Three ‘driving forces’ behind the silence: Social anxiety, autism spectrum symptoms, and language difficulties as correlates of selective mutism in young children

Selective mutism (SM) is an early childhood condition characterized by a consistent lack of speech in challenging social settings (e.g., at school) despite normal speech in other undemanding situations (e.g., at home). This study aimed to examine the relationships between social anxiety, autistic traits, and language difficulties/delay on the one hand, and symptoms of SM on the other hand. Parents of 81 preschool children aged 3 to 6 years - recruited either from the general population (n = 52) or from a clinical setting/special online forum for parents of children with SM (n = 29) - completed the Selective Mutism Questionnaire, the social anxiety subscale of the Preschool Anxiety Scale), the Autism Spectrum Questionnaire, and the Early Language Scale. The results showed that social anxiety and autistic traits were both positively and significantly correlated with SM symptoms, while no significant correlation was found between language difficulties and SM symptoms. However, an additional analysis indicated that language delay was modestly and positively associated with SM symptoms. Regression analysis further revealed that both social anxiety and autistic traits were significant independent predictors, each uniquely contributing to the variance in SM symptom scores. Implications of these findings for the psychological assessment and treatment of children with suspected SM are discussed. Social anxiety and autistic traits were both significantly and positively associated with symptoms of selective mutism (SM) in preschool children. Language difficulties were not significantly correlated with SM symptoms, but language delay showed a modest positive association. Social anxiety and autistic traits independently predicted variance in SM symptom scores. Assessment and interventions for suspected SM should prioritize social anxiety and autism spectrum symptoms.