Elsevier

Behavior Therapy

Volume 40, Issue 4, December 2009, Pages 380-392
Behavior Therapy

Treating Youths With Selective Mutism With an Alternating Design of Exposure-Based Practice and Contingency Management

https://doi.org/10.1016/j.beth.2008.10.005Get rights and content

Abstract

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.

Section snippets

Participants

Nine children aged 4 to 9 years and their parents voluntarily participated in this study. Children were mostly female (7), had a mean age of 6.6 years (SD =  1.9), and were European-American (4), biracial (2), Asian-American (2), or Hispanic (1). Most families (7) had two parents, and mean annual family income was $67,889. Participants were recruited from public and private schools (7), a preschool (1), and from a general press release to the community (1). All children met diagnostic criteria

Interrater Reliability of Interview and Daily Measures

An additional graduate student attended 67% of ADIS-C/P interviews, and 100% interrater diagnostic agreement was obtained. Regarding daily measures, interrater reliability for ratings of number of words spoken was initially calculated across all three data sources: children, parents, and teachers. Interrater reliability was .86. Interrater reliability for daily ratings of number of words spoken was also calculated for only children and parents: .92. Child and parent ratings of child anxiety and

Discussion

This study is one of the first to employ systematic assessment and treatment procedures in a controlled investigation of outcome utilizing exposure-based practices and contingency management for selective mutism. Results indicated that both treatment approaches may be effective for increasing audible speech in this population, though exposure-based practices may be significantly more effective. Results of the study match those of several previously published case reports, but do so in more

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