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

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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.

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Abbreviations

ADHD:

Attention deficit hyperactivity disorder

ADIS-IV-L:

Anxiety disorders interview schedule for DSM-IV: Lifetime version

MCBT:

Modular cognitive behavior treatment

CGI:

Clinical global impression

CGI-I:

Clinical global of impression—improvement scale

CGI-S:

Clinical global of impressions—severity scale

DSM-IV:

Diagnostic and statistics manual IV

DSM-IV-TR:

Diagnostic and statistics manual IV—text revision

ODD:

Oppositional defiant disorder

SAD:

Social anxiety disorder

SCARED:

Screen for child anxiety related emotional disorders

SD:

Standard deviation

SM:

Selective mutism

SMQ:

Selective mutism questionnaire

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Acknowledgments

We would like to thank the children and parents for participating in our treatment study.

Authors’ contributions

Claudia Lang administered the treatment protocol,

Ziv Nir and Shoshi Domachevsky carried out the evaluations and administered the questionnaires.

Claudia Lang, Ayelet Gothelf, Lee Ginton, Jonathan Kushnir, and Doron Gothelf managed the literature search and statistical analyses

Ziv Nir and Claudia Lang wrote the first draft of the manuscript, and Ayelet Gothelf, Lee Ginton, Jonathan Kushnir, and Doron Gothelf assisted in further preparation of the manuscript.

All authors contributed to and have approved the final version of the manuscript.

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Author notes

    Authors and Affiliations

    1. The Anxiety Clinic at the Child Psychiatry Unit, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, 52621, Israel

      Claudia Lang, Shoshi Domachevsky, Jonathan Kushnir & Doron Gothelf

    2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

      Ziv Nir, Ayelet Gothelf & Doron Gothelf

    3. The Interdisciplinary Center, Herzliya, Israel

      Shoshi Domachevsky & Jonathan Kushnir

    4. The Psychology Department, Boston University, Boston, MA, USA

      Lee Ginton

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    1. Claudia Lang
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    Correspondence to Doron Gothelf.

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    The authors declare that they have no competing interests.

    Additional information

    Communicated by Jaan Toelen

    Revisions received: 02 July 2015; 16 September 2015

    This work was performed in partial fulfillment of the M.D. thesis requirements of the Sackler Faculty of Medicine Tel Aviv University.

    Claudia Lang and Ziv Nir contributed equally to this paper.

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    Lang, C., Nir, Z., Gothelf, A. et al. The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study. Eur J Pediatr 175, 481–487 (2016). https://doi.org/10.1007/s00431-015-2651-0

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    • DOI: https://doi.org/10.1007/s00431-015-2651-0

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