The Quality of Polish Pediatric Healthcare-The First Study of Caregiver Reported Pediatric Oncology Patient Experiences.

Selective mutism (SM) is an anxiety disorder in which an individual is unable to speak in specific situations where speech is expected (e.g. to teachers in class) despite being able to speak in other situations (e.g. to parents at home) (American Psychiatric Association , World Health Organization ). To meet diagnostic criteria this pattern of mutism should last for over a month and not be due to a lack of knowledge or comfort with the language or be better explained by another communication disorder or condition like autism, schizophrenia or another psychotic disorder (American Psychiatric Association , World Health Organization ). The condition often first manifests between the ages of 2 and 5 years with prevalence figures ranging between 0.03% and 2% in the paediatric population (Bergman et al. , Elizur and Perednik , Karakaya et al. , Kopp and Gillberg , Kumpulainen et al. , Sharkey and McNicholas , Szczerbinski et al. ). Variation in figures reflects the type of the study, the age of children, and the different criteria used to identify SM (Hipolito and Johnson ). SM has a negative impact on children's education and interactions with others (Bergman et al. , Kumpulainen et al. ) and is associated with high rates of emotional and behavioural problems during childhood (Kristensen , Steinhausen and Juzi ). These mental health problems and difficulties with communication during education, leisure activities, and work often continue into adulthood (Remschmidt et al. , Steinhausen et al. ). SM is treatable (Hipolito et al. ), particularly when identified early (Stone et al. ). A recent systematic review and meta‐analysis found that combined systems interventions (targeting the knowledge, skills, and interactions of significant people around the child with SM; Zakszeski and DuPaul ) and behavioural interventions (targeting behavioural factors thought to maintain the mutism, e.g. avoidance) were promising for improving both speaking behaviour and SM remission in children aged 3–9 years (Hipolito et al. ). The review analysed 25 nonpharmacological intervention studies targeting SM. The most common components used in interventions for SM were exposure activities (through prompting, graded exposure shaping, video modelling and/or stimulus fading), positive reinforcement/reward systems (e.g. quiet praise, tangible reinforcers such as reward charts or activity reinforcers like screen time), psychoeducation about SM, and rapport building strategies (e.g. defocused communication, triangle tactic; Oerbeck et al. , Johnson and Wintgens ). Six other components that were also identified were used in less than half of the studies (coping strategies, transfer of control, social skills, cognitive strategies, problem solving and play therapy). Although effective interventions exist, many parents of children with SM are not able to access support services (Hipolito and Creswell ). During a Patient Public Involvement activity that the authors conducted in the UK in 2021, 64% ( = 61/95 responders) of parents and carers of children with SM surveyed via the Selective Mutism Information and Research Association (SMIRA) Parent Facebook page indicated that they were not able to receive intervention for their child's SM from their Health Service or Local Authority.