Associated tính năng có thể bao gồm sự nhút nhát quá mức, cách ly xã hội, đặc điểm ép buộc cũng như hành vi chống đối, đặc biệt là ở nhà. Ngoài ra, tỷ lệ phần trăm cao của trẻ em với SM cũng có bài phát biểu và sự chậm trễ ngôn ngữ (ước tính từ 30 đến 50%) cũng như sự chậm trễ động cơ | 574 SECTION 20 BEHAVIORAL AND PSYCHIATRIC DISORDERS Associated features may include excessive shyness social isolation compulsive traits as well as oppositional behavior particularly at home. In addition high percentage of children with SM also have speech and language delays estimates between 30 and 50 as well as motor delays With regard to differential diagnosis 1. Caution is emphasized in diagnosing this disorder in bilingual or immigrant children. 2. Must determine if inhibition of speech is secondary to a more general communication disorder mental retardation pervasive developmental disorder or psychotic disorder including schizophrenia. EPIDEMIOLOGY Few studies have focused on the epidemiology of SM prevalence rate is estimated as approximately 1 of school-age children. Diagnosis is most typically made between ages 5 and 10 years although age of onset may be much earlier. The female male ratio appears to be approximately 1 although a recent . study did not find a gender difference. ETIOLOGY Early theories focused on family dynamics or reactions to trauma. Current conceptualizations emphasize a likely genetic contribution focusing on strong evidence of familial anxiety and early behaviorally inhibited temperament. PROGNOSIS Little information is available concerning prognosis. A recent community study showed some preliminary support for a distinction between transient and persistent SM with younger children with milder symptoms more likely to remit spontaneously. Retrospective self-report data suggest that individuals with a history of SM continue to experience significant social anxiety. EVALUATION MANAGEMENT AND TREATMENT Assessment focuses primarily on parental report including review of psychiatric symptoms medical history and social interactions and assessment of academic cognitive and speech and language skills. Pediatricians are encouraged to ask parents specifi cally about speech in school when a child does not speak during an office visit. Most
