DOCSLIB.ORG

Children with Autism Spectrum Disorders and Selective Mutism

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Children with Autism Spectrum Disorders and Selective Mutism Journal name: Neuropsychiatric Disease and Treatment Article Designation: ORIGINAL RESEARCH Year: 2018 Volume: 14 Neuropsychiatric Disease and Treatment Dovepress Running head verso: Steffenburg et al Running head recto: Are ASDs comorbid in SM open access to scientific and medical research DOI: 154966 Open Access Full Text Article ORIGINAL RESEARCH Children with autism spectrum disorders and selective mutism Hanna Steffenburg Background: It has been suggested that autism spectrum disorder (ASD) might be a “comorbid” Suzanne Steffenburg condition in selective mutism (SM). Christopher Gillberg Methods: In this retrospective study, we examined medical records of children with SM Eva Billstedt diagnosis (n=97) at a medical center specializing in assessment of ASD. Results: Mean age for onset of SM symptoms was 4.5 years and mean age at SM diagnosis Gillberg Neuropsychiatry Centre, Institute of Neuroscience was 8.8 years. SM was more common among girls (boy:girl ratio=2.7:1). We found that 63% and Physiology, University of the study group had an ASD (no gender difference). The SM group with combined ASD had of Gothenburg, Sahlgrenska later onset of symptoms, higher age at diagnosis, more often a history of speech delay, and a Academy, Gothenburg, Sweden higher proportion of borderline IQ or intellectual disability. Conclusion: The results highlight the risk of overlap between ASD and SM. Keywords: selective mutism, autism spectrum disorders, Asperger syndrome, autistic disorder For personal use only. Introduction Selective mutism (SM) is described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) and Fifth edition (DSM-5) as a rare anxiety disor- der, characterized by a consistent failure to speak in specific social situations in which there is an expectation of speaking, despite speaking in other situations1,2 (Americal Psychological Association 1994; 2013). In 1877, Kussmaul described SM and he used the term aphasia voluntaria to underline the awareness and the free will not to speak.3 In 1934, Tramer3 introduced the concept of elective mutism that continued emphasiz- ing the voluntariness in not speaking in certain situations. Throughout its history, SM has been described as an oppositional trait with an unwillingness to speak rather than a single diagnosis.3 In the publication of DSM-IV,1 the diagnosis of SM was included, Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 54.70.40.11 on 21-Dec-2018 which underlines the lack of speech in certain situations. The shift broadened the diag- nosis phenomenology, from a voluntarily controlled and defiant behavior to a pattern of reaction in response to an overwhelming or threatening context change.4 The failure to speak cannot be explained by lack of language skills. The duration of disturbance should be at least 1 month. The disorder should not be categorized as a communication disorder, pervasive developmental disorder (PDD), schizophrenia, or other psychotic disorder.1,2 In the DSM-5, SM is categorized under the category of Anxiety Disorders, and this marks an increased focus on supposed underlying social anxiety problems. Correspondence: Eva Billstedt Communication patterns in SM vary from total absence of speech in almost all Gillberg Neuropsychiatry Centre, situations to lack of speech in only certain situations. The most common situations University of Gothenburg, Kungsgatan 12, Gothenburg 411 19, Sweden for the appearance of SM symptoms are in school, where the teacher is the person Tel +46 31 342 5980 that the child is least likely to talk to.5 Sometimes the child can talk to select students, Fax +46 31 342 5979 Email [email protected] sometimes to nobody at all. Commonly, the child speaks normally at home with the submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2018:14 1163–1169 1163 Dovepress © 2018 Steffenburg et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you http://dx.doi.org/10.2147/NDT.S154966 hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Steffenburg et al Dovepress family, but the opposite situation, where the child speaks at Participants and methods school but not at home, has also been described.6 Procedure Onset of SM symptoms is reported to be 2.7–4.1 years.4 All individuals at the Child Neuropsychiatry Clinic (CNC) Usually, the symptoms are not noticed until the child starts in Gothenburg who had received a DSM-IV diagnosis of SM primary school, which might be explained by the increased between 2003 and 2014 were eligible for participation in the social demand and increased demands for performance, study. CNC is a regional clinic in Gothenburg, West Sweden, making the symptoms more obvious.3 The long interval focusing on the assessment of neurodevelopmental disorders between symptom onset and detection of problems is prob- (autism, ADHD, Tourette syndrome, etc), and at that period ably explained by the fact that children often speak without also on the assessment of SM, in children and adolescents. any problem in the home environment. All data were retrieved from medical records including the The reported prevalence rates vary between 0.2% and diagnosis, except for in some cases where there was an ASD 0.8%.4,7–9 SM is reported to be more common among girls diagnostic re-evaluation based on the medical records at the than boys, with an estimated girl:boy ratio varying between time of the study, by the second author SZ, who was the 2.6:1 and 1.5:1.3 SM is described as a condition in children clinical doctor for a large proportion of the study group. The but can also be recognized in adults; however, the symptoms time period was chosen to coincide with the introduction of are more often categorized as social phobia,3 under the a computerized medical record system at the CNC in 2003, anxiety disorders umbrella. A few longitudinal studies of making data retrieval easier. SM have been performed and the persistence of symptoms varies in the literature, from months to several years. There Participants is usually remaining shyness; social anxiety;3 and lack of One hundred and six individuals were diagnosed as having self-confidence, independence, achievement, and social com- SM during the selected time period at the CNC. Nine indi- munication abilities into teenage and adult life.6,10 viduals (4 girls and 5 boys) were excluded because there was In addition to anxiety, other associated symptoms/comor- some uncertainty about diagnosis or because the medical For personal use only. bidities have also been reported, such as speech and language records contained too scanty information, leaving a total of problems,11,12 obsessive compulsive disorder,13 Fragile X 97 individuals (71 girls and 26 boys) who were included in syndrome,6 attention deficit hyperactivity disorder (ADHD),4 the study. The age at assessment in the CNC ranged from depression, panic disorder, disassociate disorders, and other 4 to 18 years (median=8 years). somatic complaints.3 Kristensen reported an association between SM and developmental disorders relating to commu- The clinical/diagnostic assessment nication, learning, motor skills in a study of 54 children with The clinical/diagnostic assessments had been performed by a SM. She found that 7% of the participants also fulfilled the team that included a medical doctor/child psychiatrist and a criteria for Asperger syndrome (AS), and an additional 7% met clinical psychologist at CNC, both with extensive experience the criteria for mild intellectual disability (ID).12 Anderson and in the field of SM and ASD, including diagnostic work-up. The Thomsen14 found in a group of 37 children with SM that 4 of diagnoses were based on all the available information provided Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 54.70.40.11 on 21-Dec-2018 them had AS. Furthermore, autism spectrum disorder (ASD) by the files, the clinical interview, and the clinical impression has been found to occur more frequently in SM families.14 according to the LEAD-principle (Longitudinal, Expert, All, The purpose of the present study was to examine the Data).16 All individuals were examined individually, and at prevalence of ASD in a relatively large clinical sample of least 1 parent was interviewed. The interview always cov- children with SM who were referred to a center specializing ered language development, onset of SM symptoms, age at in the assessment of neurodevelopmental disorders. Further- diagnosis, and whether or not the child had been exposed to more, a study on joint attention, a specific aspect of social a non-Swedish language environment at home. The clinical communication, reported fewer episodes of joint attention assessment procedure included instruments regularly used in in the SM group than in comparison group.15 More girls clinical practice, such as DSM-IV checklists, parent/teacher than boys are affected by SM;3 however, if that is the case in questionnaires
Load more

Recommended publications
  • Neuropsychological Aspects of Frontal Lobe Epilepsy
    Neuropsychological aspects of frontal lobe epilepsy. Dominic Upton, Doctor of Philosophy. Institute of Neurology. University of London. LONDON, WON 36G ROCKEFELLER MEOICAL LIBRARY INSTITUTE OF NEUROLOGY THE NATIONAL HOSPITAL QUEEN SQUARE, LONDON, WCIN 33G CLASS ACCN No. d a t e W c ProQuest Number: 10017771 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10017771 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract. This study sought to increase our understanding of the neuropsychological consequences of frontal lobe epilepsy and surgery for this condition. In so doing, some suggestions were made on the role of the frontal lobes, and ways of assessing possible dysfunction in this area. The performance of a large group of subjects with clearly defined frontal lobe epilepsy (n=74), was examined on a comprehensive battery of neuropsychological measures. The performance of this group was compared to a control group of subjects with clearly defined temporal lobe epilepsy (n=57). There were few consistent group differences in test performance. Neither were there any strong relationships between test scores and epilepsy related variables.
    [Show full text]
  • Co-Morbidities and Dementia
    VOLUME 21 ISSUE 1 SPRING- SUMMER 2011 Published by the National Association of Professional Geriatric Care of Managers 3275 West Ina Road Suite 130 Tucson, Arizona Geriatric Care Management 85741 520.881.8008 / phone 520.325.7925 / fax www.caremanager.org Co-Morbidities and Dementia Guest Editor’s Message .............................................................................2 By Karen Knutson, MSN, MBA Dementia, Diabetes, Hypertension, and Alcohol Abuse: A Case Study of Medical Co-morbidities ....................................................3 By Karen Knutson, MSN, MBA Alzheimer’s Disease Co-morbidities ............................................................7 By M. Reza Bolouri, M.D. Frontal Lobe Disorders and Dementia.........................................................9 By Patricia Gross, Ph.D., ABPP-CN A Different Dementia: Different Challenges ...............................................13 By Sharon Mayfield, BSN of Geriatric Care Management Spring/Summer 2011 Guest Editor’s Message Coordinating the Complex Care of Clients with Dementia and Co-Morbidities By Karen Knutson, MSN, MBA, RN Care managers play a pivotal role in in psychiatric classification, co- options available for our clients? coordinating the care of their clients. morbidity does not necessarily imply Selected articles have been chosen As people live longer, the complexity the presence of multiple diseases, to provide more understanding of of life will continue and the increasing but rather an inability of a single the co-morbidities associated with prevalence of chronic disease will diagnosis to account for all of the dementia. Hopefully you will find pose many challenges for coordinating individual’s symptoms. new insights and approaches to such complex care. While the experts hash out integrate into your practice. In health care, co-morbidity is definitions of co-morbidity there The first article which I authored, defined in two different ways.
    [Show full text]
  • DEVELOPMENTAL DELAYS and REGRESSIONS Selective Mutism
    CHALLENGING CASE: DEVELOPMENTAL DELAYS AND REGRESSIONS Selective Mutism* CASE Dr. Martin T. Stein Peter’s parents made an appointment with his pe- Selective mutism is an acquired disorder of inter- diatrician because of their increasing concern about personal communication in which a child does not his refusal to speak. After approximately 2 weeks speak in one or more environments where commu- following the start of a new preschool, Peter, 4 years nication typically occurs. These children most often 10 months old, refused to speak to other children or refuse to speak in school and to adults outside the the teacher. During the first week of school, he found home. Some children with selective mutism will not it difficult to separate from his mother or father. He speak to any child; others will use speech with only would cry and cling to them while asking to go a few other children. Parents report normal speech home. This difficult separation experience gradually within the home with at least one parent and some- subsided by the beginning of the third week and times with siblings. The onset of selective mutism is corresponded with the onset of mute behavior. At usually in the preschool or early school age period of home, he spoke only to his mother, with a clear development; often, it is associated with the start of speech pattern and full sentences. He limited his school. responses to his father or two older siblings with Although this disorder is uncommon (1% among body gestures. He appeared to hear well and under- children seen in mental health centers; 0.1% in the stand verbal directions.
    [Show full text]
  • WHAT Is Selective Mutism?
    WHAT is Selective Mutism? A GUIDE to Helping Parents, Educators and Treatment professionals Understand Selective Mutism as a Social Communication Anxiety Disorder Do you know a child who is mute, barely whispers to few others in school or other social settings, but is able to speak when comfortable such as at home? If so, this child may be suffering from Selective Mutism. “Copyright © [2013] Dr. Elisa Shipon-Blum and Selective Mutism Anxiety Research and Treatment Center, Inc. (SMart Center) – www.selectivemutismcenter.org. 215-887-5748 [email protected] All rights reserved. Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate in a socially appropriate manner in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure and relaxed, such as at home. To meet the diagnostic criteria for Selective Mutism (SM) a child has to be able to speak in at least one setting and be mute in at least one other setting. The typical presentation is the ‘timid’ child who can speak and act socially appropriate with family members, close peers and very familiar relatives, yet is mute or barely whispers to a few others in school or perhaps when addressed in public settings such as restaurants or stores More than 90% of children with Selective Mutism also have social anxiety. This disorder is quite debilitating and painful to the child. Children and adolescents with Selective Mutism have an actual FEAR of speaking and of social interactions where there is an expectation to speak and communicate.
    [Show full text]
  • THE CLINICAL ASSESSMENT of the PATIENT with EARLY DEMENTIA S Cooper, J D W Greene V15
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2005.081133 on 16 November 2005. Downloaded from THE CLINICAL ASSESSMENT OF THE PATIENT WITH EARLY DEMENTIA S Cooper, J D W Greene v15 J Neurol Neurosurg Psychiatry 2005;76(Suppl V):v15–v24. doi: 10.1136/jnnp.2005.081133 ementia is a clinical state characterised by a loss of function in at least two cognitive domains. When making a diagnosis of dementia, features to look for include memory Dimpairment and at least one of the following: aphasia, apraxia, agnosia and/or disturbances in executive functioning. To be significant the impairments should be severe enough to cause problems with social and occupational functioning and the decline must have occurred from a previously higher level. It is important to exclude delirium when considering such a diagnosis. When approaching the patient with a possible dementia, taking a careful history is paramount. Clues to the nature and aetiology of the disorder are often found following careful consultation with the patient and carer. A focused cognitive and physical examination is useful and the presence of specific features may aid in diagnosis. Certain investigations are mandatory and additional tests are recommended if the history and examination indicate particular aetiologies. It is useful when assessing a patient with cognitive impairment in the clinic to consider the following straightforward questions: c Is the patient demented? c If so, does the loss of function conform to a characteristic pattern? c Does the pattern of dementia conform to a particular pattern? c What is the likely disease process responsible for the dementia? An understanding of cognitive function and its anatomical correlates is necessary in order to ascertain which brain areas are affected.
    [Show full text]
  • Dementia and Aphasia in Motor Neuron Disease: an Underrecognised Association?
    J Neurol Neurosurg Psychiatry 1998;65:881–889 881 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.65.6.881 on 1 December 1998. Downloaded from Dementia and aphasia in motor neuron disease: an underrecognised association? Wojtek P Rakowicz, John R Hodges Abstract predominantly sporadic, cases have subse- Objectives—To determine the prevalence quently been found in western countries.6–9 and nature of global cognitive dysfunction The most common pattern of cognitive and language deficits in an unselected decline in MND is a progressive dementia of population based cohort of patients with the frontal lobe type.10 It is unclear whether this motor neuron disease (MND). MND-frontal lobe dementia syndrome consti- Methods——A battery of neuropsycho- tutes the extreme end of a range of disease or logical and language tests was adminis- alternatively whether it represents a separate tered to patients presenting consecutively nosological entity. Whereas some early studies overa3yearperiodtoaregional neurol- which looked for intermediate degrees of ogy service with a new diagnosis of cognitive dysfunction in clinically non- sporadic motor neuron disease. demented patients with MND found no evidence of widespread impairment,11 others Results—The 18 patients could be divided reported poor performance in isolated tests of on the basis of their performance into 12 13 three groups: Three patients were de- memory or concentration. The emerging picture is of consistent abnormalities on tests of mented and had impaired language func- so-called “frontal executive” function, most tion (group 1); two non-demented patients notably decreased verbal fluency, aVecting a had an aphasic syndrome characterised large proportion of non-demented patients with Y by word finding di culties and anomia MND.
    [Show full text]
  • 1 Serious Emotional Disturbance (SED) Expert Panel
    Serious Emotional Disturbance (SED) Expert Panel Meetings Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ) September 8 and November 12, 2014 Summary of Panel Discussions and Recommendations In September and November of 2014, SAMHSA/CBHSQ convened two expert panels to discuss several issues that are relevant to generating national and State estimates of childhood serious emotional disturbance (SED). Childhood SED is defined as the presence of a diagnosable mental, behavioral, or emotional disorder that resulted in functional impairment which substantially interferes with or limits the child's role or functioning in family, school, or community activities (SAMHSA, 1993). The September and November 2014 panels brought together experts with critical knowledge around the history of this federal SED definition as well as clinical and measurement expertise in childhood mental disorders and their associated functional impairments. The goals for the two expert panel meetings were to operationalize the definition of SED for the production of national and state prevalence estimates (Expert Panel 1, September 8, 2014) and discuss instrumentation and measurement issues for estimating national and state prevalence of SED (Expert Panel 2, November 12, 2014). This document provides an overarching summary of these two expert panel discussions and conclusions. More comprehensive summaries of both individual meetings’ discussions and recommendations are found in the appendices to this summary. Appendix A includes a summary of the September meeting and Appendix B includes a summary of the November meeting). The appendices of this document also contain additional information about child, adolescent, and young adult psychiatric diagnostic interviews, functional impairment measures, and shorter mental health measurement tools that may be necessary to predict SED in statistical models.
    [Show full text]
  • Read the 2013 PSHA Journal
    1 PSHA JOURNAL ANNUAL PUBLICATION OF THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION DECEMBER 2013 EDITION 2 JOURNAL IS AN ANNUAL PUBLICATION OF THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION 700 McKnight Park Drive, Suite 708 Pittsburgh, PA 15237 412.366.9858 (Phone) 412.366.8804 (Fax) [email protected] THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION (PSHA), FOUNDED IN 1960, IS A PROFESSIONAL ORGANIZATION OF SPEECH-LANGUAGE PATHOLOGISTS, AUDIOLOGISTS, AND TEACHERS OF THE HEARING-IMPAIRED. AS SUCH, PSHA: Serves as a liaison between the American Speech-Language-Hearing Association and its Pennsylvania members. Represents its’ members interests in legislative affairs. Recommends standards for training and practices. Provides information about effective services and programs and services in communication disorders and other related fields. Works to inform the public about the professions, careers, programs, and services in the field of communication disorders. Encourages basic scientific study of the process of individual human communication. Monitors state Licensure Board activities. 2013-2014 PSHA EXECUTIVE BOARD PRESIDENT: Kathleen Helfrich-Miller PRESIDENT-ELECT: Amy Goldman PAST PRESIDENT: Craig Coleman VICE-PRESIDENT – PROFESSIONAL PRACTICE (SPEECH-LANGUAGE PATHOLOGY): Susan Hough VICE-PRESIDENT – PROFESSIONAL PRACTICE (AUDIOLOGY/EDUCATION): Jennifer Rakers VICE-PRESIDENT – PROFESSIONAL PREPARATION/CONTINUING EDUCATION: Joan Luckhurst VICE-PRESIDENT – MEMBERSHIP/ETHICAL PRACTICES: Nancy Carlino VICE-PRESIDENT – PUBLIC INFORMATION/PROFESSIONAL COMMUNICATION: Eileen Cirelli VICE-PRESIDENT – CONVENTION PLANNING/PROGRAMMING: Mary Beth Mason-Baughman VICE-PRESIDENT – GOVERNMENTAL RELATIONS: Caterina Stalteri VICE-PRESIDENT – PUBLICATIONS/EDITOR: Cheryl Gunter SECRETARY: Emily Katzaman TREASURER: Hunter Manasco Ex Officio STUDENT REPRESENTATIVE: Kathryn Young BUSINESS MANAGER: Diane Yenerall ACCOUNT MANAGER: Amy Caye 3 JOURNAL EDITOR Cheryl D. Gunter, Ph.D.
    [Show full text]
  • Paranoid – Suspicious; Argumentative; Paranoid; Continually on the Lookout for Trickery and Abuse; Jealous; Tendency to Blame Others; Cold and Humorless
    Personality Disturbance Gathering, nr.49 (key to possible disturbances) Every person may be used only once, except “by proxy” will overlap another person/condition, and there is one condition which will not be assigned to characters. 1. Agoraphobia – Fear of being out in the open or in public places; nervous; anxious 2. Autophobia/Monophobia – Extreme dislike or anger of oneself, or of an ethnic group from which one descends. 3. Anti-Social Personality Disorder – Failure to conform to societal norms; lack of remorse or indifferent; impulsivity or failure to plan ahead; consistent irresponsibility; deceitfulness. 4. Avoidant Personality Disorder – Socially awkward; fear of criticism, disapproval or rejection; views self as socially inept; reluctant to take personal risks or to engage in new activities because they may prove embarrassing. 5. Body Dysmorphic Disorder – A perceived defect of oneself. 6. Borderline – Very unstable relationships; erratic emotions; self-damaging behavior; impulsive; unpredictable aggressive and sexual behavior; sometimes similar to Autophobia/Monophobia; easily angered. 7. Brief Psychotic Disorder – Delusions, hallucination, disorganized speech or catatonic behavior which last between one and four weeks. 8. “…by Proxy” – Any condition where someone uses another (adult, children) to achieve their needs. 9. Cognitive Dissonance – the wrestling with opposing viewpoints in our mind, and determine which decision to make; our effort to fundamentally strive for harmony in our thinking. 10. Compulsive – Perfectionists, preoccupied with details, rules and schedules; more concerned about work than pleasure; serious and formal; cannot express tender feelings. 11. Compulsive Hoarding – Excessive acquisition of possessions, and failure to use or discard them, even if the items are worthless, hazardous or unsanitary.
    [Show full text]
  • Selective Mutism and the Anxiety Spectrum – a Long-Term Case Report
    Cartas aos Editores 172 K-SADS), she met diagnostic criteria for Separation Anxiety Financiamento: Inexistente Disorder (in the past), current diagnosis of Specific Phobia. She Conflito de interesses: Inexistente didn’t have any other anxious (including social anxiety), affective or psychotic symptoms. Before her referral, she was treated with psychodynamic Referências therapy and took paroxetine (20 mg/daily) for 12 months without 1. Aggege S. Sem hospícios, morrem mais doentes mentais. O Globo,Rio de Janeiro. 2007 09 dez/set; Seção O País: 14. improvement. At our service, she was treated with cognitive- 2. Datasus. Informações de Saúde: Estatísticas vitais - mortalidade behavioral therapy (CBT) for 10 months with poor outcome. e nascidos vivos. citado 10 dez 2007. Disponível em: http:www. Then, CBT was associated with sertraline (150 mg/daily). After datasus.gov.br. 3 months, the level of anxiety on CBT exposures lowered. She 3. Laurenti R, Mello Jorge MHP, Gotlieb SLD. A confiabilidade dos dados started to shout when playing handball, she talks louder to de mortalidade e morbidade por doenças crônicas não-transmissíveis. Cienc Saude Coletiva. 2004;9(4):909-20. her mother in public places, and talks to friends through lips 4. Mello Jorge MHP, Gotlieb SLD, Laurenti R. O sistema de informações sobre movements. Though she isn’t talking to many people yet, she mortalidade: problemas e propostas para o seu enfrentamento I — Mortes is clearly less anxious. por causas naturais. Rev Bras Epidemiol. 2002;5(2):197-211. There is some controversy whether SM is an anxiety disorder 5. Sampaio ALP, Caetano D. Mortalidade em pacientes psiquiátricos: (AD) or an independent diagnosis.
    [Show full text]
  • Selective Mutism: a Three-Tiered Approach to Prevention and Intervention
    53 Selective Mutism: A Three-Tiered Approach to Prevention and Intervention R.T. Busse and Jenna Downey, Chapman University Selective mutism is a rare anxiety disorder that prevents a child from speaking at school or other community settings, and can be detrimental to a child’s social development. School psy- chologists can play an important role in the prevention and treatment of selective mutism. As an advocate for students, school psychologists can work with teachers, parent caregivers, speech pathologists, and other support staff toward helping children who may develop or have selec- tive mutism. The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the incidence and severity of selec- tive mutism. We present theories and research on the etiology and prevalence of the disorder, followed by a review of intervention methods and research at each tier. Based on the theoretical and research literature base, we conclude that early intervention may result in the prevention and amelioration of many occurrences of selective mutism. KEYWORDS: Selective Mutism, Childhood Anxiety Disorders, Social Phobia, Prevention, Treatment The purpose of this article is to present school-based prevention and intervention approaches within a three-tiered approach that may reduce the prevalence and severity of selective mutism. Children with selective mutism (SM) experience a “consistent failure to speak in specific social situations (in which there is an expectation for
    [Show full text]
  • Selective Mutism
    Selective Mutism Communication Profile In comfortable situations, children with selective mutism usually demonstrate age- appropriate language and communication skills. If a child is not in a comfortable environment, The current Diagnostic and Statistical Manual of he or she generally will be unable to speak at all. Mental Disorders (DSM.5) classifies selective With select individuals, the child may be able to mutism as an anxiety disorder. speak at a whisper. Characteristics include: In specific situations leading to mutism, a child may: Consistent failure to speak in specific Be motionless or expressionless social situations (in which there is an Avoid eye contact expectation for speaking, such as at school) despite speaking in other situations. Have stiff posture or body language Be slow to respond (even nonverbally) or Not speaking interferes with school or have trouble initiating work, or with social communication. Withdraw or turn away Lasts at least 1 month (not limited to the first month of school). Communication Concerns Failure to speak is not due to the lack of Children with selective mutism vary in their knowledge with the spoken language use of nonverbal communication, such as that is required in a social situation. pointing or using pictures. Though some may use gestures or facial expressions, others may Not due to a communication disorder seem paralyzed. (e.g., stuttering) and it does not only This poses significant health and safety occur during the course of a pervasive concerns, because a child may not be able to developmental disorder, schizophrenia, or express their needs. For example, children at other psychotic disorders.
    [Show full text]