Selective mutism

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Selective mutism
Specialty Psychiatry

Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serving as triggers. This is caused by the freeze response. Selective mutism usually co-exists with social anxiety disorder. [1] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment. [2]

Contents

Signs and symptoms

Children and adults with selective mutism are fully capable of speech and understanding language but are completely unable to speak in certain situations, though speech is expected of them. [3] The behaviour may be perceived as shyness or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. In a severe form known as "progressive mutism", the disorder progresses until the person with this condition no longer speaks to anyone in any situation, even close family members.

To meet DSM-5 criteria for selective mutism, one must exhibit the following: [4]

Selective mutism is strongly associated with other anxiety disorders, particularly social anxiety disorder. In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another). [5] [6] [7] Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations. [8] [9]

Particularly in young children, selective mutism can sometimes be conflated with an autism spectrum disorder, especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment. Although many autistic people are also selectively mute, they often display other behaviors—stimming, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism alone. Some autistic people may be selectively mute due to anxiety in unfamiliar social situations. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.

The former name elective mutism indicates a widespread misconception among psychologists that selectively mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994, although some people are calling for a name change to "situational mutism" because the current name can promote the belief that it is a behavior the individual selects rather than it occurring in certain situations. [10]

The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000, 0.1%. [11] However, a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry estimated the incidence to be 0.71%. [12]

Other symptoms

Besides lack of speech, other common behaviors and characteristics displayed by selectively mute people, according to Elisa Shipon-Blum's findings, include: [13] [14] [15] [16]

On the flip side, there are some positive traits observed in many cases:

Causes

Selective mutism (SM) is an umbrella term for the condition of otherwise well-developed children or adults who cannot speak or communicate under certain settings. The exact causes that affect each person may be different and yet unknown. There have been attempts to categorize, but there are no definitive answers yet due to the under-diagnosis and small/biased sample sizes. Many people are not diagnosed until late in childhood only because they do not speak at school and therefore fail to accomplish assignments requiring public speaking. Their involuntary silence makes the condition harder to understand or test. Parents often are unaware of the condition since the children may be functioning well at home. Teachers and pediatricians also sometimes mistake it for severe shyness or common stage fright.[ citation needed ]

Most children and adults with selective mutism are hypothesized to have an inherited predisposition to anxiety. They often have inhibited temperaments, which is hypothesized to be the result of over-excitability of the area of the brain called the amygdala. [17] This area receives indications of possible threats and sets off the fight-or-flight response. Behavioral inhibitions, or inhibited temperaments, encompass feelings of emotional distress and social withdrawals. In a 2016 study, [18] the relationship between behavioral inhibition and selective mutism was investigated. Children between the ages of three and 19 with lifetime selective mutism, social phobia, internalizing behavior, and healthy controls were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire, consisting of 20 questions that addressed shyness and fear, as well as other subscales. The results indicated behavioral inhibition does indeed predispose selective mutism. Corresponding with the researchers’ hypothesis, children diagnosed with long-term selective mutism had a higher behavioral inhibition score as an infant. This is indicative of the positive correlation between behavioral inhibition and selective mutism.

Given the very high incidence of social anxiety disorder within selective mutism (as high as 100% in some studies [5] [6] [7] ), it is possible that social anxiety disorder causes selective mutism. Some children or adults with selective mutism may have trouble processing sensory information. This could cause anxiety and a sense of being overwhelmed in unfamiliar situations, which may cause the child or adult to "shut down" and not be able to speak (something that some autistic people also experience). Many children or adults with selective mutism have some auditory processing difficulties.

About 20–30% of children or adults with selective mutism have speech or language disorders that add stress to situations in which the child is expected to speak. [19] In the DSM-4, the term “elective mutism” was changed to “selective mutism.” This name change intended to deemphasize this refusal and oppositional aspect of the disorder. Instead, it highlighted that in select environments, the child is unable to speak rather than choosing not to. [20] In fact, children with selective mutism have a lower rate of oppositional behavior than their peers in a school setting. [21] Some previous studies on the subject of selective mutism have been dismissed as containing serious flaws in their design. According to a more recent systematic study it is believed that children or adults who have selective mutism are not more likely than other children or adults to have a history of early trauma or stressful life events. [22] Many children or adults who have selective mutism almost always speak confidently in some situations.

Treatment

Contrary to popular belief, people with selective mutism do not necessarily improve with age. [23] Effective treatment is necessary for a child to develop properly. Without treatment, selective mutism can contribute to chronic depression, further anxiety, and other social and emotional problems. [24] [25] [26]

Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing. Others may eventually expect an affected child to not speak and therefore stop attempting to initiate verbal contact. Alternatively, they may pressure the child to talk, increasing their anxiety levels in situations where speech is expected. Due to these problems, a change of environment may be a viable consideration. However, changing school is worth considering only if the alternative environment is highly supportive, otherwise a whole new environment could also be a social shock for the individual or deprive them of any friends or support they have currently. Regardless of the cause, increasing awareness and ensuring an accommodating, supportive environment are the first steps towards effective treatment. Most often affected children do not have to change schools or classes and have no difficulty keeping up except on the communication and social front. Treatment in teenage or adult years can be more difficult because the affected individual has become accustomed to being mute, and lacks social skills to respond to social cues.[ citation needed ]

The exact treatment depends on the person's age, any comorbid mental illnesses, and a number of other factors. For instance, stimulus fading is typically used with younger children because older children and teenagers recognize the situation as an attempt to make them speak, and older people with this condition and people with depression are more likely to need medication. [27]

Like other disabilities, adequate accommodations are needed for those with the condition to succeed at school, work, and in the home. In the United States, under the Individuals with Disabilities Education Act (IDEA), a federal law, those with the disorder qualify for services based upon the fact that they have an impairment that hinders their ability to speak, thus disrupting their lives. This assistance is typically documented in the form of an Individualized Education Program (IEP). Post-secondary accommodations are also available for people with disabilities.[ citation needed ]

Under another law in the US, Section 504 of the Rehabilitation Act of 1973, public school districts are required to provide a free, appropriate public education to every "qualified handicapped person" residing within their jurisdiction. If the child is found to have impairments that substantially limit a major life activity (in this case, learning), the education agency has to decide what related aids or services are required to provide equal access to the learning environment. [28]

Social Communication Anxiety Treatment (S-CAT) is a common treatment approach by professionals and has proven to be successful. [29] S-CAT integrates components of behavioral-therapy, cognitive-behavioral therapy (CBT), and an insight-oriented approach to increase social communication and promote social confidence. Tactics such as systemic desensitization, modeling, fading, and positive reinforcement enable individuals to develop social engagement skills and begin to progress communicatively in a step-by-step manner. There are many treatment plans that exist and it is recommended for families to do thorough research before deciding on their treatment approach.[ citation needed ]

Self-modeling

An affected child is brought into the classroom or the environment where the child will not speak and is videotaped. First, the teacher or another adult prompts the child with questions that likely will not be answered. A parent, or someone the child feels comfortable speaking to, then replaces the prompter and asks the child the same questions, this time eliciting a verbal response. The two videos of the conversations are then edited together to show the child directly answering the questions posed by the teacher or other adult. This video is then shown to the child over a series of several weeks, and every time the child sees themself verbally answering the teacher/other adult, the tape is stopped and the child is given positive reinforcement.[ citation needed ]

Such videos can also be shown to affected children's classmates to set an expectation in their peers that they can speak. The classmates thereby learn the sound of the child's voice and, albeit through editing, have the opportunity to see the child conversing with the teacher. [30] [31]

Mystery motivators

Mystery motivation is often paired with self-modeling. An envelope is placed in the child's classroom in a visible place. On the envelope, the child's name is written along with a question mark. Inside is an item that the child's parent has determined to be desirable to the child. The child is told that when they ask for the envelope loudly enough for the teacher and others in the classroom to hear, the child will receive the mystery motivator. The class is also told of the expectation that the child ask for the envelope loudly enough that the class can hear. [30] [31] [32]

Stimulus fading

Affected subjects can be brought into a controlled environment with someone with whom they are at ease and can communicate. Gradually, another person is introduced into the situation. One example of stimulus fading is the sliding-in technique, [23] where a new person is slowly brought into the talking group. This can take a long time for the first one or two faded-in people but may become faster as the patient gets more comfortable with the technique.

As an example, a child may be playing a board game with a family member in a classroom at school. Gradually, the teacher is brought in to play as well. When the child adjusts to the teacher's presence, then a peer is brought in to be a part of the game. Each person is only brought in if the child continues to engage verbally and positively. [30] [31] [32]

Desensitization

The subject communicates indirectly with a person to whom they are afraid to speak through such means as email, instant messaging (text, audio or video), online chat, voice or video recordings, and speaking or whispering to an intermediary in the presence of the target person. This can make the subject more comfortable with the idea of communicating with this person.

Shaping

The subject is slowly encouraged to speak. The subject is reinforced first for interacting nonverbally, then for saying certain sounds (such as the sound that each letter of the alphabet makes) rather than words, then for whispering, and finally saying a word or more. [33]

Spacing

Spacing is important to integrate, especially with self-modeling. Repeated and spaced out use of interventions is shown to be the most helpful long-term for learning. Viewing videotapes of self-modeling should be shown over a spaced out period of time of approximately 6 weeks. [30] [31] [32]

Drug treatments

Some practitioners believe there would be evidence indicating anxiolytics to be helpful in treating children and adults with selective mutism, [34] to decrease anxiety levels and thereby speed the process of therapy. Use of medication may end after nine to twelve months, once the person has learned skills to cope with anxiety and has become more comfortable in social situations.[ citation needed ] Medication is more often used for older children, teenagers, and adults whose anxiety has led to depression and other problems.

Medication, when used, should never be considered the entire treatment for a person with selective mutism. However, the reason why medication needs to be considered as a treatment at all is because selective mutism is still prevalent, despite psychosocial efforts. But while on medication, the person should still be in therapy to help them learn how to handle anxiety and prepare them for life without medication, as medication is typically a short-term solution.[ citation needed ]

Since selective mutism is categorized as an anxiety disorder, using similar medication to treat either makes sense. Antidepressants have been used in addition to self-modeling and mystery motivation to aid in the learning process.[ further explanation needed ] [30] [31] Furthermore, SSRIs in particular have been used to treat selective mutism. In a systematic review, ten studies were looked at which involved SSRI medications, and all reported medication was well tolerated. [35] In one of them, Black and Uhde (1994) conducted a double-blind, placebo-controlled study investigating the effects of fluoxetine. By parent report, fluoxetine-treated children showed significantly greater improvement than placebo-treated children. In another, Dummit III et al. (1996) administered fluoxetine to 21 children for nine weeks and found that 76% of the children had reduced or no symptoms by the end of the experiment. [36] This indicates that fluoxetine is an SSRI that is indeed helpful in treating selective mutism.

History

In 1877, German physician Adolph Kussmaul described children who were able to speak normally but often refused to as having a disorder he named aphasia voluntaria. [37] Although this is now an obsolete term, it was part of an early effort to describe the concept now called selective mutism.

In 1980, a study by Torey Hayden identified what she called four "subtypes" of elective mutism (as it was called then), although this set of subtypes is not in current diagnostic use. [38] These subtypes are no longer recognized, though "speech phobia" is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, first included selective mutism in its third edition, published in 1980. Selective mutism was described as "a continuous refusal to speak in almost all social situations" despite normal ability to speak. While "excessive shyness" and other anxiety-related traits were listed as associated features, predisposing factors included "maternal overprotection", "mental retardation", and trauma. Elective mutism in the third edition revised (DSM III-R) is described similarly to the third edition except for specifying that the disorder is not related to social phobia.

In 1994, Sue Newman, co-founder of the Selective Mutism Foundation, requested that the fourth edition of the DSM reflect the name change from elective mutism to selective mutism and describe the disorder as a failure to speak. The relation to anxiety disorders was emphasized, particularly in the revised version (DSM IV-TR). As part of the reorganization of the DSM categories, the DSM-5 moved selective mutism from the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" to the section for anxiety disorders. [39]

See also

Citations

  1. ↑ Viana, A. G.; Beidel, D. C.; Rabian, B. (2009). "Selective mutism: A review and integration of the last 15 years". Clinical Psychology Review. 29 (1): 57–67. doi:10.1016/j.cpr.2008.09.009. PMID   18986742.
  2. ↑ Brown, Harriet (12 April 2005). "The Child Who Would Not Speak a Word". The New York Times.
  3. ↑ Adelman, L. (2007). Don't Call me Shy . LangMarc Publishing. ISBN   978-1880292327.
  4. ↑ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. p. 195. ISBN   978-0-89042-555-8.
  5. 1 2 Dummit, E. Steven; Klein, Rachel G.; Tancer, Nancy K.; Asche, Barbara; Martin, Jacqueline; Fairbanks, Janet A. (May 1997). "Systematic Assessment of 50 Children With Selective Mutism". Journal of the American Academy of Child & Adolescent Psychiatry. 36 (5): 653–660. doi: 10.1097/00004583-199705000-00016 . PMID   9136500.
  6. 1 2 Vecchio, J. L.; Kearney, C. A. (2005). "Selective Mutism in Children: Comparison to Youths with and Without Anxiety Disorders". Journal of Psychopathology and Behavioral Assessment. 27: 31–37. doi:10.1007/s10862-005-3263-1. S2CID   144770110.
  7. 1 2 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:10.1097/00004583-199507000-00007. PMID   7649954.
  8. ↑ Yeganeh, R.; Beidel, D. C.; Turner, S. M. (2006). "Selective mutism: More than social anxiety?". Depression and Anxiety. 23 (3): 117–123. doi: 10.1002/da.20139 . PMID   16421889. S2CID   39403140.
  9. ↑ Sharp, W. G.; Sherman, C.; Gross, A. M. (2007). "Selective mutism and anxiety: A review of the current conceptualization of the disorder". Journal of Anxiety Disorders. 21 (4): 568–579. CiteSeerX   10.1.1.560.5956 . doi:10.1016/j.janxdis.2006.07.002. PMID   16949249.
  10. ↑ "Situational / Selective Mutism". 10 June 2023.
  11. ↑ Chvira, Denise A.; Shipon-Blum, Elisa; Hitchcock, Carla; Cohan, Sharon; Stein, Murray B. (2007). "Selective Mutism and Social Anxiety Disorder: All in the Family?". Journal of the American Academy of Child & Adolescent Psychiatry. 46 (11): 1464–472. doi:10.1097/chi.0b013e318149366a. PMID   18049296.
  12. ↑ Bergman, RL; Piacentini, J; McCracken, JT (2002). "Prevalence and description of selective mutism in a school-based sample". J Am Acad Child Adolesc Psychiatry. 41 (8): 938–46. doi:10.1097/00004583-200208000-00012. PMID   12162629. S2CID   20947226.
  13. ↑ "Selective Mutism Symptoms". Theselectivemutism.info. Archived from the original on 2008-08-21. Retrieved 2013-02-21.[ unreliable source? ]
  14. ↑ Online Parent Support (2005-05-26). "Selective Mutism". Myoutofcontrolteen.com. Archived from the original on 2013-01-17. Retrieved 2013-02-21.[ unreliable source? ]
  15. ↑ Moini, Jahangir; Justin Koenitzer; Anthony LoGalbo (2021). Global Emergency of Mental Disorders. London: Academic Press. pp. 82–84. ISBN   978-0-323-85843-4. OCLC   1252050397. However, there are some positive features of selective mutism. These include above average intelligence, inquisitiveness, or perception; a strong sense of right and wrong; creativity; love for the arts; empathy; and sensitivity for other people.[ page needed ]
  16. ↑ Perednik, Ruth (1 June 2012). "An interview with Ruth Perednik: treating selective mutism". North American Journal of Psychology. 14 (2): 365. Gale   A288873877 ProQuest   1013609961. Many are above average in intelligence, creative, and sensitive to others thoughts and feelings.
  17. ↑ "What Is Selective Mutism". Selective Mutism Anxiety & Related Disorders Treatment Center.
  18. ↑ Gensthaler, Angelika; Khalaf, Sally; Ligges, Marc; Kaess, Michael; Freitag, Christine M.; Schwenck, Chrstina (October 2016). "Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar". European Child & Adolescent Psychiatry. 25 (10): 1113–20. doi:10.1007/s00787-016-0835-4. PMID   26970743. S2CID   12074063.
  19. ↑ Cohan, Sharon L.; Chavira, Denise A.; Shipon-Blum, Elisa; Hitchcock, Carla; Roesch, Scott C.; Stein, Murray B. (7 October 2008). "Refining the Classification of Children with Selective Mutism: A Latent Profile Analysis". Journal of Clinical Child & Adolescent Psychology. 37 (4): 770–784. doi:10.1080/15374410802359759. PMC   2925839 . PMID   18991128.
  20. ↑ "Selective Mutism: What it is and Approaches to Intervention". May 2019. Retrieved 2023-02-14.
  21. ↑ Sharp, William G.; Sherman, Colleen; Gross, Alan M. (1 January 2007). "Selective mutism and anxiety: A review of the current conceptualization of the disorder". Journal of Anxiety Disorders. 21 (4): 568–579. CiteSeerX   10.1.1.560.5956 . doi:10.1016/j.janxdis.2006.07.002. PMID   16949249.
  22. ↑ Steinhausen, Hans-Christoph; Juzi, Claudia (May 1996). "Elective Mutism: An Analysis of 100 Cases". Journal of the American Academy of Child & Adolescent Psychiatry. 35 (5): 606–614. doi:10.1097/00004583-199605000-00015. PMID   8935207.
  23. 1 2 Johnson, Maggie; Wintgens, Alison (2001). The Selective Mutism Resource Manual. Speechmark. ISBN   978-0-86388-280-7.[ page needed ]
  24. ↑ Selective Mutism Group: Ask the Doc archives: When do I need to seek professional help for my child? Archived 2012-03-11 at the Wayback Machine
  25. ↑ "What about adults? What are the long-term effects of SM?". Archived from the original on 2012-07-01. Retrieved 2008-05-09.
  26. ↑ Ketteley, Emma (8 April 2008). "Killer's history of social disorders". BBC This World.
  27. ↑ Blau, Ricki. "The Older Child or Teen with Selective Mutism" (PDF).[ self-published source? ]
  28. ↑ "Your Rights Under Section 504 of the Rehabilitation Act" (PDF). June 2006. Retrieved 2023-02-09.
  29. ↑ Klein, Evelyn R.; Armstrong, Sharon Lee; Skira, Kathryn; Gordon, Janice (January 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:10.1177/1359104516633497. PMID   26940121. S2CID   206708229.
  30. 1 2 3 4 5 Kehle, Thomas J.; Madaus, Melissa R.; Baratta, Victoria S.; Bray, Melissa A. (September 1998). "Augmented Self-Modeling as a Treatment for Children with Selective Mutism". Journal of School Psychology. 36 (3): 247–260. doi:10.1016/S0022-4405(98)00013-2.
  31. 1 2 3 4 5 Shriver, Mark D.; Segool, Natasha; Gortmaker, Valerie (2011). "Behavior Observations for Linking Assessment to Treatment for Selective Mutism". Education and Treatment of Children. 34 (3): 389–410. doi:10.1353/etc.2011.0023. S2CID   143555332.
  32. 1 2 3 Anstendig, Karin (1998). "Selective mutism: A review of the treatment literature by modality from 1980–1996". Psychotherapy: Theory, Research, Practice, Training. 35 (3): 381–391. doi:10.1037/h0087851.
  33. ↑ "WHAT is Selective Mutism?" (PDF).[ unreliable source? ]
  34. ↑ "Treatment Of Selective Mutism". 21 March 2019.[ unreliable source? ]
  35. ↑ Manassis, Katharina; Oerbeck, Beate; Overgaard, Kristen Romvig (June 2016). "The use of medication in selective mutism: A systematic review". European Child & Adolescent Psychiatry. 25 (6): 571–8. doi:10.1007/s00787-015-0794-1. PMID   26560144. S2CID   5859770.
  36. ↑ Dummit, E Steven; Klein, Rachel G.; Asche, Barbara; Martin, Jacqueline; Tancer, Nancy K. (May 1996). "Fluoxetine Treatment of Children with Selective Mutism: An Open Trial". Journal of the American Academy of Child & Adolescent Psychiatry. 35 (5): 615–621. doi: 10.1097/00004583-199605000-00016 . PMID   8935208.
  37. ↑ Tots, Bright. "Selective mutism what is selective mutism childhood disorder". Archived from the original on 2007-12-14. Retrieved 2009-07-14.
  38. ↑ Torey Hayden. Classification of Elective Mutism
  39. ↑ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp.  189. ISBN   978-0-89042-555-8.

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Mental disorders diagnosed in childhood can be neurodevelopmental, emotional, or behavioral disorders. These disorders negatively impact the mental and social wellbeing of a child, and children with these disorders require support from their families and schools. Childhood mental disorders often persist into adulthood. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM-5 and in the ICD-11.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

<span class="mw-page-title-main">Panic disorder</span> Anxiety disorder characterized by reoccurring unexpected panic attacks

Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.

Ruth Perednik is an English-born Israeli psychologist, pioneer in the field of selective mutism.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders developed in 1997. The SCARED is intended for youth, 9–18 years old, and their parents to complete in about 10 minutes. It can discriminate between depression and anxiety, as well as among distinct anxiety disorders. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and school anxiety problems. Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV and DSM-5 categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.

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