ARTICLES
The Sounds of Silence: Language, Cognition, and Anxiety in Selective Mutism

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ABSTRACT

Objectives:

To determine whether oral language, working memory, and social anxiety differentiate children with selective mutism (SM), children with anxiety disorders (ANX), and normal controls (NCs) and explore predictors of mutism severity.

Method:

Children ages 6 to 10 years with SM (n = 44) were compared with children with ANX (n = 28) and NCs (n = 19) of similar age on standardized measures of language, nonverbal working memory, and social anxiety. Variables correlating with mutism severity were entered in stepwise regressions to determine predictors of mute behavior in SM.

Results:

Children with SM scored significantly lower on standardized language measures than children with ANX and NCs and showed greater visual memory deficits and social anxiety relative to these two groups. Age and receptive grammar ability predicted less severe mutism, whereas social anxiety predicted more severe mutism. These factors accounted for 38% of the variance in mutism severity.

Conclusions:

Social anxiety and language deficits are evident in SM, may predict mutism severity, and should be evaluated in clinical assessment. Replication is indicated, as are further studies of cognition and of intervention in SM, using large, diverse samples.

Section snippets

Sample

After obtaining approval from research ethics boards at all of the participating sites, the sample was recruited through specialized anxiety disorders clinics in three urban areas. Children were physician referred and from all socioeconomic classes, with some overrepresentation of more affluent relative to less affluent families (mean Hollingshead level II; minor professional) and of white families relative to other racial groups. There were no group differences in socioeconomic status or

Group Differences in Comorbidity, Severity, and Age

Twenty-seven of the children with SM also met criteria for social phobia, and these children had more severe social anxiety by maternal report (t = 2.94, p < .01), but not self-report, than those without social phobia. Additional comorbidities in this group included oppositional defiant disorder (three children) and specific phobia (one child). Seven children in the anxiety group had more than one disorder (all were anxiety disorders). The role of comorbidity was only examined in selectively

DISCUSSION

Although our findings are limited by small comparison groups and variability in age, the consistently poorer performance of the SM group on linguistic measures is striking. All three linguistic measures differentiated groups with children with SM performing worst. This difference remained significant for two of three measures even when covarying for performance IQ and socioeconomic level. This finding is consistent with data from our previous study and other studies reporting subtle language

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    This work was supported by a grant from the Ontario Mental Health Foundation.

    Disclosure: Dr. Manassis obtains royalties from her book Keys to Parenting Your Anxious Child, which was used in the clinical care of some participating children and families. The other authors have no financial relationships to disclose.

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