Integrated Behavior Therapy for Selective Mutism: A randomized controlled pilot study

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Highlights

  • There are no randomized trials for the behavioral treatment of selective mutism (SM).

  • We conducted a randomized pilot study testing a novel behavioral treatment of SM.

  • Results provide evidence for feasibility and acceptance of the intervention.

  • The intervention resulted in significant improvements in SM compared to waitlist.

  • Treatment gains were maintained over short-term follow-up.

Abstract

Objective

To evaluate the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention for reducing symptoms of selective mutism and increasing functional speech.

Method

A total of 21 children ages 4 to 8 with primary selective mutism were randomized to 24 weeks of Integrated Behavior Therapy for Selective Mutism (IBTSM) or a 12-week Waitlist control. Clinical outcomes were assessed using blind independent evaluators, parent-, and teacher-report, and an objective behavioral measure. Treatment recipients completed a three-month follow-up to assess durability of treatment gains.

Results

Data indicated increased functional speaking behavior post-treatment as rated by parents and teachers, with a high rate of treatment responders as rated by blind independent evaluators (75%). Conversely, children in the Waitlist comparison group did not experience significant improvements in speaking behaviors. Children who received IBTSM also demonstrated significant improvements in number of words spoken at school compared to baseline, however, significant group differences did not emerge. Treatment recipients also experienced significant reductions in social anxiety per parent, but not teacher, report. Clinical gains were maintained over 3 month follow-up.

Conclusion

IBTSM appears to be a promising new intervention that is efficacious in increasing functional speaking behaviors, feasible, and acceptable to parents and teachers.

Section snippets

Participants

Participants were recruited from a pediatric anxiety specialty clinic, mental health practitioner referrals, and postings on internet websites focused on selective mutism. Children were eligible for inclusion if they were ages 4–8 years, inclusive, at baseline and met.

DSM-IV criteria for a primary diagnosis of selective mutism (SM). Because a goal of this intervention was to integrate treatment within a functional context, children were required to be attending school or some other form of

Data analytic plan

Prior to analyses, data were screened to test statistical assumptions (e.g., normality). Standardized z-scores on all continuous data were examined, and a criterion of z ≥ ± 3.0 was used to identify outliers. One child had a z-score of z = 4.56 on the SNAP at baseline and was therefore not included in analyses of the SNAP. Simple between-group comparisons were conducted using χ2 tests for categorical measures and t-tests for continuous measures. Treatment effects were analyzed using 2 (Group:

Discussion

To our knowledge, this study represents the first randomized trial to provide empirical support for the feasibility, acceptability, and preliminary efficacy of a behavioral treatment adapted to the needs of children with SM. Parents and teachers reported high levels of satisfaction with the 24-week treatment, and all children assigned to Integrated Behavioral Therapy for SM (IBTSM) completed the intervention. Evaluation of treatment efficacy was promising; IBTSM resulted in increased functional

Acknowledgments

This study was supported by grant R34MH70938-01 from the National Institute of Mental health. The authors wish to thank Lisa O'Malley, MA, school assessment coordinator for her helpful input and support of the teachers involved in the study, and the therapists, interviewers, and research coordinators who were part of the study team. Special appreciation is extended to the children and families who participated in this research. Lastly, we would like to thank the teachers of the children who

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