SMRI produces research to expand the world’s knowledge on Selective Mutism. We have the largest database of information from children/teens with Selective Mutism. Every day we are working to decipher relationships from this database to dive even deeper into understanding this disorder.

SMRI’s first mission was to study the efficacy of Dr. Shipon-Blum’s S-CAT® Program and we are happy to share the results!

95% Success Rate!

Since then, SMRI has continued to publish numerous articles/presentations that we are proud to share. Click on each of the links below for a sample of abstracts and publications of our posters and presentations and to stay up-to-date on our current discoveries.

Publications & Presentations

Evelyn R Klein, Sharon Lee Armstrong, Kathryn Skira, and Janice Gordon
Department of Communication Sciences and Disorders, La Salle University, USA
Department of Psychology, La Salle University, USA
Selective Mutism Research Institute, USA

Abstract
This research assessed the feasibility of Social Communication Anxiety Treatment (S-CAT) developed by Elisa Shipon-Blum, a brief multimodal approach, to increase social communication in 40 children aged 5–12years with selective mutism (SM). SM is a disorder in which children consistently fail to speak in specific situations although they have the ability to do so. Key features of this approach are the SM-Social Communication Comfort Scale (SCCS), transfer of control
(ToC), a nonchalant therapeutic style, and cognitive-behavioral strategies over a brief time frame. Following 9 weeks of treatment, children showed significant gains in speaking frequency on all 17 items from the Selective Mutism Questionnaire (SMQ), a standardized measure of SM severity. Children also showed decreased levels of anxiety and withdrawal as reported by parents on the Child Behavior Checklist (CBCL). SM initial symptom severity and family therapy compliance, but not duration of SM, contributed to treatment outcomes.

Click here to read the full study.

Click here to read the results summary.

The EXPRESS Program for Children with Selective Mutism.

Sharon Lee Armstrong, Janice Gordon, Donna Spillman Kennedy, Evelyn Klein, Carolyn Gerber Satko, &. Elisa Shipon-Blum

Communication deficits in both receptive and expressive language abilities often accompany SM. Klein, Armstrong, and Shipon-Blum (2013) found that 60% of a sample of 146 children with SM exhibited language deficits. Specifically, these children demonstrated difficulties using a sufficient number of words per sentence, using compound and complex sentences, retelling a story, making up a story about a picture, using imagination to express thoughts, and conveying information via decontextualized language. These language needs inspired an inter-professional team comprised of SLPs, a psychologist, and a psycholinguist to work collaboratively to develop the EXPRESS (EXPanding Receptive and Expressive Skills through Stories) story-based program workbook for children ages 3-11. EXPRESS sessions begin with reading a story to a child that is appropriate for the child’s age, verbal ability, and level of communication comfort. Building on Social Communication Anxiety Treatment (Shipon-Blum, 2015), these comfort levels include: Nonvocal Communication, Indirect Vocalization, Direct Vocalization, Scripted Vocalization, and Spontaneous Vocalization. Story-based activities that teach words and sentences (simple, compound, complex) are followed by question-answer routines and story generation supported by pictures and text. The present study examines activity strategies and data from children receiving EXPRESS. Preliminary results indicate that every child achieved increased vocabulary and some achieved increased mean length of utterance. Identifying children with SM and treating them appropriately is critical for their communicative, social, and academic success. The unique approach inherent in EXPRESS provides an organized method for working effectively with children who have SM.

A Large Sample Study of Comorbidities in Childhood Selective Mutism.

Pantone, M.L., Armstrong, S.L., Shipon-Blum, E., Debski, M. & Steinbeck, L.K.

Approximately 80% of children with SM are diagnosed with another mental health diagnosis, with 55% having between 3 and 7 diagnoses. The most common comorbid diagnosis children with SM face is anxiety, with social anxiety disorder being particularly prevalent (Kristensen, 2000). Previous research also indicates that developmental disorders and/or delays are commonly comorbid with SM (Kristensen, 2000). The current study examines the frequency of SM comorbidity, in a large-scale sample of children diagnosed with SM.

Analyses examining frequencies of comorbidities in the current sample of children (1,311 children; 63% female, mean age = 6.9, 77.8% Caucasian) indicate the top two most common comorbidities are anxiety disorders and sensory processing disorder. These prevalence rates are higher than those found in typically developing children. Prevalence rates for autism spectrum disorder are also higher in the current sample. Approximately 34% of the current sample had one comorbid diagnosis. Further, 13% of children’s caregivers reported at least two comorbid conditions.

Gender Differences in the Sensory Profiles of Children with Selective Mutism.

Bowden, L., Blum, J., Martin, P., Michaels, K., Khrapatina, I., Shipon-Blum, E., & Armstrong, S.L.

Selective Mutism (SM) is a childhood anxiety disorder characterized by difficulty speaking in certain situations while exhibiting no difficulties speaking in other situations (American Psychiatric Association, 2013; Klein et al., 2013). Research on gender differences in the SM population is mixed. Mash & Barkley (2014) found no gender differences in prevalence rates. Black (1996) and Weinstock (1999) found that more females have SM than males. Children with SM may possess unique characteristics associated with sensory processing (Garcia et al., 2004). Dunn (1997) found no gender differences in sensory processing in the general population. However, there is no current research published that addresses gender differences in sensory processing among children with SM. The current study examines gender differences in the sensory profiles of children with SM using the Sensory Profile-2 (SP-2; Dunn, 2014).

Similar to previous findings with typically developing children (Dunn, 1997), results show a minimal amount of gender differences in the sensory profiles of children with SM. On the 86 items found in the SP-2, only 8 items show significant gender differences. Significant gender differences in sensory processing may be better explained by differences in gender presentations (Basow, 1992). Males more frequently engage in risky behaviors that include more movement (Eaton & Enns, 1986). Females engage in more behaviors that involve bright colors and being near others (LoBue & DeLoache, 2011).

CommuniTeens: Using Group Treatment to Build Social Communication Skill in Adolescents.

Blanchard, B., Khrapatina, I., & Shipon-Blum, E.

Working with teenagers who have selective mutism (SM) presents with unique challenges and rewards. Adolescents with SM may have ingrained, conditioned patterns of interacting with others that are not likely to be conducive to building and maintaining relationships (Shipon-Blum, 2002). Parents and peers may also reinforce socially conditioned response patterns (Shipon-Blum, 2015). Adolescents may come to see SM symptoms as an ingrained part of their identity, thereby making symptoms harder to shed with age (Omdal, 2007). This can have a lasting impact on adolescents’ ability to form meaningful relationships. Group treatment presents a unique opportunity to help adolescents broaden and build social communication skills in a setting that normalizes their challenges, and provides opportunity for insight, risk-taking and growth through interaction with peers facing similar challenges (Sharkey et al., 2008). At an SM specialty treatment center, we sought to address the unique needs of adolescents with SM by adapting our treatment program for use in a group format. CommuniTeens is an eight-week group treatment program that combines Dr. Elisa Shipon-Blum’s Social Communication Anxiety Treatment (S-CAT®) & cognitive-behavioral strategies (Shipon-Blum, 2015), and is tailored the unique needs of adolescents. Treatment includes a combination approach of behavioral and cognitive behavioral intervention, family-based approaches, and strategies aimed at increasing insight, control, awareness, and motivation (Klein et al., 2017; Shipon-Blum, 2015).

CommuniTeens is beneficial in that it offers a unique opportunity for adolescents with SM to learn life skills that are both practical & relevant to the adolescent experience. Adolescents are also able to reap benefits proportional to the work that they put in. In addition, the CommuniTeens curriculum benefits participants by facilitating ownership and responsibility for personal progress. Some challenges of administering treatment in a group format to this population include difficulty that group leaders may have in over-facilitating interactions with adolescents as a means to fill the silence. Potential inconsistent attendance of group participants and limited parental involvement may also pose a challenge in the group treatment modality. Lastly, because the CommuniTeens curriculum is heavily skills-based, adolescents may have less of an opportunity to process their own emotional experiences within the group setting. Outcome data demonstrate beneficial post-group theme changes among participants. Preliminary results indicate an increase in participants’ independence, normalization, self-confidence, expansion of social networks, and emotional awareness after having participated in the eight-week CommuniTeens group treatment program.

Assessing the Co-occurrence of Developmental Diagnoses in Children with Selective Mutism.

Martin, P., Bowden, L., Michaels, K., Khrapatina, I., Shipon-Blum, E., & Armstrong, S.L.

Previous research indicates that overall, 68% of children with SM have a history of developmental delays (Kristensen, 2000). Within this population, research indicates that 42% of children have difficulties in expressive language deficits (Klein, Armstrong & Shipon-Blum, 2013), 81% exhibit either language or speech deficits (Armstrong & Klein, 2014), and 82% are reported to have at least one sensory processing issue (Steinbeck, Shipon-Blum & Pantone, 2016). Difficulties in expressive language ability and articulation have been shown to be particularly notable in this population (Steinhausen & Juzi, 1996). The present study examines the type and prevalence of developmental diagnoses in a large sample of children with SM. Data gathered via parent responses to the Selective Mutism Comprehensive Diagnostic Questionnaire (SMCDQ) was be used to examine qualitative descriptions of the developmental functioning of children with SM. It is hypothesized that within this sample of children with SM, more children will experience co-occurring developmental diagnoses, and diagnoses related to speech and language will be most prevalent among children in this sample.

Findings show a significant difference between the percentage of children with SM who also have developmental delays (37%) and the percentage of children with SM who do not have developmental delays (63%), as assessed by this parent-report measure. While results suggest that a majority of children with SM do not experience developmental delays, developmental delays related to Speech and Language are most commonly seen in the population of children with SM. Prior research indicates that up to 81% of children with SM exhibit speech and/or language deficits when assessed via standardized measures (Armstrong & Klein, 2014). This represents a significant increase in prevalence compared to the present study, which utilized a parent-report measure (15% speech/language delays). Therefore, it is likely that standardized assessments such as those administered by Armstrong and Klein (2014) are more valid indicators of developmental diagnoses as compared to parent-report measures.

Exploring the Communicative Profiles of Children with Selective Mutism: How Does Age Impact Language Skills?

Khrapatina, I., Michaels, K., Martin, P., Bowden, L., Shipon-Blum, E., & Armstrong, S.L.

The DSM 5 specifies that while children with SM may exhibit expressive language deficits, the symptoms should not be better accounted for by a communication disorder, such as a Specific Language Impairment (American Psychiatric Association, 2013). To receive a language impairment diagnosis, the speech deficit must be present in all settings, which is not the case for children with SM. Klein and colleagues (2013) found expressive language deficits in 68% of their sample of 33 children with SM. Language formulation delays in children with SM may be due to a lack of experience with expressive language, possibly due to social communication anxiety. Over time, speech impairments may worsen and become more resistant to change (McInnes et al., 2004). The current study explored whether prolonged social non-engagement leads to worsened social communication deficits. We hypothesized that in children with SM, age will be negatively correlated with communication skill proficiency, such that as age increases, communication skills decrease. Data was collected from 144 families seeking services at a treatment center specializing exclusively in SM (ages 4-17). Structural and pragmatic communication skills were assessed via Children’s Communication Checklist – 2nd edition (CCC-2; Bishop, 2006).

The present study provides support for the hypothesis that as children with SM get older, proficiency decreases for communication skills, across both structural and pragmatic language domains. Over time, expressive language deficiencies may worsen and become harder to treat (Klein et al., 2013; McInnes et al., 2004).  In line with this finding, Oerbeck and colleagues (2014) found that while 50% of children no longer met criteria for SM one-year post-treatment, the recovery rate for older children was 33%, compared to 78% for younger children. Significant correlations were found for Age and both Indicators of ASD scales, suggesting that for children with co-occurring SM and ASD, symptoms may be harder to treat and may persist with age. In line with this finding, Steffenberg and colleagues (2018) found that children with comorbid SM and ASD had an overall later age of onset and later age of diagnosis. Additionally, the present study used a parent-report measure of language skills. Previous research has found that parents tend to over-estimate children’s language functioning (Klein et al., 2013). Future research should focus on using objective assessment tools to better understand the relationship between age and communication skills in children with SM.

Main Effects and Interactions of Age and Gender on Socio-Emotional Functioning of Children with Selective Mutism Using the BASC-3 Parent Rating Scales (PRS).

Martin, P., Bowden, L., Michaels, K., Steinbeck, L., Manfredi, R., Shipon-Blum, E., &  Armstrong, S.L.

The present study examines the main effects and interactions between gender and age on socio-emotional characteristics for children with SM using the BASC-3 Parent Rating Scales (PRS). Data was collected from September 2016 to March 2018 from a total of 161 families. Parents completed the BASC-3 prior to beginning treatment for SM at a Philadelphia area specialty practice. A series of 2(gender) x 2(age) between-subjects ANOVAs were conducted for each of the 14 socio-emotional characteristics on the BASC-3.

Significant differences were found for gender in the socio-emotional functioning of children with SM: Females exhibit heightened symptoms of Depression and Somatization when compared to males with SM. This finding supports prior research suggesting that for children with SM, females tend to exhibit significant levels of internalization that manifest as depressive symptomology and somaticizing complaints when compared to males (Cunningham et al., 2004). A potential explanation for this can be that females report the experience of greater peer-related stressors (Hankin, Mermelstein, & Roesch, 2007). The greatest differences in socio-emotional functioning were found in relation to age. As compared to children, adolescents experience significantly higher levels of symptomology in the areas of: Somatization, Attention Problems, and Functional Communication. This finding corroborates existing research, suggesting that difficulties with functional communication presenting in early childhood may exacerbate over time into adolescent years if SM is left untreated (Rodebaugh, Holaway, & Heimberg, 2004). This also suggests that difficulties with attention and somatization may increase with age (Chavira et al., 2004).

Exploration of Developmental Delays Present Among Children Diagnosed with Selective Mutism.

Martin, P., Bowden, L., Michaels, K., Khrapatina, I., Shipon-Blum, E., &  Armstrong, S.L.

Sixty eight percent of children with SM have a history of developmental delays (Kristensen, 2000). Difficulties in expressive language ability and articulation are particularly notable in this population (Klein, Armstrong, & Shipon-Blum, 2012). The present study examines the type and prevalence of developmental delays within a sample of children with SM, as assessed via the Selective Mutism Comprehensive Diagnostic Questionnaire (SMCDQ). Data was collected from a total of 109 families, at a specialty treatment center for SM in the Philadelphia area. This study utilized qualitative data gathered via parent responses to the SM Comprehensive Diagnostic Questionnaire in order to examine qualitative descriptions of the developmental functioning of children with SM. The SMCDQ is a measure that assesses a child’s psychological, behavioral, and environmental background. This questionnaire was created by the director of the SM specialty center and consists of open- and close-ended questions (Shipon-Blum, 2002). The current sample includes 109 children (N = 109), ranging from 3-20 years, with a mean age of 8.12 years, is 72% female, and is 77% Caucasian.

Findings show a significant difference between the percentage of children with SM that also have developmental delays and the percentage of children with SM that do not have developmental delays (t(108) = 3.78, p < .001), such that 67% of participants in this sample did not experience developmental delays. In particular, findings suggest that children with SM that do experience developmental delays exhibit delays in the domains of Speech and Language (64%), Gross and Fine Motor ability (44%), Sensory Processing (42%), and Other, inclusive of delays related to social skills and problem-solving ability (33%). While results suggest that a majority of children with SM do not experience parent-reported developmental delays, when developmental delays are present, Speech and Language delays are most commonly seen. The current findings corroborate existing research highlighting the high prevalence of speech and language difficulties among children with SM (Klein et al., 2012). The current prevalence rate is lower than that of Klein et al., 2012, which is most likely due to the use of parent-report measures as opposed to standardized measures of language competence.

Debunking the Myth: Selective Mutism and Trauma

Bowden, L., Martin, P., Michaels, K., Khrapatina, I., Shipon-Blum, E., & Armstrong, S.L.

 The present study examines the prevalence and specific types of trauma experienced in children with SM, assessed via the Selective Mutism Comprehensive Diagnostic Questionnaire (SMCDQ). The SMCDQ was given to parents of children with SM at a center that specializes in SM. The SMCDQ is a measure that assesses a child’s psychological, behavioral, and environmental background. This questionnaire was created by the director of the SM specialty center and consists of open- and close-ended questions (Shipon-Blum, 2002). Differences within the sample were examined using a one-sample t-test between percents. Data collection began January 2016 and was completed November 2017. The sample of children (N = 109) has a mean age of 8.12 years, is 72% female, and is 77% Caucasian.

The findings indicate a significant difference between the percentage of children with SM who experience a traumatic event from those who do not (t(108) = 4.733, p < .001). Specifically, the majority of children with SM in the present sample did not experience a traumatic event. The traumatic events children with SM typically encounter fell into four major themes: family stressors, unsafe environments, medical procedures, and school. For example, parental divorce, unsafe neighborhoods, hospitalizations and surgeries, and embarrassing events in school were all identified as traumatic events for this population. While the majority of this study’s sample did not experience trauma, the presence of specific traumatic experiences for some children with SM supports the findings by Dow and colleagues (1995).

Shyness and Sociability in a Large Sample of Children with Selective Mutism.

Michaels, K., Martin, P., Bowden, L., Khrapatina, I., Shipon-Blum, E., & Armstrong, S.L.

The purpose of this study was to explore the relationship between SM and sociability, a type of temperament characterized by the desire to affiliate with others. Data was collected at a treatment center specializing exclusively in selective mutism. The SMCDQ was administered to 325 families seeking treatment for SM (ages 3-18; 206 females, 119 males). The SMCDQ is a measure that assesses a child’s psychological, behavioral, and environmental background. This questionnaire was created by the director of the SM specialty center and consists of open- and close-ended questions (Shipon-Blum, 2002). For the purposes of this study, responses to the question, “is your child interested in having friends” were used as an indicator for the desire to affiliate with others. Differences within the sample were examined using a one-sample t-test between percents. Data collection began January 2016 and was completed November 2017. The findings indicate a significant difference between the percentage of children with SM who are interested in having friends and those who are not (t(324) = 36.253, p < .001). Specifically, 94.77% of children with SM were reportedly interested in having friends.

Sensory Processing Patterns in Selective Mutism using the Sensory Profile.

Shipon-Blum, E., Manfredi, R., Armstrong, S.L., Steinbeck, L., & Blum, S.

Difficulties in sensory processing in individuals with selective mutism (SM), a social communication anxiety disorder, have been anecdotally reported and observed clinically. Hofmann and Bitran (2007) found a high incidence of sensory-processing sensitivity in the generalized-subtype of social anxiety disorders and a strong correlation between sensory-processing sensitivity and both harm and agoraphobic avoidance. Thus, it may be that sensory-avoidance behaviors contribute to the mute and withdrawn behavior of children with SM. Although there is substantial research documenting sensory issues in children with ASD anddd ADHD (Ghanizadeh, 2011), there is little information about sensory processing in children with SM. The current study investigated the incidence and patterns of sensory processing issues in a large sample of children (N=554) ages 3-10 with SM using a standardized measure, the Sensory Profile (Dunn, 1999).

Results suggest that children with SM, as a whole, are similar to typically-developing individuals in most areas of sensory functioning. However, a substantial minority experience significant sensory difficulties in some specific areas. More than 30% of children with SM were found to fall outside of the typical development range in emotional reactivity, the ability to use visual cues in the environment to relate to others, psychosocial coping strategies, and the ability to meet performance expectations. More than 20% of children with SM were found to fall outside of the typical development range in poor endurance and low muscle tone, inattention and distractibility, responsivity to auditory stimuli, responsivity to tactile stimuli, the ability to sustain a consistent level of performance, and the ability to modulate sensory input on emotional responses. Children with SM do not generally seek out sensory stimulation more than other children. Thus, they may be easily overwhelmed by environmental stimulation, which may contribute to the development of SM. These results suggest that sensory processing and sensitivities should be regularly evaluated in children with SM, as difficulties in these areas may be present in a substantial minority of children. In those who experience sensory difficulties, most difficulties suggest that children with SM may be overly sensitive to even minor stimuli, particularly in the auditory and tactile domains.

BASC-3 Parent Rating Scales: Portrayals of Children with Selective Mutism.

Martin, P., Bowden, L., Michaels, K., Steinbeck, L., Manfredi, R., Shipon-Blum, E., &  Armstrong, S.L.

The present research study used the BASC-3 Parent Rating Scales (PRS) to examine the unique trends present for 86 children with SM across multiple domains of behavioral and socio-emotional functioning. The current sample includes preschoolers (ages 2-5, n = 29), children (ages 6-11, n = 44), and adolescents (ages 12-21, n = 13). The present study is consistent with previous research indicating that children with SM experience heightened levels of anxiety and withdrawal symptoms, and lower levels of adaptive skills, as compared to neurotypical children (Shipon-Blum et al., 2016). However, these results suggest that these difficulties are more common in adolescents with SM. Data collected from this sample also demonstrated elevations in related areas, including developmental social problems and risk for autism spectrum disorder, even though the members of this sample did not meet diagnostic criteria for these disorders. These elevations highlight the increased risk of inaccurate or inappropriate diagnosis, or misinterpretation of the child’s symptoms. These results highlight the necessity of thorough and comprehensive assessments for children with SM so that appropriate treatment can be initiated. Finally, the current study does not support previous interpretations of SM symptoms as manifestations of oppositional, defiant, or manipulative behaviors, as scores on these scales were within normal limits.

Parents’ Perspective: Children with Selective Mutism and Sensory Processing

Bowden, L., Martin, P., Michaels, K., Steinbeck, L., Manfredi, R., Shipon-Blum, E., &  Armstrong, S.L.

This study examines the descriptive characteristics of 78 children with SM and their sensory profiles, assessed via the Sensory Profile-2 (SP-2). The SP-2 is a set of norm-referenced, standardized items designed to assess children’s sensory processing (Dunn, 2014). The present study suggests that children with SM engage in higher social emotional responses and social avoiding behaviors compared to the neurotypical population. In addition, data shows that children with SM exhibit lower visual processing skills, social seeking behaviors, and movement processing skills associated with sensory processing than is seen in the general population. This study implies that therapists treating children with SM should consider the potential impact of sensory sensitivities or sensory processing problems.

Data from the present study suggests that children with SM exhibit similar sensory processing compared to the general population in many areas. However, the current research is consistent with previous findings indicating that children with SM have different social emotional responses associated with sensory processing than neurotypical children (Shipon-Blum et al., 2016). In fact, more than half of the sample (55%) were found to have stronger social emotional responses to sensory stimuli. This finding suggests that children with SM may be more emotionally sensitive to their environment and behavior accordingly (rigid thinking, poor coping skills). This study also found that 43% of children with SM respond less or much less to visual stimuli than others their age. Lastly, this study found that children with SM tend to more commonly avoid sensory stimulation (38% of the sample) and less commonly seek out sensory stimulation (26% of the sample) than others their age.

Beneath the Silence: Exploring the Communicative Profiles of Children with Selective Mutism (SM)

Michaels, K., Martin, P., Bowden, L., Steinbeck, L., Manfredi, R., Shipon-Blum, E., &  Armstrong, S.L.

Despite progression in the field toward a better understanding of SM, misperceptions still exist; current research on SM focuses on the child’s failure to speak as a behavioral problem stemming from anxiety. However, research suggests that underlying difficulties with language may be present in a substantial minority of children with SM, and may contribute to their clinical presentation. With the hope of demystifying SM, we explored the communicative profiles of 60 children with SM, using data collected from the Children’s Communicative Checklist-2 (CCC-2).

The current study has two important findings: firstly, that most children with SM have the structural language skills necessary to communicate at a normal level, as evidenced by Average scores on the CCC-2 sub-scales. At the same time, a substantial minority of children with SM (approximately 40%) experience difficulties in the use of pragmatic language skills. These difficulties overlap with those seen in autism spectrum disorders and other disorders of social communication. Thus, there is a potential for children with SM to be misdiagnosed with possible ASDs, as the nature of their social communication difficulties may be misunderstood. Therefore, a comprehensive evaluation exploring the social communication profile, pragmatic language skills, and underlying social-emotional functioning of a child with SM is critical in obtaining an accurate understanding of the child’s clinical picture.

Beneath The Silence – Exploring The Communicative Profiles Of Children With Selective Mutism Using The CCC-2.

Michaels, K., Martin, P., Bowden, L., Steinbeck, L., Manfredi, R., Shipon-Blum, E., & Armstrong, S.L.

Many children with SM do not receive adequate speech-language evaluations. Evaluators may often presume that the child is intentionally being defiant, so rather than trying to accommodate the child by reducing anxiety, the evaluator may push the child to speak, thereby increasing anxiety for the child. As a result, the necessary clinical data may not be obtained. Research demonstrates that comfort and anxiety reduction may precede communication for children with SM. However, for many children, there is more going on beneath their silence. The current study seeks to examine the communicative profiles of children with SM, as reported by their parents on the Children’s Communication Checklist 2 (CCC-2). One purpose of the study is to evaluate the use of the CCC-2 to screen for possible speech and language delays or difficulties in this population. It is hypothesized that the results may slightly underestimate the true prevalence of speech and language difficulties in children with SM, as parents are often the ones who see the child’s communication at its best. Descriptive analyses indicated that, as a group, children with SM perform just like the majority of others, when rated by their parents. For most of the communicative scales of the CCC-2, mean scores for this sample fell in the average range. However, the mean sample score fell in the slightly Below Average range on the scales of Social Relations (M=7.76) and Nonverbal Communication (M=7.32). Lastly, a negative SIDI score indicates a tendency towards pragmatic difficulties, such as those seen in ASD and S(P)CD. The mean for this sample was within normal limits on the SIDI (mean SIDI= -5.56). While the mean score was within normal limits, it should be noted that 32.85% of the sample received a score of -11 or lower, suggesting a communicative profile similar to those with ASD. This study adds to the research literature supporting the need for comprehensive assessment of children with SM.

BASC-3 Parent Rating Scales: Portrayals of Children with Selective Mutism.

Martin, P., Bowden, L., Michaels, K., Steinbeck, L., Manfredi, R., Shipon-Blum, E., &  Armstrong, S.L.

The present study examines descriptive behavioral and socio-emotional characteristics collected from 86 children with SM using the BASC-3 Parent Rating Scales (PRS). The BASC-3 PRS is a parent-report measure used to examine children’s observable behavioral and emotional functioning (Reynolds & Kamphaus, 2015). Previous research has shown that children with SM experience particular difficulties in some areas of behavioral and socio-emotional functioning. Specifically, past research has demonstrated a relationship between internalizing symptoms, such as anxiety, and the prevalence of SM in children (Vecchio & Kearney, 2005), though other research has failed to demonstrate the same relationship (Elizur & Perednik, 2003). The current study attempted to provide a more comprehensive assessment of the social and emotional functioning of children and adolescents with SM. Data was collected at a specialty treatment center for SM in the Philadelphia area. The present research study used the BASC-3 Parent Rating Scales (PRS) to examine the unique trends present for children with SM across multiple domains of behavioral and socio-emotional functioning.

The present research is consistent with previous research indicating that children with SM experience heightened levels of anxiety and withdrawal symptoms, and lower levels of adaptive skills, as compared to neurotypical children (Shipon-Blum et al., 2016). The current study does not support previous interpretations of SM symptoms as manifestations of oppositional-defiant, or manipulative behaviors, as scores on these scales were within normal limits.

Parents’ Perspective: Children with Selective Mutism and Sensory Processing.

Bowden, L., Martin, P., Steinbeck, L., Michaels, K., Manfredi, R., & Shipon-Blum, E.

Observations made at an SM specialty treatment center in the Philadelphia area suggest that inconsistent speech is not the only difficulty present in children with SM. Furthermore, sensory processing difficulties appear to exist in this population. Sensory processing challenges can manifest in different domains: visual, auditory, oral, touch, and kinesthetic processing, as well as through emotional responses and behaviors. Sensory difficulties have been found in numerous other populations. Social anxiety disorders (SAD), which may be characterized by similar mute and withdrawn behaviors, have been shown to be related to sensory sensitivities. Specifically, the generalized-subtype of SAD has a high incidence of sensory-processing sensitivity, while agoraphobic avoidance has a strong correlation with sensory-processing sensitivity (Hofmann & Bitran, 2007). The current study examines the prevalence of these challenges in children with SM using the Sensory Profile-2 (SP-2). The SP-2 is a set of norm-referenced, standardized items designed to assess children’s sensory processing (Dunn, 2014). This measurement was given to the parents of children with SM seeking services at the SM specialty treatment center in the Philadelphia area. This parental report data was then coded and the descriptive results were examined. Results indicated that 34% of children with SM respond less or much less to visual stimuli than others their age, 16% of children with SM have less appropriate movement capabilities than others their age, and children with SM tend to avoid sensory stimulation (38% of this sample) and less commonly seek out sensory stimulation (22% of the sample) than others their age.

Sensory sensitivities in children with selective mutism: Why are they important to consider?

Steinbeck, L. K., Armstrong, S. L., Pantone, M. L., Murphy, M. T., Harrison, L., & Shipon-Blum, E. (2015, October).

There is a paucity of information surrounding the incidence of sensory processing difficulties in children with SM and their impact on mute behavior (Van Hulle et al., 2012). In contrast, there is ample research on sensory processing difficulties in Autism Spectrum Disorder (ASD) and in typically-developing (TD) children. The current study examines the prevalence of sensory issues in SM compared to ASD and TD populations.

Although sensory sensitivities are more common among children with ASD than children with SM, these sensitivities are in fact present at a higher rate in children with SM than typically developing children. To a statistically significant degree, children with SM are more overly sensitive to sound, likely to be picky eaters, overly sensitive to hair brushing or washing, and overly sensitive to lights compared to TD children.

What Else is Going On? Selective Mutism Comorbidities.

Pantone, M.L., Armstrong, S.L., Shipon-Blum, E., Debski, M. & Steinbeck, L.K.

Approximately 80% of children with SM are diagnosed with another mental health diagnosis, with 55% having between 3 and 7 diagnoses. The most common comorbid diagnosis children with SM face is anxiety, social anxiety disorder being particularly prevalent (Kristensen, 2000). Previous research also indicates that developmental disorders and/or delays are commonly comorbid with SM (Kristensen, 2000). The current study examines the frequency of SM comorbidity, in a large-scale sample of children diagnosed with SM.

Analyses examining frequencies of comorbidities in the current sample of children (1266 children; 63% female, mean age = 6.9, 75.7% Caucasian) indicate the top three most common comorbidities are anxiety disorders, sensory processing disorder, and autism spectrum disorders. Prevalence rates for anxiety disorders and ASD are higher in the present sample compared to typically developing children. Prevalence rates for conduct disorder, giftedness, and learning disabilities are lower in the current sample compared to typically developing children. Approximately 44% of the current sample had one comorbid diagnosis. Further, 26% of children’s caregivers reported at least two comorbid conditions.

Perceptions are important! Caregivers’ perceptions of their own and their schools’ views about selective mutism

Pantone, M. L., Armstrong, S. L., Shipon-Blum, E., & Steinbeck, L. K.

When a child’s condition is not fully understood, there may be aversive effects on the child’s development, as they may not be properly diagnosed or treated. A common symptom in children with SM is the inability to talk to teachers or peers in school (Omdal, 2008) and thus, teachers are often the first to notice a child’s symptoms of SM (Kumpulainen et al., 1998). Without proper understanding of what SM is, teachers may inadvertently play a role in delaying the process of getting a child proper support and/or exacerbate a child’s symptoms (Cline & Baldwin, 1984; Kumpulainen et al., 1998). The current study examines both parents’ views, and parents’ perceptions of their children’s schools’ views about symptoms of SM.

Findings from the present study show that more parents in 2002 than in 2015 thought schools believed SM to be oppositional (i.e. controlling, willful), a function of being unable to speak, or a result of trauma. In addition, parents in 2015 perceived schools to view their children’s SM largely as a symptom of anxiety and excessive shyness. However, parents still viewed schools as having inaccurate understandings of SM (i.e. willful, lacking social skills). Lastly, findings show that in 2015, parents themselves perceived SM predominantly as a manifestation of anxiety and second, as excessive shyness.

The “QUAD”: Eating, Sleeping, Toileting and Difficult Behaviors in Children with Selective Mutism.

Steinbeck, L., Armstrong, S.L., Shipon-Blum, E., & Pantone, M.

As individuals with Social Anxiety Disorder often report anxiety surrounding eating and using the restroom in public, and children with Separation Anxiety often report nightmares and sleep refusal, it follows that these issues may also be pronounced in selectively-mute children, as the aforementioned disorders most commonly occur with SM (American Psychiatric Association, 2013). However, there is a dearth of evidence regarding the prevalence of eating, sleeping, toileting, and behavioral difficulties in SM. The current study examines the prevalence of this “Quad” of co-occurring challenges in SM.

Approximately half of the current sample reported eating, toileting, and sleeping issues. These frequencies are comparable to those estimated for typically-developing children (TD). Although comparable to TD children, the prevalence of these challenges in SM may be attributed to the child’s anxiety in social contexts, such as a fear of eating or using the restroom in front of others.

Sensory Sensitives in Children with Selective Mutism: Are They Different Than the Norm

Steinbeck, L., Armstrong, S.L., Shipon-Blum, E., & Pantone, M.

There is a paucity of information surrounding the incidence of sensory processing difficulties in children with SM and their impact on mute behavior (Van Hulle et al., 2012). In contrast, there is ample research on sensory processing difficulties in Autism Spectrum Disorder (ASD) and in typically-developing (TD) children. The current study examines the prevalence of sensory issues in SM compared to ASD and TD populations.

Although sensory sensitivities are more common among children with ASD than children with SM, these sensitivities are in fact present at a higher rate in children with SM than typically developing children. To a statistically significant degree, children with SM are more overly sensitive to sound, likely to be picky eaters, overly sensitive to hair brushing or washing, and overly sensitive to lights compared to TD children.

Help us support continued research and the dissemination of our discoveries with your contribution!

How often do we hear…

“He’s just shy. He’ll grow out of it soon…” “I think your daughter has Selective Mutism but I’m not sure how to treat it…” “Johnny is refusing to speak and we can’t assess his learning.” “Erica is being completely defiant and won’t speak to us. We need to put her on medication for her behavior…”

In a world where evidence-based treatment and training programs are readily accessible to every individual affected by Selective Mutism, the misguided statements above would not be delivered to families in need of help by doctors, the education system, and other treatment professionals.

Contributions made to SMRI will stimulate and sponsor much needed scientific and clinical research in Selective Mutism and to provide financial support to advance training, education, and research into the understanding, early diagnosis, and treatment of Selective Mutism.

Specifically, funding will be used:

  • to hire research staff,  including  statisticians,  to continue gathering data, statistically analyze all data, and write research papers for publication.
  • to seek out relevant research being conducted by other institutions and will support this work through collaboration and recruitment of participants.
  • for pre-doctoral, post-doctoral, and institution-based researchers to study various aspects of SM that are currently misunderstood due to lack of published data.
  • to give more families Mr. B Scholarship Awards to provide financial assistance towards S-CAT® services and S-CAT® treatment programs such as CommuniCamp™.

For every contribution made to SMRI, the founder has agreed to match up to $10,000.00 each month—whether a one-time donation or recurring monthly contributions!