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揭開緘默症神秘之面紗－從DSM-5的改變談選擇性緘默症與焦慮之關係
Uncover the Mystery of Mutism-Discussing the Relation between Selective Mutism and Anxiety Disorders through Modification of DSM-5
摘要
選擇性緘默症是指孩童在某些地方持續地無法說話（例如學校，或是其他社交場合），但在其他地方則可以說話（例如家庭）。美國《精神疾病診斷準則手冊第五版》（DSM-5）於2013年將選擇性緘默症歸為焦慮症之一，呼應了二十年來研究者們所提倡的，選擇性緘默症應將重新分類為焦慮性疾患。本文欲以文獻回顧方式，探討選擇性緘默症於美國《精神疾病診斷準則手冊》三、四、五版之變革、選擇性緘默症與焦慮症相關的研究，以及學者們對於DSM-5改變之觀點。本研究結論：一、選擇性緘默症在三、四版為「通常初診斷於嬰兒期、兒童期、或青春期的疾患。」（Other Disorders of Infancy, Childhood or Adolescence），但在第五版則列為焦慮症（Anxiety Disorders）；二、選擇性緘默症與其他焦慮症有共病之關係；三、部分學者認為，選擇性緘默症孩童能用非語言溝通方式與人互動，應屬特定型語言表達缺陷。最後，以此結論提供鑑定之建議。
並列摘要
Selective mutism (SM) is a disorder in children who are unable to speak in specific settings (e.g., schools or social situations), yet they can usually speak in others (e.g., at home). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists SM as an anxiety disorder. It has been researched in a substantial number of empirical studies within the last two decades and led to the reclassification of SM as an anxiety disorder. This study adopts a literature review to explore the development of SM on DSM-Ⅲ, DSM-Ⅳ, and DSM-5; as well as research on the relationship between anxiety disorders and SM, and some researcher's viewpoints on this change. The conclusion is :1). On DSM-Ⅲ and Ⅳ, SM was attributed to the category of Other Disorders of Infancy, Childhood or Adolescence; however, on DSM-5 it is listed as an anxiety disorder. 2). SM overlaps with other anxiety disorders. 3) other researchers argue that children with SM could interact with others by using non-verbal communication and propose to re-conceptualize SM as a specific language impairment. Finally, the author provides some implications for assessment based on the conclusions.