لالی انتخابی و اضطراب اجتماعی اختلال: همه در خانواده؟

ABSTRACT Objective To examine the history of lifetime psychiatric disorders in the parents of children with selective mutism (SM) compared to parents of children in a control group. Method Seventy parent dyads (n = 140) of children with lifetime SM and 31 parent dyads (n = 62) of children without SM were interviewed with the Structured Clinical Interview for DSM-IV (IV and II) anxiety disorders, mood disorders, avoidant personality disorder, and schizoid personality disorder modules via telephone. Interviewers were blind to proband status. The NEO Personality Inventory was also administered. Results Lifetime generalized social phobia was present in 37.0% of SM parents compared to 14.1% of control parents (χ2 = 10.98; p < .001; odds ratio 3.6, 95% confidence interval 1.6-7.9). Avoidant personality disorder was present in 17.5% of the SM parents compared to 4.7% of control parents (χ2 = 6.18; p < .05; odds ratio 4.3, 95% confidence interval 1.3-14.9). The proportion of parents with other psychiatric disorders was not different between groups. SM parents had higher neuroticism and lower openness scores on the NEO Personality Inventory than control parents. Conclusions These results support earlier uncontrolled findings of a familial relationship between generalized social phobia and SM.

RESULTS Parent and Child Demographics The geographic distribution of the SM families was as follows: 24% were from the west, 26% were from the midwest, 20% were from the south, and 40% were from the northeast. The majority of controls were from the west (84%). As shown in Table 1, there were no significant differences in age of parent, education, or ethnicity across the SM and control groups. Among children, there were also no sex or age differences across groups: There were 9 boys and 22 girls in the control sample and 26 boys and 44 girls in the SM sample (χ21,100 = 0.51; p = .48). The mean age of children with SM was 6.37 years old (SD 2.51) and 7.12 years old (SD 2.99) for controls (F1,96 = 1.73; p = .19). TABLE 1. Parent Demographics for SM and Controls SM Fathers (n = 70) Control Fathers (n = 31) SM Mothers (n = 70) Control Mothers (n = 31) Parent age Mean 40.4 Mean 41.7 Mean 38 Mean 40.23 SD 6.4 SD 6.6 SD 5.5 SD 7.4 F = 2.9; p = .09 F = .78; p = .38 Education  High school 17.1% 12.9% 11.4% 3.3%  Some college 15.7% 19.4% 21.4% 13.3%  College degree 31.4% 16.1% 38.6% 40.0%  Graduate degree 35.7% 51.6% 28.6% 43.3% χ23 = 3.63; p = .30 χ23 = 3.65; p = .31 Ethnicity  Caucasian 91.4 74.2 94.3 90.3  Latino 4.3 9.7 2.9 6.5  African American — 3.2 — 3.2  Asian 1.4 3.2 1.4 —  Filipino/Pacific Islander 0 0 1.4 —  Mixed race 2.9 9.7 — — χ24 = 6.42; p = .17 χ24 = 3.89; p = .42 Note: SM = selective mutism. Table options Child Psychiatric Disorders and SMQ Severity The distribution of lifetime Axis I psychiatric disorders is presented in Table 2. Children with lifetime SM (i.e., had a current or past diagnosis) had significantly higher lifetime rates of SP, specifically the generalized type, than control children. Rates of separation anxiety disorder were also significantly higher among the children with SM when compared to controls. The same findings emerged when only children with current SM diagnoses were included. On the SMQ, which assesses SM severity, the child SM group had a mean total score of 53.55 (SD 6.65) and the control group had a mean score of 21.15 (SD 3.34; F1,91 = 578.83; p < .001). For indirect comparison purposes, the score of the original psychometric sample of children with SM was 50.47 ( Bergman et al., 2001). In a series of univariate logistic regressions, child SM severity was found to be associated with an increased odds of parent SP (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.09, χ2 = 12.22; p < .001) for each 1-point increase in total SMQ score. There was no significant relationship between childhood SM severity and any other parent psychiatric disorder as measured by the SCID (data not shown). TABLE 2. Distributions of Lifetime Psychiatric Disorders Across Children With SM and Controls SM Children (n = 70) Control Children (n = 31) No. % No. % χ2 p SAD 28 40 2 6.5 10.0 .002 SP 70 100 1 3.2 91.8 .000  GSP 69 98.6 1 3.2 87.4 .000  NGSP 1 2.9 0 0 0.03 .86 GAD 8 11.4 2 6.5 0.17 .68 OCD 6 8.6 0 0 1.50 .22 DYS 3 4.3 0 0 0.29 .59 MDD 5 7.1 2 6.5 0 1.0 ADHD 4 5.7 3 9.7 0.09 .77 CD 0 0 1 3.2 0.18 .67 ODD 4 5.7 1 3.2 0.001 .97 TIC 2 2.9 0 0 0.03 .86 Enuresis 10 14.3 2 6.5 0.62 .43 Note: SAD = separation anxiety disorder; SP = social phobia; GSP = generalized social phobia; NGSP = nongeneralized social phobia; GAD = generalized anxiety disorder; OCD = obsessive-compulsive disorder; DYS = dysthymia; MDD = major depressive disorder; ADHD = attention-deficit/hyperactivity disorder; CD = conduct disorder; ODD = oppositional defiant disorder; TIC = tic disorder. Table options Parent Psychiatric Disorders As shown in Table 3, parents of SM children had significantly higher lifetime rates of GSP (OR 3.6, 95% CI 1.6-7.9) and avoidant personality disorder (AVPD; OR 4.3, 95% CI 1.3-14.9) than the parents of the control children. Rates of non-GSP (which consisted mostly of public-speaking phobias) as well as other psychiatric disorders were not significantly different across groups. The mean total of social fears for the GSP group was 8.0, 2.7 for the non-GSP group and 1.4 for the no SP group. The GSP group had significantly more fears than either the non-GSP or the no SP group. TABLE 3. Distributions of Lifetime Psychiatric Disorders Across Parents of SM Probands and Controls Parents-SM Parents-Controls No. % No. % χ2 p MDD 40 29 17 26.6 0.12 .72 Mania 1 0.7 0 0 0.47 .50 Hypomania 3 2.2 0 0 1.41 .50 Dysthymia 5 3.6 1 1.6 0.64 .42 OCD 5 3.6 2 3.1 0.03 .86 PTSD 6 4.3 3 4.7 0.01 .91 Panic/agora 4 2.9 2 3.1 0.02 .93 Specific phobia 13 9.5 6 9.4 0.001 .98 GSP 51 37 9 14.1 10.98 .001 NGSP 9 6.6 4 6.3 0.005 .94 GAD 14 10.2 2 3.1 2.99 .08 AVPD 24 17.5 3 4.7 6.18 .013 SPD 0 0 0 0 0 0 SM 6 4.4 2 3.1 0.18 .67 SEP 8 5.8 1 1.6 1.84 .18 Note: SM = selective mutism; MDD = major depressive disorder; OCD = obsessive-compulsive disorder; PTSD = posttraumatic stress disorder; Panic/agora = panic disorder with agoraphobia; GSP = generalized social phobia; NGSP = nongeneralized social phobia; GAD = generalized anxiety disorder; AVPD = avoidant personality disorder; SPD = schizoid personality disorder; SAD = separation anxiety disorder. Table options Sex: Simple Main and Moderating Effects Fathers of SM children had significantly higher rates of GSP (χ21 [n = 101] = 7.9; p = .005) and AVPD than their control counterparts (χ21 [n = 101] = 3.97; p = .046). The pattern was different for mothers. There was a trend toward significance for GSP (χ21 [n = 101] = 3.62; p = .057), but not for AVPD (χ21 [n = 101] = 2.45; p = .13). Logistic regression analyses were conducted to test for an interaction between sex and proband status predicting the various psychiatric disorders. Neither the effect of sex nor the proband status by sex interactions was significant. NEO Personality Inventory-Revised Domains and Facets MANOVAs were conducted with sex included in the model as well as the interaction between sex and SM status (SM versus control). Neither the main effect for sex (F5,163 = 1.8; p = .12) nor the interaction between sex and SM status was significant (F5,163 = 0.82; p = .71). MANOVAs revealed a main effect of proband status on the NEO Personality Inventory-Revised domains (Wilks F5,163 = 3.39; p = .006). As shown in Figure 1, parents of SM children had significantly higher mean T scores on the neuroticism and lower mean T scores on the openness domains than parents of control children. There were no significant differences for extraversion, agreeableness, or conscientiousness. Two MANOVAs were conducted on the six lower level neuroticism facets (anxiety, angry hostility, depression, self-consciousness, impulsiveness, and vulnerability) and the six openness facets (fantasy, aesthetics, feelings, actions, ideas, values; Wilks F6,164 = 2.16; p = .05 and Wilks F6,164 = 2.56; p = .02, respectively). The parents of the SM children scored higher than control parents on the anxiety, depression, self-consciousness, and vulnerability facets of neuroticism (data not shown). Parents of the SM children scored lower than parents of control children on the aesthetics and ideas facets of openness (data not shown). NEO Personality Inventory-Revised domain mean (T scores) and SDs (in ... Fig. 1. NEO Personality Inventory-Revised domain mean (T scores) and SDs (in parentheses) across the SM and control groups. *Significant difference between groups on the given domain (p < .05). N = Neuroticism; E = Extraversion; O = Openness; A = Agreeableness; C = Conscientiousness; SM = selective mutism.