Geçmişte Seçici Konuşmazlık Tanısı Alan Hastaların İzlem Çalışması ve Seçici Konuşmazlık Semptomları ile Mükemmeliyetçilik Arasındaki İlişkinin İncelenmesi

Abstract

The aim of this study was to examine the current psychiatric status, anxiety levels, perfectionism traits, and self-esteem of adolescents diagnosed with selective mutism (SM) in childhood, and to evaluate the relationships between these variables and parental perfectionism and parenting attitudes. A total of 36 adolescents aged 12-18 years at the time of assessment, who had been diagnosed with SM between 2015 and 2020 according to the records of the Hacettepe University Department of Child and Adolescent Psychiatry, and their parents were included in this single-center, cross-sectional, descriptive-correlational follow-up study. The diagnosis of SM was confirmed through file review and clinical evaluation. Lifetime and current psychiatric diagnoses were assessed using the DSM-5-adapted K-SADS-PL semi-structured diagnostic interview. Adolescents completed the Screen for Child Anxiety Related Emotional Disorders (SCARED) to assess anxiety levels, the Child and Adolescent Perfectionism Scale (CAPS) to evaluate perfectionism, the Rosenberg Self-Esteem Scale to assess self-esteem, and the Parental Attitude Scale (PAS) to evaluate perceived parental attitudes. Parents completed the Hewitt Multidimensional Perfectionism Scale (HMPS) and the PARI (Parental Attitude Research Instrument). At least one psychiatric diagnosis during adolescence was identified in 94.4% of the sample. The most common comorbid diagnoses were attention-deficit/hyperactivity disorder (55.6%), specific learning disorder (41.7%), and social anxiety disorder (36.1%). Approximately half of the participants were still under psychiatric follow-up, and more than one-third were using psychotropic medication. While only 6 adolescents (16.7%) met the full diagnostic criteria for SM, 10 adolescents (27.8%) exhibited subthreshold SM symptoms. Higher levels of social anxiety were observed in cases in which SM symptoms persisted for a longer duration. Contrary to expectations, adolescents without current SM symptoms had higher levels of self-oriented perfectionism. Logistic regression analysis showed that self-oriented perfectionism was negatively associated with the presence of SM symptoms in adolescence. No significant relationship was found between parental perfectionism, parenting attitudes, and the persistence of SM symptoms during adolescence. Self-esteem levels were found to be more related to anxiety levels than to perfectionism symptoms; as anxiety increased, self-esteem decreased and perfectionism scores increased. In conclusion, selective mutism should not be considered merely a transient speech inhibition limited to early childhood; it may continue into adolescence as a multidimensional clinical condition associated with anxiety levels, neurodevelopmental comorbidities, and certain dimensions of perfectionism.