Torgersen S (2001) MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case–control study. J Abnorm Psychol 110:648CrossRefPubMed

16.

Krohn DD, Weckstein SM, Wright HL (1992) A study of the effectiveness of a specific treatment for elective mutism. J Am Acad Child Adolesc Psychiatry 31:711–718CrossRefPubMed

17.

Kumpulainen K, Räsänen E, Raaska H, Somppi V (1998) Selective mutism among second-graders in elementary school. Eur Child Adolesc Psychiatry 7:24–29CrossRefPubMed

18.

Manassis K, Tannock R, Garland E, Minde K, McINNES A, Clark S (2007) The sounds of silence: language, cognition, and anxiety in selective mutism. J Am Acad Child Adolesc Psychiatry 46:1187–1195CrossRefPubMed

19.

Mitchell AD, Kratochwill TR (2013) Treatment of selective mutism: applications in the clinic and school through conjoint consultation. J Educ Psychol Consult 23:36–62CrossRef

20.

Monga S, Young A, Owens M (2009) Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depress Anxiety 26:243–250CrossRefPubMed

21.

Oerbeck B, Stein MB, Pripp AH, Kristensen H (2014) Selective mutism: follow-up study 1 year after end of treatment. Eur Child Adolesc Psychiatry 24:1–10

22.

Remschmidt H, Poller M, Herpertz-Dahlmann B, Hennighausen K, Gutenbrunner C (2001) A follow-up study of 45 patients with elective mutism. Eur Arch Psychiatry Clin Neurosci 251:284–296CrossRefPubMed

23.

Reuther ET, Davis TE III, Moree BN, Matson JL (2011) Treating selective mutism using modular CBT for child anxiety: a case study. J Clin Child Adolesc Psychol 40:156–163CrossRefPubMed

24.

Schwartz RH, Freedy AS, Sheridan MJ (2006) Selective mutism: are primary care physicians missing the silence? Clin Pediatr 45:43–48CrossRef

25.

Schwartz RH, Shipon-Blum E (2005) “Shy” child? Don’t overlook selective mutism. Contemp Pediatr 22:30

26.

Sluckin A, Foreman N, Herbert M (1991) Behavioural treatment programs and selectivity of speaking at follow-up in a sample of 25 selective mutes. Aust Psychol 26:132–137CrossRef

27.

Steinhausen HC, Wachter M, Laimböck K, Metzke CW (2006) A long‐term outcome study of selective mutism in childhood. J Child Psychol Psychiatry 47:751–756CrossRefPubMed

28.

Viana AG, Beidel DC, Rabian B (2009) Selective mutism: a review and integration of the last 15 years. Clin Psychol Rev 29:57–67CrossRefPubMed

Title: The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study
Authors: Claudia Lang
Ziv Nir
Ayelet Gothelf
Shoshi Domachevsky
Lee Ginton
Jonathan Kushnir
Doron Gothelf
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 4/2016
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-015-2651-0

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Springer Medicine

The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study

Abstract

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Abstract

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