ORCID Profile
0000-0003-1450-8457
Current Organisations
St George's Hospital
,
University of Oxford
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Publisher: Springer International Publishing
Date: 2021
Publisher: Royal College of Surgeons of England
Date: 04-2021
Abstract: Selective mutism (SM) is an anxiety disorder that is characterised by a consistent failure to speak in certain social settings where the in idual is expected to speak while in other situations, speech is normal. It often starts in childhood and is thought to affect around 1 in 140 children in the UK. If recognised and treated early, SM can be overcome but left untreated, it can lead to long-term problems. It is thought to be caused by a complex interaction between various vulnerabilities such as genetics, temperament, environment and neurodevelopmental factors. Treatment methods are variable and can include non-medication-based therapies (eg behavioural therapy) or pharmacotherapy. This paper specifically addresses the child with SM. Few professionals are trained in dealing with SM and many have little knowledge of the condition. SM awareness for parents and professionals along with appropriate information and intervention techniques are vital. For children with SM, dental visits can prove challenging. Each child is unique in how they present with their difficulties. A child attending the dentist for a dental problem or a routine examination may not yet be diagnosed with SM, and so knowledge of the condition and what appropriate services are available is important. The dental team should understand the possible modes of therapy that the child is receiving and work with these principles during dental appointments. Simple strategies such as asking the parent how best to communicate with the child, understanding what makes the child feel at ease and whether the child has any other phobias or anxieties can help.
Publisher: Wiley
Date: 03-05-2023
DOI: 10.1002/JCV2.12166
Abstract: Selective mutism (SM) is an anxiety disorder that often starts in early years with serious and lasting consequences. Nonpharmacological interventions are commonly seen as the preferred first treatment. This systematic review identifies outcome measures used and outcomes achieved for nonpharmacological interventions for children and adolescents with SM. Systematic searches were conducted using 13 electronic databases and hand searches, including peer‐reviewed and grey literature since 1992. Twenty‐five studies were identified. While specific measures varied, all studies reported an outcome measure for speaking behaviour and 18 used a measure of anxiety. Few studies reported measures of SM remission ( k = 6), well‐being ( k = 6), academic impact ( k = 2), or quality of life ( k = 1). Within subject outcomes for nonpharmacological interventions were variable for improvements in speaking behaviours (very small to large positive effects) and reduction in anxiety symptoms (very small negative to large positive effects). Only five randomised controlled trials (RCTs) were included in the meta‐analysis. Three studies compared a combined systems/behavioural approach with waitlist controls indicating a significant and large effect (Hedges g = 1.06, p .0001, 95% CI: 0.57–1.56) on improved speaking behaviour. Two of these RCTs showed a large effect for SM remission favouring the intervention (Risk Ratio = 4.25, p = .1774, 95% CI: 0.52–34.84) but this did not reach statistical significance. Non‐significant outcomes for two RCTs with active controls (Hedges g = 0.55, p .2885, 95% CI: −0.47 to 1.57) showed considerable heterogeneity in approach and outcomes, one with large and one with negligible effects. Despite the considerable impairment caused by SM, there has been little systematic evaluation of non‐pharmacological interventions. Although combined systems/behavioural interventions are promising, further systematic evaluations are urgently needed to inform treatment approaches. Cross‐study measurement harmonisation is required to promote learning from all studies, including wider clinical and economic outcomes. Not applicable.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Gino Hipolito.