Residual symptoms of selective mutism in adolescence: associations with perfectionism and psychopathology

Background

Selective mutism (SM) is an early-onset anxiety disorder that often shows partial remission; however, residual symptoms and associated psychopathology may persist into adolescence. Although traditionally considered a childhood-limited condition, emerging evidence suggests that SM may be associated with enduring emotional, behavioural, and developmental difficulties. Long-term outcomes, particularly in relation to anxiety, perfectionism, and self-concept, remain insufficiently characterised. Understanding these long-term outcomes is important for improving assessment and intervention strategies.

Aims

This study aimed to examine current psychiatric status, anxiety, perfectionism, and self-esteem in adolescents with a childhood history of SM, and to evaluate the associations between residual SM symptoms, individual and parental perfectionism, and parenting attitudes.

Methods

This single-centre, cross-sectional follow-up study included 36 adolescents aged 12-18 years with a prior diagnosis of SM between 2015 and 2020, and their parents. SM diagnosis was confirmed through file review and clinical evaluation. Lifetime and current psychiatric diagnoses were assessed using the DSM-5-adapted K-SADS-PL semi-structured diagnostic interview. Adolescents completed measures of anxiety, perfectionism, self-esteem, and perceived parenting attitudes; parents completed self-report measures of perfectionism and parenting attitudes. Adolescents were classified according to current SM symptom status. Descriptive statistics, group comparisons, correlation analyses, and logistic regression analysis were conducted. Statistical significance was set at p < 0.05. In addition, analyses were conducted to examine associations between clinical variables and residual symptom severity.

Results

At least one psychiatric diagnosis during adolescence was present in 94.4% of participants; the most common comorbidities were attention-deficit/hyperactivity disorder (55.6%), specific learning disorder (41.7%), and social anxiety disorder (36.1%). Six adolescents met full SM criteria, and 10 showed subthreshold symptoms. According to parent reports, a longer duration of selective mutism symptoms was associated with higher social anxiety levels (p < 0.05). Contrary to expectations, adolescents without current SM symptoms had higher self-oriented perfectionism scores. In logistic regression analysis, self-oriented perfectionism was negatively associated with the presence of SM symptoms in adolescence (OR = 0.67, p < 0.01). Parental perfectionism and general parenting attitudes were not directly associated with SM symptoms. Higher anxiety levels were associated with increased perfectionism and lower self-esteem. Approximately half of the adolescents were still under psychiatric follow-up at the time of assessment, and more than one-third were receiving psychotropic medication.

Conclusions

Selective mutism appears to be associated with lasting emotional and developmental challenges beyond childhood. Persistent anxiety, frequent neurodevelopmental comorbidity, and specific dimensions of perfectionism appear relevant to adolescent outcomes, even when speech symptoms partially remit. These results suggest that improvement in speech alone may not reflect full clinical recovery. Long-term, developmentally informed follow-up focusing on anxiety regulation, self-concept, and functional outcomes may be particularly important for adolescents with a history of selective mutism. These findings also highlight the potential importance of targeting anxiety and self-related processes in intervention and follow-up. However, causal interpretations are limited by the cross-sectional design.

References

No references