Emotion Regulation and Neurocognitive Profiles in Adolescents With Selective Mutism

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.