Clinical characteristics according to sex and symptom severity in children with selective mutism: a four-center study

Abstract

Introduction

Clinical information regarding selective mutism (SM), a persistent and debilitating psychiatric disorder, in children is extremely limited. We aimed to examine sociodemographic characteristics and comorbid psychiatric conditions and identify clinical variables associated with sex and SM severity among children with SM.

Methods

We analyzed the medical records of 49 children who received treatment for SM in four different tertiary hospitals in Turkey between 2016 and 2021. Children’s charts were reviewed to examine clinical characteristics, comorbidities, and response to treatment.

Results

Thirty-one children were female, and 18 were male (female:male ratio is 1.7:1). Most children (73.5%) with SM displayed onset of SM in 3–6 years. However, most children (57.1%) were diagnosed between the ages of 7–11. The mean time from onset to diagnosis was 1.69 ± 1.37 years. Females displayed a later onset of SM (6.42 ± 2.40 vs. 4.89 ± 0.96; p= 0.013) and higher comorbidity rates (71% vs. 38.9%, p= 0.039) than males. The vast majority of children received two or more psychiatric diagnoses. Children in the severe group had a longer duration of illness, higher rates of psychiatric comorbidity, speech delay, and treatment resistance.

Conclusion

Our study suggests that SM may have different clinical features according to sex and symptom severity of SM. More information about children with SM is needed to understand the development and maintenance of SM.

Keywords:

• Comorbidity
• selective mutism
• sex differences
• severity

Acknowledgements

The authors thank all the children and their families who participated in this study.

Ethical approval

This study was approved by the local Ethics Committee of the Medical Faculty of the Cumhuriyet University (reference number: 2021-02/40).

Disclosure statement

The authors have no conflicts of interest to report.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [HD], upon reasonable request.

Additional information

Notes on contributors

Hicran Dogru

Hicran Dogru, MD, is currently a clinical instructor at the Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, USA.

Ilknur Ucuz

Ilknur Ucuz, MD, is an associate professor at the Department of Child and Adolescent Psychiatry, Inonu University, Malatya, Turkey.

Ayla Uzun Cicek

Ayla Uzun Cicek, MD, is an associate professor at the Department of Child and Adolescent Psychiatry, Cumhuriyet University, Sivas, Turkey.

Semiha Comertoglu Arslan

Semiha Comertoglu Arslan, MD, is an assistant professor at the Department of Child and Adolescent Psychiatry, Kahramanmaraş Sütçüimam University, Kahramanmaraş, Turkey.