![]() ![]() Additionally, etiological similarities between both disorders exist such as the increased risk of the temperament of Behavioral Inhibition (BI) during early childhood. The overlap between SM and SAD is, for example, reflected in high comorbidity rates up to 100% of SAD in children with SM and findings that social fear is a central phenomenon in children with SM. ![]() SAD is characterized by a marked fear of being evaluated by others in social situations as well as physiological symptoms. The reason for this was evidence that SM shares numerous similarities with other anxiety disorders, particularly social anxiety disorder (SAD). With the introduction of the DSM-5, SM was classified among anxiety disorders for the first time. Previous research suggests a prevalence of approximately 1%, although the occurrence of SM is probably underestimated. The disorder is associated with a chronic course of increased psychopathological symptoms persisting into adulthood and resulting in impairments in academic and socio-emotional development. Selective mutism (SM) is a mental health disorder in which affected children fail to speak in certain social situations where they are expected to, but their speech remains unaffected in other situations. Treatment of SM should take into account that children with SM may suffer from chronically elevated stress levels and that different mechanisms might operate in verbal and nonverbal social situations. Our findings support the idea that the failure to speak might function as an avoidance mechanism, which is already active in anticipation of a verbal situation. Furthermore, the differential physiological stress response may indicate that silence acts as a maladaptive compensatory mechanism reducing stress in verbal social situations, which does not function in nonverbal situations. The increased tonic arousal generalized to non-social situations in SM could indicate a long-term alteration of the autonomic nervous system. Further analyses revealed that children with SM who did not speak during the verbal task already demonstrated reduced arousal in anticipation of the verbal task. ResultsĬhildren with SM were characterized by increased tonic arousal compared to the other two groups, and by a more inflexible stress response in the nonverbal but not in the verbal task compared to TD-children. We assessed in a total of N = 96 children resting baseline arousal in absence of social threat and the course of physiological fear response in two social stress paradigms, differing in terms of whether the children are expected to speak (verbal task) or not (nonverbal task). The aim of our study is to investigate psychophysiological mechanisms of the failure to speak in children with SM. Due to the large overlap between SM and SAD, similar mechanisms might apply to both disorders, while differences might explain why children with SM fail to speak. ![]() In contrast, children with SAD are characterized by a combination of a chronically elevated physiological arousal and a blunted physiological fear response to social stress. However, psychophysiological studies in children with SM are scarce and physiological mechanisms underlying the failure to speak are largely unknown. Selective mutism (SM) has been conceptualized as an extreme variant of social anxiety disorder (SAD), in which the failure to speak functions as an avoidance mechanism leading to a reduction of intense fear arousal. ![]()
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