PREVALENCE AND TREATMENT OF SELECTIVE MUTISM IN CLINICAL-PRACTICE - ASURVEY OF CHILD AND ADOLESCENT PSYCHIATRISTS

This study investigates the use of medications by child and adolescent psychiatrists for treating selective mutism. In 1993, a one-page surv ey was mailed to 962 child and adolescent psychiatrists selected at ra ndom from approximately 2500 active members of the American Academy of Child and Adolescent Psychiatry. Of the 962 questionnaires sent, 411 were returned (return rate 43%) and 308 were completed (sample partici pation rate 32%). A prevalence estimate of selective mutism within a c linical sample was calculated to be 1 case of selective mutism per 936 new patients (0.11%). Less than two-thirds (199/308) of the respondin g psychiatrists reported having treated a child with selective mutism in their practice. Of those who had treated a child with selective mut ism, 36% (n = 71) reported having prescribed medication for this disor der. Antidepressants were the most frequently endorsed medication for being potentially beneficial in treating a hypothetical case example a nd, in addition, for being actually used by child psychiatrists in cli nical practice for children diagnosed with selective mutism. Antianxie ty agents were reported, at much lower rates, to be potentially useful in a hypothetical case and actually used in clinical practice for tre ating children with this disorder. These findings suggest that child p sychiatrists may view selective mutism as being related to, having sym ptoms similar to, or often presenting comorbidly with depressive or an xiety disorders. However, a therapeutic program that includes pharmaco therapy was endorsed as the most effective treatment modality for sele ctive mutism by only 14% of the reporting psychiatrists. Psychiatrists ' impressions and observations cannot, even collectively, be used to m ake clinical inferences about the usefulness of treatments. This study did not examine treatment efficacy, since the outcomes of these open clinical trials were not judged by independent observers but were repo rted as observed and recollected by the clinicians involved. Moreover, these data on the treatment practices of sampled members of the Ameri can Academy of Child and Adolescent Psychiatry may not reflect the pra ctices of other psychiatrists or pediatricians. The results indicate t hat child and adolescent psychiatrists are prescribing a variety of me dications for selective mutism without the benefit of adequate efficac y studies. There is a significant need for further research and dissem ination of information in this area.