Black B, Uhde T W
New England Medical Center, Boston, MA 02111, USA.
J Am Acad Child Adolesc Psychiatry. 1995 Jul;34(7):847-56. doi: 10.1097/00004583-199507000-00007.
To ascertain characteristics of children with selective mutism.
Subjects with selective mutism were evaluated by means of parent and teacher rating scales and structured diagnostic interviews.
Thirty children were evaluated. Mutism severity varied markedly in different environmental settings. Ninety-seven percent of the subjects were diagnosed with social phobia or avoidant disorder of childhood or adolescence or both and 30% with simple phobia. No other psychiatric disorders were common. Parent and teacher rating scales showed high levels of anxiety symptoms, especially social anxiety, and low levels of all other psychiatric symptoms. Anxiety and social anxiety severity correlated with mutism severity. First-degree family history of social phobia and of selective mutism, obtained by family history method, was present in 70% and 37% of families, respectively. There was no evidence of a causal relationship between psychologically or physically traumatic experiences and development of selective mutism.
Selective mutism may be a symptom of social anxiety, rather than a distinct diagnostic syndrome. Further study of the characteristics of children with selective mutism and their families is warranted.
确定选择性缄默症儿童的特征。
通过家长和教师评定量表以及结构化诊断访谈对选择性缄默症患者进行评估。
对30名儿童进行了评估。缄默严重程度在不同环境中差异显著。97%的受试者被诊断患有社交恐惧症或儿童期或青春期回避型障碍，或两者兼有，30%被诊断患有单纯恐惧症。无其他常见精神障碍。家长和教师评定量表显示焦虑症状水平较高，尤其是社交焦虑，而其他所有精神症状水平较低。焦虑和社交焦虑严重程度与缄默严重程度相关。通过家族史方法获得的社交恐惧症和选择性缄默症一级家族史分别存在于70%和37%的家庭中。没有证据表明心理或身体创伤经历与选择性缄默症的发展之间存在因果关系。
选择性缄默症可能是社交焦虑的一种症状，而非一种独特的诊断综合征。有必要对选择性缄默症儿童及其家庭的特征进行进一步研究。
