Betrayed by the nervous system: a comparison group study to investigate the 'unsafe world' model of selective mutism.

The study presented in the following verifies some assumptions of the novel 'unsafe world' model of selective mutism (SM). According to this model, SM is a stress reaction to situations erroneously experienced via cognition without awareness as 'unsafe'. It assumes a high sensitivity to unsafety, whereby the nervous system triggers dissociation or freeze mode at relatively low thresholds. We examine whether there is a correlation between SM, sensory-processing sensitivity and dissociation. We compared a sample of 28 children and adolescents with SM (mean age 12.66 years; 18 females) to 33 controls without SM (mean age 12.45 years; 21 females). Both groups were compared using a medical history sheet, the 'Selective Mutism Questionnaire' (SMQ), a 'Checklist for Speaking Behaviour' (CheckS), the 'Highly Sensitive Person Scale' (HSPS), the 'Child Dissociative Checklist' (CDC), the 'Adolescent Dissociative Experience Scale' (A-DES) and the 'Social Phobia and Anxiety Inventory for Children' (SPAIK). Appropriate parametric and non-parametric tests were conducted to examine differences between groups. The results indicate that sensory-processing sensitivity was significantly higher in the group of children and adolescents with SM [X2(1) = 7.224, p = 0.0007; d = 1.092]. Furthermore, dissociative symptoms were more common in children and adolescents with SM than in controls [F(1, 33) = 13.004, p = 0.001; d = 0.986]. The results indicate that sensory-processing sensitivity and dissociation are important factors of SM that may hold important implications for the treatment. TRIAL REGISTRATION: This study is registered with the ClinicalTrials.gov number NCT04233905.

[Cognition in children with social anxiety disorder experiencing stress]. / Kognitionen von Kindern mit sozialer Angststörung unter Stress.

Cognition in children with social anxiety disorder experiencing stress Abstract. Empirical data on cognitions of children with social anxiety disorder (SAD) are inconclusive. Objective: The present study examines the significance of cognition in children with SAD. Method: Thirty children suffering from SAD and 30 control children free of diagnosis (HC) aged between 9 and 15 years took part in an experiment. Their cognition was assessed before, during, and after a stress-inducing social situation. The assessment method was a self-report measurement. Coping perception was also assessed. Results: Children with SAD did not report a higher level of negative or coping cognition than those in the HC group. An interaction was apparent on the positive cognition scale: Older children (11-12 or 13-15 years) with SAD reported less positive cognition than those in the HC group, and younger children with SAD (9-10 years) reported more than those in the HC group. No group differences were found for perceived coping. Conclusions: The findings are important to the cognitive model and for the psychological treatment of SAD in children.

[School refusal and dropping out of school: positioning regarding a Swiss perspective]. / Schulverweigerung und Schulabbruch: Eine Standortbestimmung unter Berücksichtigung von Perspektiven aus der Schweiz.

This article deals with refusal to attend school and dropping out of school from the point of view of child and adolescent psychiatry and psychology, in German speaking countries and from the perspective of Swiss schools and their administrative bodies. General epidemiological data on refusal to attend school show that approximately 5% of children and adolescents are likely to try to avoid attending school at some point. There is very little data available on the frequency of school drop-out. In the past two years (2011 and 2012), approximately 2% of all patients seen for the first time at the department of Child and Adolescent Psychiatry, University Zurich, were referred because of failure to attend school, making this phenomenon one of the most common reasons for referral in child and adolescent psychiatry. After a discussion of the epidemiology, symptomatology, causes and its risk factors, the article presents examples drawn from practice and guidelines for intervention in cases of refusal to attend school, and discusses ways of preventing school drop-out from the point of view of schools, hospitals and bodies such as educational psychology services in Switzerland.

Emotion regulation in selective mutism: A comparison group study in children and adolescents with selective mutism.

A deficit in emotion regulation skills could be an important factor influencing the vulnerability and maintenance of symptoms in selective mutism (SM). Unfortunately, to date only a few studies have examined emotion regulation in SM. Therefore, the present study investigated whether SM is associated with dysfunctional emotion regulation strategies. We compared a sample of 28 children and adolescents with SM (M = 12.66 years, SD = 3.98; 18 females) to 33 controls without SM (M = 12.45 years, SD = 3.18; 21 females). Both groups were investigated for the assessment of SM, social anxiety and emotion regulation using self and parent report questionnaires. We assumed that the disorder is associated with less adaptive and more maladaptive strategies, especially maladaptive cognitive strategies. Instead of significant differences in these overall values, only significant differences in individual emotion regulation strategies were found. In terms of adaptive strategies, children and adolescents with SM reported less problem-oriented behaviour and less cognitive problem-solving. Instead, they reported the maladaptive strategy of abandonment more often than the control group. In contrast to other anxiety disorders, children and adolescents with SM did neither report maladaptive cognitive strategies nor seek support more frequently than the control group. Their emotion regulation strategies are qualitatively closely related to the symptoms of SM, which makes it difficult to determine their independent significance. Trial registration: This study is registered with the ClinicalTrials.gov number NCT04233905.

Family Relationships in Selective Mutism-A Comparison Group Study of Children and Adolescents.

Selective mutism (SM) mostly develops early in childhood and this has led to interest into whether there could be differences in relationships in families with SM compared to a control group without SM. Currently, there are merely few empirical studies examining family relationships in SM. A sample of 28 children and adolescents with SM was compared to 33 controls without SM. The groups were investigated using self-report questionnaires (Selective Mutism Questionnaire, Child-Parent Relationship Test-Child Version) for the assessment of SM and family relationships. Children with SM did not report a significantly different relationship to their mothers compared with the control group without SM. However, the scores in respect to the relationship to their fathers were significantly lower in cohesion, identification and autonomy compared with children without SM. Relationships in families with SM should be considered more in therapy.

[Psychometric properties and clinical norms for the German version (SPAIK) of the Social Phobia and Anxiety Inventory for Children (SPAI-C)]. / Psychometrische Eigenschaften und Normierung des Sozialphobie und -angstinventars für Kinder (SPAIK) an einer klinischen Stichprobe.

OBJECTIVE: The Social Phobia and Anxiety Inventory for Children (SPAIK) is a frequently used German questionnaire. The study investigates its psychometric properties and norms in a clinical study. METHODS: The questionnaire was presented to a clinical sample of n = 320 school-age children (7 to 18 years) prior to beginning therapy. RESULTS: The items indicated a high internal consistency and homogeneity. With regard to dimensions, a one-factor solution was preferred. As to validity, there was a significant difference in total score between the normal and the clinical sample. The sample was also used to provide some normative data. CONCLUSIONS: The SPAIK appears to be a reliable and valid measure of childhood social anxiety.

[Treatment of selective mutism]. / Uberblick zur Behandlung des Selektiven Mutismus.

Selective mutism is a communication disorder of childhood in which the child does not speak in specific social situations despite the ability to speak in other situations. A literature review was completed in order to provide practical guidelines for the assessment and treatment of children with selective mutism. There are many different behavioral approaches in the treatment of this disorder, e.g. contingency management, shaping, stimulus fading, escape-avoidance, self-modeling, learning theory approaches. A clearer diagnostic understanding of the disorder as part of anxiety or oppositional disorders needs to be realized prior to generalize an effective treatment for this disorder.

[Socially anxious cognitions scale for children]. / Fragebogen zur Erfassung sozial ängstlicher Kognitionen bei Kindern und Jugendlichen.

In our study we investigated the psychometric properties of the Socially Anxious Cognitions Scale for Children (SAKK). This scale is a measure designed for children and is based on the Children's Cognitive Assessment Questionnaire (CCAQ). We presented it to 600 pupils along with the German version of the Social Phobia and Anxiety Inventory for Children (SPAI-C). The new instrument showed good psychometric properties. Normative values for the SAKK are presented for grades 3-6.

[Treatment of social phobia in childhood and adolescence]. / Die Behandlung sozialer Angste im Kindes- und Jugendalter.

OBJECTIVES: The following article investigates the extent to which the current status of cognitive behavioral research on the treatment of socially phobic children and adolescents is reflected by the currently used guidelines for psychotherapy. METHODS: The current literature on research in psychotherapy was systematically reviewed. RESULTS: The results show the significance of single-setting treatment, of cognitive interventions, and of parental participation in the therapy. The results also show the limitations encountered if the treatment consists only of training social competence skills. CONCLUSIONS: The current treatment recommendations for socially phobic children must be supplemented and modified.

[Validation of the German version of the Australian Scale of Asperger's Syndrome (ASAS)]. / Validierung der deutschen Version der Australian Scale of Asperger's Syndrome (ASAS).

OBJECTIVES: The aim of the study was to validate the German version of the Australian Scale for Asperger's Syndrome (ASAS). Furthermore, the scoring of the ASAS as applied by the Australian authors was verified. METHODS: The mothers of 18 children with Asperger's Syndrome, those of 18 children referred for a possible diagnosis of Asperger's Syndrome, but who did not receive that diagnosis, and the mothers of 15 children with other mental disorders participated in the study. All of the children were inpatients at the University of Wuerzburg Hospital of Child and Adolescent Psychiatry. RESULTS: According to an analysis of variance, the scale successfully differentiates among the three samples. A stepwise discriminant analysis was performed. Classification results show that the membership of the three groups could be labelled accurately (accuracy rate: 60.78%). The ASAS's scoring methodology appears to yield good results for German patients. CONCLUSIONS: The scale appears to be an adequate tool for screening purposes in that it correctly discriminates children and adolescents with Asperger's Syndrome.

Obsessive-compulsive disorder in children and adolescents.

BACKGROUND: Early-onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses of children and adolescents, with prevalence of 1% to 3%. Its manifestations often lead to severe impairment and to conflict in the family. In this review, we summarize the manifestations, comorbidity, pathophysiology, and course of this disease as well as current modes of diagnosis and treatment. METHODS: We selectively review the relevant literature and the German-language guidelines for the diagnosis and treatment of mental illnesses in children and adolescents. RESULTS: Obsessive-compulsive manifestations are of many types and cause severe impairment. Comorbid mental disturbances are present in as many as 70% of patients. The disease takes a chronic course in more than 40% of patients. Cognitive behavioral therapy is the treatment of first choice, followed by combination pharmacotherapy including selective serotonin reuptake inhibitors (SSRI) and then by SSRI alone. CONCLUSION: OCD often begins in childhood or adolescence. There are empirically based neurobiological and cognitive-behavioral models of its pathophysiology. Multiaxial diagnostic evaluation permits early diagnosis. Behavioral therapy and medications are highly effective treatments, but the disorder nonetheless takes a chronic course in a large percentage of patients.

Cognitive behavioral therapy of socially phobic children focusing on cognition: a randomised wait-list control study.

BACKGROUND: Although literature provides support for cognitive behavioral therapy (CBT) as an efficacious intervention for social phobia, more research is needed to improve treatments for children. METHODS: Forty four Caucasian children (ages 8-14) meeting diagnostic criteria of social phobia according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; APA, 1994) were randomly allocated to either a newly developed CBT program focusing on cognition according to the model of Clark and Wells (n = 21) or a wait-list control group (n = 23). The primary outcome measure was clinical improvement. Secondary outcomes included improvements in anxiety coping, dysfunctional cognitions, interaction frequency and comorbid symptoms. Outcome measures included child report and clinican completed measures as well as a diagnostic interview. RESULTS: Significant differences between treatment participants (4 dropouts) and controls (2 dropouts) were observed at post test on the German version of the Social Phobia and Anxiety Inventory for Children. Furthermore, in the treatment group, significantly more children were free of diagnosis than in wait-list group at post-test. Additional child completed and clinician completed measures support the results. DISCUSSION: The study is a first step towards investigating whether CBT focusing on cognition is efficacious in treating children with social phobia. Future research will need to compare this treatment to an active treatment group. There remain the questions of whether the effect of the treatment is specific to the disorder and whether the underlying theoretical model is adequate. CONCLUSION: Preliminary support is provided for the efficacy of the cognitive behavioral treatment focusing on cognition in socially phobic children. Active comparators should be established with other evidence-based CBT programs for anxiety disorders, which differ significantly in their dosage and type of cognitive interventions from those of the manual under evaluation (e.g. Coping Cat).

The extent of social anxiety in combination with mental disorders.

The aim of the study was to investigate the extent of social anxiety in different mental disorders. A total of 341 patients aged 7-18 years participated in the study. To measure social anxiety, the German version (SPAIK) of the Social Phobia and Anxiety Inventory for Children (SPAI-C) was used. Subgroups were built dependent on mental disorders. A total score above 20, which was assumed to indicate social anxiety, was observed in children with selective mutism (n = 9; M = 22.68; SD = 11.29) and in children with Asperger's Syndrome (n = 7; M = 20.77; SD = 13.77). Patients who had the following mental disorders also showed a higher total score of social anxiety: obsessive-compulsive disorder, anorexia nervosa, schizophrenia, depression and conduct disorder. In none of these disorders, however, did the mean total score exceed the cut-off of 20.