• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.17 no.2
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• pp.106-113
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• 2006

Objectives : The purpose of this study was to investigate the adult attachment style characteristics of mothers with selective mutism children and their relations to selective mutism. Methods :The subjects of this study were 15 mothers with selective mutism children who were diagnosed by DSM-IV criteria at psychiatry outpatient department of Kyungpook National University Hospital from March 1998 to February 2005. The controls of this study were 30 mothers with normal children who are in the second grade of elementary school in Daegu. We assessed the adult attachment style characteristics of these mothers by Revised Adult Attachment Scale, and Reciprocal Attachment Questionnaire-Korean version, self-report attachment style questionnaire. Results : 1) On the self-report attachment style questionnaire, it revealed that mothers with selective mutism children had both of the secure and the dismissing-avoidant types predominantly and the tendency that mothers with selective mutism children more commonly had dismissing-avoidant type than controls did. 2) On the comparison of attachment quality of mothers, although only the anxiety subscale difference was significant, it revealed that mothers with selective mutism children had generally lower score pattern in all of closeness, dependence and anxiety subscale than controls did. It was consistent with the consequence of self-report attachment style questionnaire in this study. Conclusion : This study showed that the distribution of adult attachment style of mothers with selective mutism children was different from those of controls. The dismissing-avoidant attachment style was predominant in mothers with selective mutism children. we suppose the possibility that the dismissing-avoidant attachment style of mothers with selective mutism children has relation with selective mutism.

• Korean Journal of Child Studies
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• v.33 no.1
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• pp.41-62
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• 2012

This study explored the case of sandplay therapy for a 4th grade girl suffering from selective mutism. Her selective mutism apparently began following an extremely embarrassing experience in kindergarten. Her symptoms were a combination of symbiotic, reactive and passive- aggressive type behaviors. The goal of the therapy undertaken with this child was to enable her to express her repression and suppression, within a free and protective space during sandplay therapy. There were a total of 60 sessions of sandplay therapy. The client described the situations she had experienced in the first sandtray, by placing babies absent caring adults and food on the sandbox. She also placed baby fish away from their mother. In the mid-point of the sessions, she repeated her regressive behaviors by babbling like a baby and fought with snakes and monsters. In the final sessions, she showed integration and adaptation by engaging in snow play, expressing the union of opposites, placing blue and red mig and making a cross on the sand. This study showed the effectiveness of sandplay therapy since her selective mutism was lessened.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.6 no.1
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• pp.74-89
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• 1995

Selective mutism is a childhood condition defined by persisten failure to speak in specific social situation when speaking is expected, dispite preserved ability to comprehend spoken language and speak. Present study is to investigate clinical characteristics, treatment method and outcome of 23 children who were diagnosed as selective mutism by DSM-IV criteria at the child psychiatry ouptatient department of SNUH. The results were as follows : 1) The Sex ratio was 1: 4.8, female dominant Mear age of onset was 33 years old and mean age of first referral was 7.7 years old. 2) 22% of subjects had perinatal problem such as low birth weight, preterm birth, 26% of the subjects have history of delayed language development. There are subjects who had been separated with mam caretaker before 3 years old(26%) and who experienced physical or psychological trauma before 3 years old(26%). A few subjects had enurests(30%) and encoprests(4%). 3) Many subjects(65%) had symbiotic relationship with their mother. These families consist of dominant, verbally aggressive mother and passive father. Parents of 39% of all subjects were judged to have definite psychopathology(social phobic, depression, hysterical trait or alcohol problem) 26% of all subject, were reported physically abused. 4) The personality trait of the subjects were frequently described as follows(in order of frequency) ; Shy(100%), anxious(83%), stubborn(83%)m rigid and tense posture(78%), immature(65%) overdependent(65%), irritable(52%), manipulative(39%), depressive(39%). 5) The mean performance IQ of 16 subjects by KEDI-WISC was 88.3 Among them, the subjects with IQ below 69 were seven and those with IQ above 70 were nine. When comparing these two group(Mental retardation group vs Normal IQ group), we could find some difference in language development, personality trait, family dynamics and treatment outcome. 6) Among several treatment methods for selective mutism, play therapy was the most frequently used method(65%). Other commonly used treatment methods were pharmacotherapy(21%), behavioral therapy(8%), combined therapy(play therapy+pharmacotherapy+family therapy+behavioral therapy)(12%), 7) Regarding the outcome of treatment 8.6% was evaluated as Excellent, 30.4% as Good, 52% as Fair, 8.7% as Poor at the tinic of treatment. At follow up interview 21.7% was evaluated Excellent, 13% as Good, 21.7% as Fair, 34.8% as Poor. 8) We classified all subjects by Havden's 4 subtype. Symbiotic mutism was most common(65%) and other subtypes are Speech phobic mutism(8.6), Reactive mutism(13%) and Passive-aggressive mutism(30%).

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.8 no.2
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• pp.266-272
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• 1997

We examine the clinical efficacies of fluoxetine in treating the children with selective mutism. In an 8-week open-label clinical study, 17 children with selective mutism are received 20-60mg/day of fluoxetine. Our results reveal that 13 subjects(76%) of 17 subjects improve statistically in within subjects comparison of pre- and post-treatment changes in the scores of Clinical Global Impression scale for mutism, Children’s Depression Inventory scale, and Revised Children’s Manifest Anxiety Scale. These data suggest that selective serotonergic antidepressants may be effective in treating selective mutism in children and adolescents.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.10 no.2
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• pp.145-157
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• 1999

This study was performed by the children and adolescents who were abused or neglected physically, emotionally that were selected in child & adolescents psychiatric ward. We investigated the number of these case in admitted children & adolescents, and also observed characteristics of symptoms, developmental history, characteristics of abuse style, characteristics of abusers, family dynamics and psychopathology. We hypothesized that all kinds of abuse will influnced to emotional, behavioral problems, developmental courses on victims, interactive effects on family dynamics and psychopathology. That subjects were 22 persons of victims who be determined by clinical observation and clinical note. The results of the study were as follows：1) Demographic characteristics of victims：ratio of sex was 1：6.3(male：female), mean age was $11.1{\pm}2.5$. According to birth order, lst was 12(54.5%), 2nd was 5(23%), 3rd was 2(9%) and only child was 3(13.5%). 2) Characteristics of family：According to socioeconomic status, middle to high class was 3(13.5%), middle one was 9(41.% ), middle to low one was 9(41%), low one was 1(0.5%). according to number of family, under the 3 person was 3(13.5%), 4-5 was 17(77.5%), 6-7 was 2(9%). according to marital status of parents, divorce or seperation were 5(23%), remarriage 2(9%), severe marital discord was 19(86.5%). In father, antisocial behavior was 7(32%), alcohol dependence was 10(45.5%). In mother, alcohol abuse was 5(23%), depression was 17(77.3%), history of psychiatric management was 6(27%). 3) Characteristics of abuse：Physical abuse was 18(81.8%), physical and emotional abuse and neglect were 4(18.2%). according to onset of abuse, before 3 years was 15(54.5%), 3-6 years was 5(27.5%), schooler was 1(15%). Only father offender was 2(19%), only mother offender was 8(35.4%), both offender was 8(35.4%), accompaning with spouse abuse was 7(27%), and accompaning with other sibling abuse was 4(18.2%). 4) General characteristics and developmental history of victims：Unwanted baby was 12(54.5%), developmental delay before abuse was9(41%), comorbid developmental disorder was 15(68%). there were 6(27.5%) who didn‘t show definite sign of developmental delay before abuse. 5) Main diagnosis and comorbid diagnosis：According to main diagnosis, conduct disorder 6(27.3%), borderline child 5(23%), depression4(18%), attention deficit hyperactivity disorder(ADHD) 4(18%), pervasive developmental disorder not otherwise specified 2(9%), selective mutism 1(5%). According to comorbid diagnosis, ADHD, borderline intelligence, mental retardation, learning disorder, developmental language disorder, oppositional defiant disorder, chronic tic disorder, functional enuresis and encoporesis, anxiety disorder, dissociative disorder, personality disorder due to medical condition. 5) Course of treatment：A mean duration of admission was $2.4{\pm}1.5$ months. 11(15%) showed improvement of symtoms, however 11(50%) was not changed of symtoms.