Anxiety disorder

 Anxiety Disorder a mental condition where individuals respond to threat such as environmental changes. There are different types of anxiety disorders and these types differ with respect to situations that trigger fear and anxiety. Clinicians conduct diagnosis by employing cultural contextual factors to understand whether the disorder is developmentally normative or persistent fear (American Psychiatric Association, 2013). In addition, clinicians conduct diagnosis of the different anxiety disorders when they are aware that the disorder is not contributed by physiological effects. According to American Psychiatric Association, individuals may suffer from separation anxiety disorder due to the feeling that emotional attachment is separated.  Selective mutism is also a condition where individuals especially children are unable to communication in some social settings simply because they feel uncomfortable and unsecured. Other type of anxiety disorder is specific phobia and this occur when individual develop fear due to specific situations   such as negative experience with  animals. People also develop social phobia when they meet with unfamiliar people, eat in presence of people and fear being humiliated. Panic disorder is contributed by physical and cognitive factors that cause panic due to situation or panic for no reason. Last is agoraphobia and this occur when an individual develop fear when walking alone, finds himself in either open or encloses places among other situations.

 

 Selective Mutism

Diagnostic Criteria

 A person with this condition fails to speak in expected situations like school, and speaks in other situations. This condition interferes with life since social life such as education, social activities and interactions are minimized. During diagnosis, a child must have shown the symptom for a least one month. An important point to note is that a person does not refuse to speak due to lack of knowledge on the language being spoken. In addition, the condition is not as a result of communication disorder or other psychotic disorder.

 

 Diagnostic features

  Children with selective mutism do not talk with other people in social interactions.  When they meet their friends, relatives, schoolmates and teachers, they develop social anxiety.  This leads to disastrous effects since teachers are unable to asses skills and other adults may not understand the social needs of the child.  However, these children talk to their family members, and in school they may use nonverbal means as they also feel the need to perform in social settings.

 Associated Features

Associated features with selective disorder are oppositional behaviors, social isolation, children show shyness in social setting, they fear social embarrassments and they always show negativism. An important point is that such children have the necessary language skills but their behaviors relate with communication disorder though not medically identified.  In diagnosis, physician considers other disorders such as social phobia.

Prevalence

  The prevalence is 0.03% and 1% as it shown by clinical samples. The prevalence also varies due to factors such as setting and age. However, sex or race is assessed when measuring prevalence.  This disorder is very rare and young children are more vulnerable compared with adults. In diagnosing prevalence rates of childhood disorder, selective mutism is not included since it is not well understood.

Development and course

            This condition or symptoms of selective mutism occur when a children is below 5 years.  The problem is detected when a child join school since social interaction and performance will help identify the problem. This is the period when the child develops social resistance and poor academic performance due to inability to read. This condition also changes in terms of physiology or in other words, the condition may disappear but in some cases the symptoms may stay for several years. The clinical research has not reported the cause of chronic condition.

Risk and Prognostic factors

Behavioral inhibit, or anxiety toward unfamiliar situation may be rooted from parental history.  In addition, children with selection autism have problems in understanding the spoken language.  Parents who develop social inhibit in social interaction contribute to selection mutism to their children. Environmental factors also show that  parents  to these children were overprotective or protect  their children excessively compared with parents whose children has no selective mutism. Physiological factors explain that the condition may be contributed by benefit factors which exist between selective mutism and social phobes.

 Cultural-related diagnosis issues

 Research has shown that immigrant children are at a risk of developing selective mutism   since they face language problems. In the new country, children remain silent since lack of knowledge becomes an obstacle. They face challenges in speaking second language and this is termed as a cultural issues. However,  clinician may diagnose selective mutism if challenges to learning second language have been met  or programs to teach second language   have been developed, yet children suffer from selective mutism.  

 

Functional consequences

 Since children with selective mutism fear socializing with children and other people in social setting, they develop social impairment.  In their adulthood, the probability of being isolated is high.  In academic setting, they develop academic impairment where they show poor performance. Due to lack of communication, teachers are unable to meet their academic needs.  In school, these children are disturbed and annoyed by other students. This increases social rejection to avoid peer teasing.

Differential diagnosis

Communication disorder such as speech sound disorder, stuttering, language disorders among others should not be placed in the category of selective mutism. This is because, communication disorder does not occur in specific social situation but selective mutism occurs specifically on social setting and disappears when children interact with family members or other close people. The second point is that children with psychotic disorders are not able to speak in social situations. Thus, a difference should make between psychotic disorders and selective mutism. In addition, clinicians should diagnose selective mutism if a child refuses to speak in expected places and speak in specific settings. Last is social phobia and the point is that social phobia and selective mutism are related and thus clinicians should diagnose both to make conclusion.

 Comorbidity

            Comorbidity or others diseases that may occur at the same time with selective mutism include social anxiety disorder, separation anxiety disorder, opposition behaviors and communication delays.

 

 

 

Reference

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub,