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A long-term outcome study of selective mutism in childhood


Hans-Christoph Steinhausen, Department of Child and Adolescent Psychiatry, University of Zurich, Neumünsterallee 9, CH-8032 Zurich, Switzerland; Tel. ++41 (0) 43 499 27 32; Fax ++41 (0) 43 499 26 02; Email:;


Objective:  Controlled study of the long-term outcome of selective mutism (SM) in childhood.

Method:  A sample of 33 young adults with SM in childhood and two age- and gender-matched comparison groups were studied. The latter comprised 26 young adults with anxiety disorders in childhood (ANX) and 30 young adults with no psychiatric disorders during childhood. The three groups were compared with regard to psychiatric disorder in young adulthood by use of the Composite International Diagnostic Interview (CIDI). In addition, the effect of various predictors on outcome of SM was studied.

Results:  The symptoms of SM improved considerably in the entire SM sample. However, both SM and ANX had significantly higher rates for phobic disorder and any psychiatric disorder than controls at outcome. Taciturnity in the family and, by trend, immigrant status and a severity indicator of SM had an impact on psychopathology and symptomatic outcome in young adulthood.

Conclusion:  This first controlled long-term outcome study of SM provides evidence of symptomatic improvement of SM in young adulthood. However, a high rate of phobic disorder at outcome points to the fact that SM may be regarded as an anxiety disorder variant.