Cover not available
Article published In:
Interaction Studies
Vol. 19:3 (2018) ► pp.445–458

Communicative, cognitive and emotional issues in selective mutism

A narrative review on elements of a multimodal intervention

| Uninettuno International University, Rome | Sapienza University of Rome
| Uninettuno International University, Rome | Sapienza University of Rome

Selective mutism (SM) is a developmental disorder characterized by a child’s inability to speak in certain contexts and/or in the presence of unfamiliar interlocutors. This work proposes a critical discussion of the most recent studies on SM, with respect to clinical and diagnostic features, as well as the etiology and treatment of this disorder. At present, all research work supports the hypothesis that SM is a complex anxiety disorder with multifactorial etiology (interaction among biological and environmental causes). The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) places SM mutism among “Anxiety Disorders”, and no longer among “Other Childhood, Infant and Adolescent Disorders” (as in DSM-IV). Other important aspects relate to cognitive biases and emotional states at the base of SM, which partly explain the disorder’s persistence and represent an important objective of intervention work. No data in the literature point to a total remission of SM, but good results are achieved with cognitive behavior intervention and multimodal therapy (MMT) involving a variety of child interaction contexts.

Keywords: selective mutism, social anxiety, diagnostic comorbidity, internalizing problems, cognitive-behavioral intervention, multimodal therapy
Article outline
  • 1.Introduction
  • 2.Identification and diagnosis
  • 3.Vulnerability conditions and associated issues
    • 3.1Comorbidity
  • 4.Thoughts, emotions and behavior
  • 5.Cognitive-behavioral strategies and integrated intervention
    • 5.1Other means of intervention
  • 6.Conclusions: Clinical and research reflections
  • References
Published online: 13 March 2019
DOI logo
https://doi.org/10.1075/is.17018.cap
References (51)
Albrigtsen, V., Eskeland, B., & Mæhle, M.
(2016) Ties of silence-Family lived experience of selective mutism in identical twins. Clinical child psychology and psychiatry, 21(2), 308–323. DOI logoGoogle Scholar
Ale, C. M., Mann, A., Menzel, J., Storch, E. A., & Lewin, A. B.
(2013) Two Cases of Early Childhood Selective Mutism. Clinical Case Studies, 12(4), 278–290. DOI logoGoogle Scholar
Alyanak, B., Kilinçaslan, A., Harmanci, H. S., Demirkaya, S. K., Yurtbay, T., & Vehid, H. E.
(2013) Parental adjustment, parenting attitudes and emotional and behavioral problems in children with selective mutism. Journal of Anxiety Disorders, 27(1), 9–15. DOI logoGoogle Scholar
American Psychiatric Association (APA)
(1980) Diagnostic and statistical manual of mental disorders (DSM-III, 3th edn., text revision). Washington, DC: American Psychiatric Association.Google Scholar
(2000) Diagnostic and statistical manual of mental disorders (DSM-IV, 4th edn., text revision). Washington, DC: American Psychiatric Association.Google Scholar
(2013) DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Publishing. DOI logoGoogle Scholar
Arie, M., Henkin, Y., Lamy, D., Tetin-Schneider, S., Apter, A., Sadeh, A., et al.
(2006) Reduced auditory processing capacity during vocalization in children with selective mutism. Biological psychiatry, 611, 419–421. DOI logoGoogle Scholar
Aron, E. N.
(2015) The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them. Danvers, MA: Harmony Books.Google Scholar
Barros, I., Lima, P., & Abramovitch, S.
(2012) Selective Mutism: A successfull case report. European Psychiatry, 271, 1.Google Scholar
Bartolomeo, L., Cerniglia, L. & Capobianco, M.
(2018) Empathy and theory of mind: Differences and interactions. [Empatia e teoria della mente: Una review narrativa su differenze e convergenze concettuali alla luce delle recenti scoperte neurobiologiche]. Ricerche di Psicologia. [ DOI logo].Google Scholar
Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L.
(2013) Integrated Behavior Therapy for Selective Mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51(10), 680–689. DOI logoGoogle Scholar
Bissoli, C.
(2007) Il mutismo selettivo. In L. Isola & F. Mancini (Eds), Psicoterapia cognitiva dell’infanzia dell’adolescenza. Milano: Franco Angeli.Google Scholar
Black, B. & Uhde, T. W.
(1995) Psychiatric Characteristics of Children with Selective Mutism: A Pilot Study. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 847–856. DOI logoGoogle Scholar
Capobianco, M.
(2009) Il Mutismo Selettivo: diagnosi, eziologia, comorbidità e trattamento, Cognitivismo Clinico, 6(2), 211–228.Google Scholar
(2010) Quando è difficile parlare: il caso di una bambina gemella di 10 anni affetta da mutismo selettivo. Cognitivismo clinico, 7(1), 3–19.Google Scholar
Capobianco, M. & Cerniglia, L.
(2017) Early language development in preterm children without neurological damage: a longitudinal study F1000Research 2017, 61:2169 ( DOI logo).Google Scholar
Capobianco, M., Pizzuto, E. & Devescovi, A.
(2017) Gesture-speech combinations and early verbal abilities new longitudinal data during the second year of age. Interaction Studies, 18:1, 55–76 (22)[ DOI logo].Google Scholar
Capobianco, M. & Cerniglia, L.
(2018) Case Report: Evaluation strategies and cognitive intervention: the case of a monovular twin child affected by selective mutism. F1000Research 2018, 7:221 [ DOI logo]Google Scholar
Capozzi, F., Manti, F., Sirchia, V., & Piperno, F.
(2012) Il Mutismo Selettivo. Roma: Giovanni Fioriti Editore.Google Scholar
Carpenter, A. L., Puliafico, A. C., Kurtz, S. M., Pincus, D. B., & Comer, J. S.
(2014) Extending parent-child interaction therapy for early childhood internalizing problems: new advances for an overlooked population. Clinical Child and Family Psychology Review, 17(4), 340–356. DOI logoGoogle Scholar
Cavarra, M., Brizio, A., & Gava, N.
(2017) Ericksonian hypnotherapy for selective mutism: A single-case study. Acta Biomed, 87(3), 299–309.Google Scholar
Christon, L. M., Robinson, E. M., Arnold, C. C., Lund, H. G., Vrana, S. R., & Southam-Gerow, M. A.
(2012) Modular Cognitive-Behavioral Treatment of an Adolescent Female With Selective Mutism and Social Phobia. Clinical Case Studies, 11(6), 474–491. DOI logoGoogle Scholar
Cimino, S., Cerniglia, L., Dentale, F., Capobianco, M. & Tambelli, R.
(2018) Maternal symptoms of depression and paranoid ideation can be predictive of the onset of eating disorders in early adolescents offspring: A nine – year longitudinal study. International journal of Psychology and Psychological Therapy. 18: 2, (221–234).Google Scholar
Conn, B., & Coyne, L.
(2014) Selective Mutism in Early Childhood: Assessment and Treatment of an African American Preschool Boy. Clinical Case Studies, 13(6), 487–500. DOI logoGoogle Scholar
Crocq, M. A.
(2015) A history of anxiety: from Hippocrates to DSM. Dialogues in Clinical Neuroscience, 17(3), 319–325. DOI logoGoogle Scholar
Cucinotta, F., Maggio, R., Gagliano, M., Venuti, M., & Gagliano, A.
(2014) Good practices in bilingual children. Italian Journal of Pediatrics, 40(Suppl. 1), A80. DOI logoGoogle Scholar
D’Ambrosio, M.
(2015) Alle origini del mutismo selettivo: un’ipotesi di disfunzione autonomica. I care, 40(4), 137–144.Google Scholar
DeMille, L.
(2013) “Psychic Twins”: A Psycho-Dynamically Informed Treatment of a Selectively Mute Adolescent and Her Mother – Part II, Journal of Infant, Child & Adolescent Psychotherapy, 12(4), 321–335. DOI logoGoogle Scholar
Di Meo, S., Van Den Hove, C., Serre-Pradere, G., Simon, A., Rezzoug, D., Moro, M., & Baubet, T.
(2015) Selective mutism among children of migrants. Sandia’s silence. European Child & Adolescent Psychiatry, 241, S16–S16.Google Scholar
Diliberto, R. A., & Kearney, C. A.
(2016) Anxiety and oppositional behavior profiles among youth with selective mutism. Journal of Communication Disorders, 591, 16–23. DOI logoGoogle Scholar
Esposito, M., Precenzano, F., Ruberto, M., & Carotenuto, M.
(2015) Efficacy and Safety of Psychomotor Approach in Children Affected by Selective Mutism: A Multicenter Study in Italian Pediatric Population. International Journal of Psychology & Behavior Analysis, 1(2), 107. DOI logoGoogle Scholar
Fernandez, K. T. G., & Sugay, C. O.
(2016) Psychodynamic play therapy: A case of selective mutism. International Journal of Play Therapy, 25(4), 203–209. DOI logoGoogle Scholar
Gensthaler, A., Khalaf, S., Ligges, M., Kaess, M., Freitag, C. M., & Schwenck, C.
(2016) Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar. European Child & Adolescent Psychiatry, 25(10), 1–8. DOI logoGoogle Scholar
Hassan, G. A. M., Taha, G. R. A., Mahmoud, A., & Azzam, H.
(2013) Selective mutism and social anxiety disorders: are they two faces of the same coin? Middle East Current Psychiatry, 20(3), 156–163. DOI logoGoogle Scholar
Henkin, Y., & Bar-Haim, Y.
(2015) An auditory-neuroscience perspective on the development of selective mutism. Developmental Cognitive Neuroscience, 121, 86–93. DOI logoGoogle Scholar
Johnson, M., & Wintgens, A.
(2016) The selective Mutism Resource Manual (2° ed). London: Speechmark.Google Scholar
Katkin, Y.
(2015) Book review: Smith BR and Sluckin A (eds) (2014) Tackling selective mutism: A guide for professionals and parents, Child Language Teaching and Therapy, 31(2), 258–259. DOI logoGoogle Scholar
Klein, E. R., Armstrong, S. L., Skira, K., & Gordon, J.
(2017) Social Communication Anxiety Treatment (S-CAT) for children and families with selective mutism: A pilot study. Clinical Child Psychology and Psychiatry, 22(1), 90–108. DOI logoGoogle Scholar
Kristensen, H.
(2000) Selective Mutism and Comorbidity With Developmental Disorder/Delay, Anxiety Disorder, and Elimination Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 39(2), 249–256. DOI logoGoogle Scholar
Lang, C., Nir, Z., Gothelf, A., Domachevsky, S., Ginton, L., Kushnir, J., & Gothelf, D.
(2016) The outcome of children with selective mutism following cognitive behavioral intervention: a follow-up study. European Journal of Pediatrics, 175(4), 481–487. DOI logoGoogle Scholar
Le Pichon, E., & de Jonge, M.
(2016) Linguistic and Psychological Perspectives on Prolonged Periods of Silence in Dual-Language Learners. International Journal of Bilingual Education and Bilingualism, 19(4), 426–441. DOI logoGoogle Scholar
Manassis, K., Oerbeck, B., & Overgaard, K. R.
(2016) The use of medication in selective mutism: a systematic review. European Child & Adolescent Psychiatry, 25(6), 571–578. DOI logoGoogle Scholar
Mulligan, C. A., Hale, J. B., & Shipon-Blum, E.
(2015) Selective Mutism: Identification of Subtypes and Implications for Treatment. Journal of Education and Human Development, 4(1), 79–96. DOI logoGoogle Scholar
Muris, P., Hendriks, E., & Bot, S.
(2016) Children of Few Words: Relations Among Selective Mutism, Behavioral Inhibition, and (Social) Anxiety Symptoms in 3- to 6-Year-Olds. Child Psychiatry & Human Development, 471, 94–101. DOI logoGoogle Scholar
Muris, P., & Ollendick, T. H.
(2015) Children Who are Anxious in Silence: A Review on Selective Mutism, the New Anxiety Disorder in DSM-5. Clinical Child and Family Psychology Review, 8(2), 151–169. DOI logoGoogle Scholar
Omdal, H.
(2015) Tackling selective mutism: a guide for professionals and parents. European Journal of Special Needs Education, 30(3), 424–426. DOI logoGoogle Scholar
Overgaard, K., Oerbeck, B., & Kristensen, H.
(2015) Selective Mutism: Diagnosis of SM Prevalence of SM and comorbid social phobia 4–6 years after treatment completion and diagnostic challenges. European Child & Adolescent Psychiatry, 241, S42–S42.Google Scholar
Remschmidt, H., Poller, M., Herpertz-Dahlmann, B., Hennighausen, K., & Gutenbrunner, C.
(2001) A follow-up study of 45 patients with elective mutism. European Archives of Psychiatry and Clinical Neuroscience, 251(6), 284–296. DOI logoGoogle Scholar
Smith, B. R., & Sluckin, A.
(Eds.) (2014) Tackling selective mutism: A guide for professionals and parents. London, UK : Jessica Kingsley.Google Scholar
Steinhausen, H. C. & Juzi, C.
(1996) Elective Mutism: An Analysis of 100 Cases. Journal of the American Academy of Child & Adolescent Psychiatry, 35(5), 606–614. DOI logoGoogle Scholar
Cited by (4)

Cited by 4 other publications

Capobianco, Micaela & Alberto Costa
2024. Selective Mutism and Comorbidity with Specific Learning Disorders: Evaluation and Multimodal Intervention in a Clinical Case of a Female Child from 7 to 11 Years of Age. Children 11:6 ► pp. 746 ff. DOI logo
Steains, Sophie Y., John M. Malouff & Nicola S. Schutte
2021. Efficacy of psychological interventions for selective mutism in children: A meta‐analysis of randomized controlled trials. Child: Care, Health and Development 47:6 ► pp. 771 ff. DOI logo
Capobianco, Micaela & Luca Cerniglia
2020. Coarticolazione temporale nelle combinazioni di gesti e parole: dati longitudinali in bambini nati a termine e pretermine nei primi due anni di età. RICERCHE DI PSICOLOGIA :2 ► pp. 547 ff. DOI logo
Cerniglia, Luca, Letizia Bartolomeo, Micaela Capobianco, Sara Lucia M. Lo Russo, Fabiana Festucci, Renata Tambelli, Walter Adriani & Silvia Cimino
2019. Intersections and Divergences Between Empathizing and Mentalizing: Development, Recent Advancements by Neuroimaging and the Future of Animal Modeling. Frontiers in Behavioral Neuroscience 13 DOI logo

This list is based on CrossRef data as of 4 july 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.