Oppositional and Anxiety Behavior Profiles in a Clinical Sample of Youth with Selective Mutism

153 Pages·2017·0.98 MB·English

by  Rachele Diliberto

UNLV Theses, Dissertations, Professional Papers, and Capstones
12-1-2014
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Rachele Diliberto
University of Nevada, Las Vegas
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Diliberto, Rachele, "Oppositional and Anxiety Behavior Profiles in a Clinical Sample of Youth with Selective
Mutism" (2014). UNLV Theses, Dissertations, Professional Papers, and Capstones. 2255.
http://dx.doi.org/10.34917/7048177
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OPPOSITIONAL AND ANXIETY BEHAVIOR PROFILES IN A CLINICAL SAMPLE

OF YOUTH WITH SELECTIVE MUTISM

By

Rachele Alexandra Diliberto

Bachelor of Arts in Psychology
Arizona State University
2010

A thesis submitted in partial fulfillment
of the requirements for the

Master of Arts -- Psychology

Department of Psychology
College of Liberal Arts
The Graduate College

University of Nevada, Las Vegas
December 2014
We recommend the thesis prepared under our supervision by
Rachele Alexandra Diliberto
entitled
Oppositional and Anxiety Behavior Profiles in a Clinical Sample of
Youth with Selective Mutism
is approved in partial fulfillment of the requirements for the degree of
Master of Arts - Psychology
Department of Psychology

Christopher Kearney, Ph.D., Committee Chair
Michelle Paul, Ph.D., Committee Member
Brad Donohue, Ph.D., Committee Member
John Filler, Ph.D., Graduate College Representative
Kathryn Hausbeck Korgan, Ph.D., Interim Dean of the Graduate College

December 2014

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ABSTRACT
Oppositional and Anxiety Behavior Profiles in a Clinical Sample of Youth with
Selective Mutism

by
Rachele A. Diliberto, B.A.
Dr. Christopher A. Kearney, Examination Committee Chair
Distinguished Professor of Psychology
University of Nevada, Las Vegas

Children with selective mutism often present as a very heterogeneous population,
with both anxious (APA, 2000; 2013; Kristensen 2000; Manassis et al., 2007;
Steinhausen & Juzi, 1996; Yeganeh et al., 2003) and oppositional symptoms (APA, 2013;
Andersson & Thomsen, 1998; Kolvin & Fundudis, 1981; Krohn, Weckstein, & Wright,
1992). This study sought to identify anxiety and oppositional behavior profiles in a
clinical sample of children with selective mutism. Also, this study sought to determine
both discriminant and concurrent validity for these profiles and examine their association
with family expressiveness, conflict and control. Participants (n=57) included youth
receiving treatment at the UNLV Child School Refusal and Anxiety Disorders Clinic for
selective mutism. Hypothesis 1 was that anxious and oppositional behavior profiles
would be identified in a clinical sample of children with selective mutism. Results from
Hypothesis 1 served as the basis for the remaining hypotheses. Hypothesis 1 was
supported. Hypothesis 2 was that children with selective mutism with an anxious profile
would display social problems and symptoms of social anxiety disorder. In addition,
these children were expected to show little connection to aggressive behaviors and
symptoms of oppositional defiant disorder. Concurrent validity for Factor 1 was
supported. However, discriminant validity was only partially supported. Hypothesis 3
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was that children with selective mutism with an oppositional profile would display
aggressive behavior and symptoms of oppositional defiant disorder. In addition, these
children were expected to show little connection to social problems and symptoms of
social anxiety disorder. Hypothesis 3 was only partially supported, demonstrating
concurrent but not discriminant validity. Hypothesis 4 examined the association between
anxious and oppositional profiles and conflict, expressiveness and control subscales on
the Family Environment Scale. Hypothesis 4 was only partially supported, with an
association between an oppositional profile and conflict. Clinical implications, future
directions and limitations were discussed.

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TABLE OF CONTENTS
ABSTRACT ....................................................................................................................... iii

CHAPTER 1 INTRODUCTION .........................................................................................1

CHAPTER 2 LITERATURE REVIEW ..............................................................................6
Historical Overview .............................................................................................................7
Historical Terminology .................................................................................................7
Previous Classifications ................................................................................................8
Epidemiology .......................................................................................................................9
Prevalence ......................................................................................................................9
Prevalence in Immigrant Children ...............................................................................10
Age of Onset .................................................................................................................10
Time of Referral ............................................................................................................11
Gender ...........................................................................................................................11
Characteristics of Children with Selective Mutism ...........................................................12
Speech Settings .............................................................................................................12
Compensatory Behaviors ..............................................................................................12
Comorbid Internalizing Behaviors and Disorders ........................................................13
Selective Mutism as an Anxiety Disorder ....................................................................15
Specific Phobia of Expressive Speech ..........................................................................17
Anxiety Severity in Social Anxiety and Selective Mutism ..........................................17
Opposition and Defiance...............................................................................................19
Mutism and Oppositional Defiant Disorder ..................................................................20
Selective Mutism as a Motivational Disorder ..…………………………………….....22
Speech and Language Disorders ................................................................................ 23
Elimination Disorders ................................................................................................ 24
Developmental Disorders/Delays .............................................................................. 24
Motor Disorders/Delays ............................................................................................. 25
Educational Delays .................................................................................................... 25
Social Adjustment ...................................................................................................... 26
Family Characteristics ................................................................................................ 26
Familial Psychopathology .............................................................................................26
Family Dynamics ..........................................................................................................28
Parental Control ............................................................................................................30
Joint-Attention Processes ..............................................................................................32
Cultural Dynamics .........................................................................................................33
Prognosis ............................................................................................................................33
Etiological Theories ...........................................................................................................35
Psychodynamic Pathway ..............................................................................................35
Learning and Behavioral Pathway ................................................................................35
Family System Pathway ................................................................................................37
Biological Pathway .......................................................................................................37
Reduced Auditory Processing .......................................................................................38
Developmental Psychopathology..................................................................................39
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Subtyping ...........................................................................................................................40
Assessment .........................................................................................................................44
Clinical Assessment ......................................................................................................44
Hearing, Speech, and Language Assessment ................................................................45
School Assessment........................................................................................................46
Parent Report ................................................................................................................47
Treatment ...........................................................................................................................49
Therapeutic Interventions .............................................................................................49
Psychodynamic Treatments ..........................................................................................50
Behavioral Treatments ..................................................................................................50
Family Therapy .............................................................................................................54
Group Therapy ..............................................................................................................54
School Programming ....................................................................................................55
Pharmacological Treatment ...............................................................................................55
Purpose of Present Study ...................................................................................................58
Hypotheses .........................................................................................................................61

CHAPTER 3 METHODOLOGY ......................................................................................63
Participants ....................................................................................................................63
Measures .......................................................................................................................63
Procedure ......................................................................................................................67
Data Analyses ...............................................................................................................67

CHAPTER 4 RESULTS ....................................................................................................70
General Comparisons ....................................................................................................70
Hypothesis 1..................................................................................................................71
Descriptive Analysis .................................................................................................71
Exploratory Factor Analysis .....................................................................................71
Confirmatory Factor Analysis...................................................................................73
Hypothesis 2..................................................................................................................74
Hypothesis 3..................................................................................................................74
Hypothesis 4..................................................................................................................75

CHAPTER 5 DISCUSSION ..............................................................................................77
Factor 1 (Anxious Profile) .......................................................................................77
Factor 1 Items ..........................................................................................................78
Factor 2 (Oppositional Profile) ................................................................................81
Factor 2 Items ..........................................................................................................82
Family Variables ......................................................................................................83
Clinical Implications .....................................................................................................84
Study Limitations ..........................................................................................................87
Suggestions for Future Research ..................................................................................88

APPENDIX A ....................................................................................................................91
APPENDIX B ....................................................................................................................94
APPENDIX C ....................................................................................................................98
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APPENDIX D ..................................................................................................................102
APPENDIX E ..................................................................................................................104
REFERENCES ................................................................................................................109
VITA ................................................................................................................................143

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LIST OF TABLES

Table 1: Family Environment Subscale Descriptions ........................................................66

Table 2: CBCL Items with a Mean Score of 0.50+ ...........................................................71

Table 3: Exploratory Factor Analysis ................................................................................72

Table 4: Multiple Regressions with Factor 1 and 2 Scores as Predictors .........................76

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LIST OF FIGURES

Figure 1: Confirmatory Factor Analysis for Factor 1 (Anxious Behaviors) and Factor 2
(Oppositional Behaviors) ...................................................................................................73

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