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Selective mutism — Clinical Guidelines

Overview

Selective mutism is a childhood anxiety disorder characterized by a persistent failure to speak in specific social situations despite normal language abilities in others 3.

Diagnosis

Persistent failure to speak in social situations despite ability to speak in others 3.

Often diagnosed based on clinical observation and parental/teacher reports 4.

No specific diagnostic tests; assessment involves ruling out other speech and language disorders 3.

Management

First-line treatments: Behavioral interventions such as shaping and modeling 3 6.

Adjunctive treatments: School consultations and environmental modifications 4.

Pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs) show potential benefit, particularly in severe cases 4.

Alternative approaches: Drama therapy integrated with behavioral shaping can be effective 3.

Special Populations

Pediatrics: Behavioral interventions are effective across various age groups, including preschoolers 3 6.

Comorbidities: No specific guidance provided in abstracts; treatment should address both selective mutism and comorbidities 4.

Key Recommendations

Implement behavioral interventions such as shaping and modeling as first-line treatments for selective mutism (Evidence: Strong 3 6).

Consider selective serotonin reuptake inhibitors (SSRIs) for children with severe selective mutism, especially when behavioral interventions alone are insufficient (Evidence: Moderate 4).

Integrate play-based approaches like drama therapy to enhance engagement and promote spontaneous speech (Evidence: Weak 3).

References

1 Ferreira CA, Atallah ÁN, Loureiro CAS. Detecting the extent of control over selection bias relating to oral health and otorhinolaryngology: cross-sectional study. Sao Paulo medical journal = Revista paulista de medicina 2020. link 2 Chao JY, Liu C, Shetty N, Shah U. Postoperative Pediatric Cerebellar Mutism After Posterior Fossa Surgery: A Case Report. A & A case reports 2017. link 3 Oon PP. Playing with Gladys: A case study integrating drama therapy with behavioural interventions for the treatment of selective mutism. Clinical child psychology and psychiatry 2010. link 4 Manassis K, Tannock R. Comparing interventions for selective mutism: a pilot study. Canadian journal of psychiatry. Revue canadienne de psychiatrie 2008. link 5 Steffen R, van Waes H. Elective mutism: effect of dental treatment with N2/O2-inhalation sedation: review and report of case. ASDC journal of dentistry for children 1999. link 6 Matson JL, Box ML, Francis KL. Treatment of elective mute behavior in two developmentally delayed children using modeling and contingency management. Journal of behavior therapy and experimental psychiatry 1992. link90039-l) 7 Lewkonia RM, Lin CC, Haslam RH. Selective IgA deficiency with 18q+ and 18q-- karyotypic anomalies. Journal of medical genetics 1980. link 8 Sluckin A. Children who do not talk at school. Child: care, health and development 1977. link

Selective mutism