Østergaard Kasper Rud
a Centre for Child and Adolescent Psychiatry, Research Unit , Aarhus University Hospital, Risskov , Risskov , Denmark.
Nord J Psychiatry. 2018 May;72(4):240-250. doi: 10.1080/08039488.2018.1439530. Epub 2018 Feb 15.
Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature.
To test whether there is evidence on treatment based on CBT, medication or a combination of these.
Systematic and critical review of the literature on CBT and/or pharmacological treatments of SM. Literature was sought on PubMed, Embase and Psycinfo in March 2017.
Of the included studies, six examined CBT, seven pharmacologic treatment and two a combination of these. Using CBT 53/60 children improved symptomatically whilst respectively 55/67 and 6/7 improved using pharmacologic- and combination-treatment.
Pharmacologic treatment and especially CBT showed promising results supported by some degree of evidence, which combination treatment lacks. Yet small numbers, few RCTs, heterogeneous study designs, lack of consistent measures, short treatment and follow-up periods, generally limits the evidence. This needs focus in future research.
选择性缄默症（SM）是一种使人衰弱的儿童焦虑症，其特征是在某些社交场合持续不说话，且被认为难以治疗。认知行为疗法（CBT）和药物治疗是文献中描述得最多的治疗方法。
检验是否有基于CBT、药物或两者结合的治疗证据。
对关于SM的CBT和/或药物治疗的文献进行系统和批判性综述。于2017年3月在PubMed、Embase和Psycinfo上检索文献。
在纳入的研究中，六项研究了CBT，七项研究了药物治疗，两项研究了两者的结合。使用CBT时，60名儿童中有53名症状改善，而使用药物治疗和联合治疗时，分别有67名中的55名和7名中的6名症状改善。
药物治疗尤其是CBT显示出有前景的结果，有一定程度的证据支持，而联合治疗缺乏此类证据。然而，研究数量少、随机对照试验少、研究设计异质性、缺乏一致的测量方法、治疗和随访期短，这些通常限制了证据。这是未来研究需要关注的重点。
