Social cognition in children with selective mutism: An eye-tracking study of attentional processing towards faces and facial emotion recognition.

Selective mutism (SM) is an anxiety disorder marked by persistent failure to speak in certain social settings, often leading to social and academic difficulties. While SM is strongly linked to social anxiety and poorer social skills, its underlying social-cognitive mechanisms remain understudied. This study investigated attention to faces and emotion recognition in young children with SM (n = 37, mean age = 5.6 years) versus typically developing controls (n = 46, mean age = 5.8 years). Emotion recognition was measured with the NEPSY-II Affect Recognition subtest, and eye-tracking assessed attentional processing of negative (angry, fearful) and neutral faces. Results revealed that children in both groups attended more to negative than neutral faces, indicating a comparable bias towards threat, with SM showing less differentiation in subsequent avoidance between emotional and neutral expressions. In line with this, children with SM exhibited a longer looking time to faces, including longer total fixation duration, delayed disengagement, and more frequent initial orientation to facial stimuli, regardless of emotional expression. Facial emotion recognition was also impaired in children with SM. These findings suggest children with SM may have atypical social cognition, characterized by difficulties in facial emotion recognition and prolonged attention to faces, which may reflect compensatory efforts to process emotional information or a freezing-like response to social stimuli. Such mechanisms may contribute to difficulties in social interaction and communication. Future research should further investigate the mechanisms underlying these difficulties and their developmental trajectory in relation to SM.