Onder de stilte: Een longitudinaal onderzoek naar chronische stress en spreekgedrag bij kinderen met selectief mutisme.

Background: Selective mutism (SM) is a psychiatric disorder characterised by a persistent inability to speak in specific social situations, despite speaking normally in others. Social contexts that require speech may act as stressors for children with SM, potentially leading to elevated physiological arousal and chronic stress. However, little is known about the role of chronic stress in children with SM. Research Aim: This thesis examined chronic stress of children with SM by assessing hair cortisol levels and average basal heart rate. First, it was investigated whether children with SM exhibit higher levels of chronic stress, indicated by elevated cortisol levels and average basal heart rate, compared to peers without SM. Second, the study examined whether SM-focused treatment leads to normalisation of chronic stress. Finally, the study explored whether cortisol and average basal heart rate are related to speaking behaviour, and whether post-treatment normalisation of these...Show moreBackground: Selective mutism (SM) is a psychiatric disorder characterised by a persistent inability to speak in specific social situations, despite speaking normally in others. Social contexts that require speech may act as stressors for children with SM, potentially leading to elevated physiological arousal and chronic stress. However, little is known about the role of chronic stress in children with SM. Research Aim: This thesis examined chronic stress of children with SM by assessing hair cortisol levels and average basal heart rate. First, it was investigated whether children with SM exhibit higher levels of chronic stress, indicated by elevated cortisol levels and average basal heart rate, compared to peers without SM. Second, the study examined whether SM-focused treatment leads to normalisation of chronic stress. Finally, the study explored whether cortisol and average basal heart rate are related to speaking behaviour, and whether post-treatment normalisation of these indicators of chronic stress are related to increased speech in children with SM. Method: This longitudinal study included 82 children aged 4 to 8 years, who were categorised into an SM group and a control group based on whether they met the criteria for SM, as determined through observation. Both groups were assessed for cortisol levels (via hair samples) and average basal heart rates. These measures were repeated in the SM group following SM-focused treatment. In the control group, only average basal heart rate was reassessed in a small subsample. Speaking behaviour in the SM group was measured at both time points using the Selective Mutism Questionnaire (SMQ). Results: Children with SM initially showed significantly higher cortisol levels and average basal heart rates than controls. Post-treatment, these indicators of chronic stress showed a significant decrease within the SM group. No significant correlations were found between chronic stress levels and speech, although a post-treatment reversal in the direction of the cortisol-speech correlation was observed. Conclusion: These findings suggest that children with SM experience elevated chronic stress, which may normalise following SM-focused treatment. However, no direct relationship was found between the level of chronic stress and the speech behaviour of children with SM. These findings underscore the need for a multifactorial approach to SM and future research that includes larger samples and more contextual variables.Show less

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Onder de stilte: Een longitudinaal onderzoek naar chronische stress en spreekgedrag bij kinderen met selectief mutisme.