Distinguishing selective mutism and social anxiety in children: a multi-method study.

Selective mutism (SM) is an anxiety disorder in which a child fails to speak in some situations (e.g., school) despite the ability to speak in other situations (e.g., home). Some work has conceptualized SM as a variant of social anxiety disorder (SAD) characterized by higher levels of social anxiety. Here, we empirically tested this hypothesis to see whether there were differences in social anxiety (SA) between SM and SAD across behavioral, psychophysiological, self-, parent-, and teacher-report measures. Participants included 158 children (Mage = 8.76 years, SD = 3.23) who were classified into three groups: children with SM and who were also highly socially anxious (SM + HSA; n = 48), highly socially anxious children without SM (HSA; n = 48), and control children (n = 62). Children participated in a videotaped self-presentation task, following which observed SA behaviors were coded, and salivary cortisol reactivity was measured. We also collected child, parent, and teacher reports of children's trait SA symptoms. The SM + HSA and HSA groups had similar observed non-verbal SA behavior, cortisol reactivity, and trait SA symptom levels according to parent and child reports, but SM + HSA children had significantly higher SA according to teacher report and observer-rated verbal SA behavior relative to the HSA group. As expected, control children had lower cortisol reactivity and SA across all measures relative to the other groups. Although SM and SAD in children share many similarities, SM may be characterized by greater SA in certain social contexts (e.g., school) and is distinguishable from SAD on behavioral measures of verbal SA.

Trajectories of Social Anxiety in Children: Influence of Child Cortisol Reactivity and Parental Social Anxiety.

Few studies have examined the interactive effect of intra- and extra-individual vulnerability factors on the trajectory of social anxiety in children. In this study, we examined the joint influence of familial vulnerability (i.e., parental social anxiety) and child biological stress vulnerability (i.e., cortisol reactivity) on trajectories of social anxiety. Children (N = 112 (57 males), M age = 8.14 years, S.D. = 2.25) were followed over three visits spanning approximately three years. Parental social anxiety was assessed using the Social Phobia and Anxiety Inventory, children's behavior and salivary cortisol reactivity were measured in response to a speech task, and children's social anxiety was assessed at all three visits using the Screen for Child Related Emotional Disorders (SCARED; Parent-report). A growth curve analysis was used to examine trajectories of child social anxiety as predicted by children's cortisol reactivity and parental social anxiety, adjusting for covariates. We found a significant interaction between parental social anxiety and child cortisol reactivity in predicting child social anxiety across time. Having a socially anxious parent coupled with heightened cortisol reactivity predicted the highest levels of child social anxiety, with scores that remained above clinically significant levels for social anxiety across all visits. Children with familial risk for social anxiety and who also exhibit high stress-reactivity appear to be at risk for persistent, clinically significant social anxiety. This highlights the importance of considering the interaction between both biological and contextual factors when considering the development, maintenance, and treatment of social anxiety in children across time.

Joint attention in parent-child dyads involving children with selective mutism: a comparison between anxious and typically developing children.

Although joint attention processes are known to play an important role in adaptive social behavior in typical development, we know little about these processes in clinical child populations. We compared early school age children with selective mutism (SM; n = 19) versus mixed anxiety (MA; n = 18) and community controls (CC; n = 26) on joint attention measures coded from direct observations with their parent during an unstructured free play task and two structured tasks. As predicted, the SM dyads established significantly fewer episodes of joint attention through parental initiation acts than the MA and CC dyads during the structured tasks. Findings suggest that children with SM may withdraw from their parents during stressful situations, thus missing out on opportunities for learning other coping skills. We discuss the implications of the present findings for understanding the maintenance and treatment of SM.

An investigation of control among parents of selectively mute, anxious, and non-anxious children.

The authors examined parent­child interactions among three groups: selectively mute, anxious, and non-anxious children in different contexts. The relation between parental control (granting autonomy and high power remarks), child factors (i.e., age, anxiety, verbal participation), and parent anxiety was investigated. Parental control varied by context but parents of children with SM were more controlling than parents in the comparison groups in all contexts. Regression analyses indicated that child and parent anxiety predicted parental control, with increased anxiety associated with increased control. Older child age predicted less parent control. Group categorization moderated the relation between age and high power remarks, such that age was not a significant predictor for children with SM. Finally child-initiated speaking predicted high power remarks over and above other variables. These results support previous theories that parents take over for their children when they fail to meet performance demands, especially when the child or parent is anxious.

Behavioral and socio-emotional functioning in children with selective mutism: a comparison with anxious and typically developing children across multiple informants.

We examined differences among 158 children, 44 with selective mutism (SM; M = 8.2 years, SD = 3.4 years), 65 with mixed anxiety (MA; M = 8.9 years, SD = 3.2 years), and 49 community controls (M = 7.7 years, SD = 2.6 years) on primary caregiver, teacher, and child reports of behavioral and socio-emotional functioning. Children with SM were rated lower than controls on a range of social skills, but the SM and MA groups did not significantly differ on many of the social skills and anxiety measures. However, children with SM were rated higher than children with MA and controls on social anxiety. Findings suggest that SM may be conceptualized as an anxiety disorder, with primary deficits in social functioning and social anxiety. This interpretation supports a more specific classification of SM as an anxiety disorder for future diagnostic manuals than is currently described in the literature. The present findings also have implications for clinical practice, whereby social skills training merits inclusion in intervention for children with anxiety disorders as well as children with SM.

Social phobia, anxiety, oppositional behavior, social skills, and self-concept in children with specific selective mutism, generalized selective mutism, and community controls.

We compared social phobia, anxiety, oppositional behavior, social skills, and self-concept in three groups: (1) 28 children with specific mutism (who did not speak to teachers but were more likely to speak to parents and peers at home and school); (2) 30 children with generalized mutism (whose speaking was restricted primarily to their homes); and (3) 52 community controls. Children with generalized mutism evidenced higher anxiety at school, and more separation anxiety, OCD, and depressive symptoms at home. Parents and teachers reported that the social phobia and anxiety scores of children in both the specific and generalized mutism subgroups were higher than controls. Children in both the specific and generalized mutism groups evidenced greater deficits in verbal and nonverbal social skills at home and school than controls. Teachers and parents did not report differences in nonverbal measures of social cooperation and conflict resolution and we found no evidence that selective mutism was linked to an increase in externalizing problems such as oppositional behavior or ADHD. Although children with specific mutism speak in a wider range of situations and appear less anxious to their teachers than children with generalized mutism, significant socially phobic behavior and social skills deficits are present in both groups.

The relationship between childhood physical abuse and suicidality among depressed women: results from a community sample.

OBJECTIVE: The aim of this study was to examine the distribution and determinants of suicidal ideation and suicide attempts in a community sample of women with major depressive disorder. Variables of interest included childhood physical abuse, individual and familial psychiatric history, and sociodemographic factors. METHOD: Women (age 15 to 64 years) from a community sample who met criteria for major depressive disorder (lifetime prevalence) (N=347) were assessed with a modified version of the Composite International Diagnostic Interview. Childhood physical abuse history was collected through a self-administered questionnaire. RESULTS: Approximately one-quarter (23.9%, N=83) of the women with major depressive disorder reported that they had made a suicide attempt, and more than half (55.6%, N=193) had experienced suicidal ideation. A history of suicide attempt was most strongly related to the number of comorbid psychiatric disorders (odds ratio=2.04, 95% confidence interval [CI]=1.21-3.43). Suicidal ideation was most strongly associated with a history of childhood physical abuse (odds ratio=2.77, 95% CI=1.26-6.12). CONCLUSIONS: Suicidal ideation and suicide attempts were reported frequently by women with a history of major depressive disorder. Correlates for suicide attempts showed some differences from those for ideation. This finding is of clinical importance, since it relates to the identification of individuals at risk for suicidal behavior.