# Emotion Regulation and Neurocognitive Profiles in Adolescents With Selective Mutism

## TL;DR

Adolescents with selective mutism show specific emotional awareness and neurocognitive issues, suggesting targeted interventions could help.

## Contribution

The study identifies a distinctive cognitive-emotional profile in adolescents with selective mutism, emphasizing the need for tailored treatment approaches.

## Key findings

- Adolescents with SM have impaired emotional awareness and specific neurocognitive deficits like memory and inhibitory control.
- They show preserved prosocial behavior and cognitive flexibility, suggesting interventions should focus on strengths.
- Emotion regulation training should target emotional awareness rather than general dysregulation.

## Abstract

While selective mutism (SM) is often conceptualized as a childhood anxiety disorder, longitudinal evidence suggests persistent difficulties into adolescence, yet the underlying cognitive and emotional mechanisms remain poorly understood. We aimed to address this gap by examining whether specific neurocognitive impairments and emotion regulation difficulties characterize adolescents with SM. Eighty‐nine adolescents (42 SM, 47 HC), aged 11–17 years, were assessed using the Strengths and Difficulties Questionnaire (SDQ), the Difficulties in Emotion Regulation Scale (DERS) and a neuropsychological battery evaluating attention, inhibition, processing speed, memory and social cognition. Adolescents with SM demonstrated greater emotional awareness difficulties (p = 0.010), with no differences in total DERS scores. SDQ scores indicated higher inattention/hyperactivity (p < 0.001), alongside significantly higher prosocial behaviour (p < 0.001). Neurocognitive findings revealed intact verbal learning but impaired immediate and delayed recall (p < 0.001), better delayed visual memory (p = 0.001). Children with SM made fewer total errors on Wisconsin Card Sorting Test (p = 0.021) and showed higher foil accuracy on CPT (p = 0.007), but demonstrated significantly poorer Stroop colour‐word (p = 0.001) and interference scores (p = 0.001). Adolescents with SM showed a distinctive cognitive–emotional profile, suggesting that internal emotional processing and external social sensitivity are dissociated during adolescence. Longitudinal and neurobiological research is warranted to elucidate mechanisms and refine treatment strategies.

Selective mutism (SM) in adolescence involves specific difficulties in emotional awareness and selective neurocognitive impairments rather than global deficits, requiring comprehensive assessment beyond speech behaviour.Adolescents with SM demonstrate preserved prosocial motivation and social cognition, suggesting interventions should leverage these strengths rather than focusing solely on deficits.Executive function profiles are heterogeneous, with preserved cognitive flexibility but impaired inhibitory control under pressure, indicating the need for targeted cognitive training in anxiety‐provoking contexts.Emotion regulation interventions should specifically target emotional awareness and recognition rather than broad‐based training, as total emotion dysregulation is not elevated in SM.

Selective mutism (SM) in adolescence involves specific difficulties in emotional awareness and selective neurocognitive impairments rather than global deficits, requiring comprehensive assessment beyond speech behaviour.

Adolescents with SM demonstrate preserved prosocial motivation and social cognition, suggesting interventions should leverage these strengths rather than focusing solely on deficits.

Executive function profiles are heterogeneous, with preserved cognitive flexibility but impaired inhibitory control under pressure, indicating the need for targeted cognitive training in anxiety‐provoking contexts.

Emotion regulation interventions should specifically target emotional awareness and recognition rather than broad‐based training, as total emotion dysregulation is not elevated in SM.