The sounds of silence: language, cognition, and anxiety in selective mutism.
OBJECTIVE
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.


METHODS
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.
Manassis
Katharina
K
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.. Electronic address: katharina.manassis@sickkids.ca.
Tannock
Rosemary
R
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.
Garland
E Jane
EJ
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.
Minde
Klaus
K
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.
McINNES
Alison
A
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.
Clark
Sandra
S
Drs. Manassis and Tannock are with The Hospital for Sick Children and the University of Toronto; Drs. Garland and Clark are with the University of British Columbia, Vancouver; Dr. Minde is with McGill University, Montreal; and Dr. McInnes is with the University of Windsor, Windsor, Ontario, Canada.
D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000175:diagnosis / Q000453:epidemiology*; D007807:Language Tests; D008297:Male; D009155:Mutism / Q000453:epidemiology* / Q000523:psychology*; D009483:Neuropsychological Tests; D012720:Severity of Illness Index