Selective mutism in China: a nationwide survey and case-control study

BackgroundSelective mutism (SM) is an anxiety disorder characterized by a consistent failure to speak in particular public settings despite speaking normally in other situations. However, quantitative SM research from China remains scanty at best. In response, this study aimed (1) to describe the sociodemographics and experiences of children and families with SM in China and (2) to identify sociodemographic and environmental correlates of SM in China. MethodsThis case-control mixed-methods study was composed of 172 cases with SM and 179 controls, recruited by online surveys. Multilevel logistic regression was performed to examine the association between potential correlates and SM. ResultsOnly 51.2% of SM cases were diagnosed by a professional, and 31.1% of SM cases that received treatment were guided by a professional. Child SM was associated with: having two parents with an introverted personality (Adjusted odds ratio (AOR): 15.05, (95% confidence interval (CI): 5.39 - 42.07), being born to a mothers aged [≥] 35 (AOR 6.44, 95%CI: 1.24-33.43), and having a sibling (AOR 1.92, 95% CI: 1.00 - 3.70). However, child SM was inversely associated with ever receiving bilingual (AOR 0.20, 95% CI 0.10-0.39) education or being enrolled in an international school (AOR 0.12, 95% CI 0.04-0.35). ConclusionsFindings suggest that many children with SM in China have not received professional treatment or interventions. Hereditary and social environmental factors may be contributing to childhood onset of SM in China. Novel policies such as access to special education resources, SM-training for therapists, and school support are needed to enhance the early detection and treatment of SM in China.