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

J Am Acad Child Adolesc Psychiatry. 2007 Sep;46(9):1187-1195. doi: 10.1097/CHI.0b013e318076b7ab.


Objectives: 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.

Method: 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.

MeSH terms

  • Adolescent
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / psychology*
  • Child
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology*
  • Comorbidity
  • Female
  • Humans
  • Language Disorders / diagnosis
  • Language Disorders / epidemiology*
  • Language Tests
  • Male
  • Mutism / epidemiology*
  • Mutism / psychology*
  • Neuropsychological Tests
  • Severity of Illness Index