Abstract
Selective mutism (SM) is a rare anxiety disorder that impairs children’s daily functioning, often during critical periods of early development. Given that schools are a common setting for mutism, it is vital that school-based practitioners are knowledgeable of recent advances in the SM treatment literature. Unfortunately, the literature base is comprised primarily of case studies and limited single-case designs, and no published narrative review has included treatment studies published after 2005. This review served to describe the SM treatment approaches, methodologies, and outcomes of 21 studies published between 2005 and 2015. Treatments most commonly utilized behavioral and systems approaches, including behavioral strategies such as contingency management, shaping, hierarchical exposure, and stimulus fading and systems strategies such as adult skills training, psychoeducation, and consultation. Although treatments were most frequently provided in schools, they were most often provided by researchers or clinicians rather than school-based professionals. Reviewed treatments were generally effective, although effect sizes were rarely provided. In general, methodological limitations noted in prior reviews applied to these studies; however, the presence of randomized controlled trials demonstrates efforts to address these criticisms. Future research directions and implications for school-based practitioners are described.
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Notes
All but two included studies reporting SM diagnoses referenced the use of DSM-IV-TR rather than DSM-5 criteria (APA, 2000; the exceptions being Conn & Coyne, 2014 and Mayworm, Dowdy, Knights, & Rebelez, 2015) due to the DSM-5 not being published until 2013; however, no changes in the diagnostic criteria were made from DSM-IV-TR to DSM-5 aside from SM’s reclassification as an anxiety disorder. Accordingly, the latest edition of the DSM was consulted for diagnostic considerations as a best practice.
References
*Studies reviewed
Achenbach, T. A., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont.
Achenbach, T. A., & Rescorla, L. A. (2001). Manual for the ASEBA school age forms & profiles. Burlington, VT: University of Vermont.
Adelman, H. S., & Taylor, L. (1999). Mental health in schools and system restructuring. Clinical Psychology Review, 19, 137–163. doi:10.1016/S0272-7358(98)00071-3.
Altman, D. G. (1991). Practical statistics for medical research. London: Chapman and Hall.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.
Anstendig, K. (1998). Selective mutism: A review of the treatment literature by modality from 1980–1996. Psychotherapy: Theory, Research, Practice, Training, 35, 381–391. doi:10.1037/h0087851.
Auster, E. R., Feeney-Kettler, K. A., & Kratochwill, T. R. (2006). Conjoint behavior consultation: Application to the school-based treatment of anxiety disorders. Education and Treatment of Children, 29, 243–256.
Barlow, D. H., & Hersen, M. (1984). Single-case experimental designs: Strategies for studying behavioral change. New York: Pergamon.
Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews. Review of General Psychology, 1, 311–320. doi:10.1037/1089-2680.1.3.311.
*Beare, P., Torgerson, C., & Creviston, C. (2008). Increasing verbal behavior of a student who is selectively mute. Journal of Emotional and Behavioral Disorders, 16, 248–255. doi:10.1177/1063426608317356.
*Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L. (2013). Integrated behavior therapy for selective mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51, 680–689. doi:10.1016/j.brat.2013.07.003.
Bergman, R. L., Keller, M. L., Piacentini, J., & Bergman, A. J. (2008). The development and psychometric properties of the Selective Mutism Questionnaire. Journal of Clinical Child and Adolescent Psychology, 37, 456–464. doi:10.1080/15374410801955805.
Bergman, R. L., Keller, M., Wood, J., Piacentini, J., & McCracken, J. (2001). Selective Mutism Questionnaire: Development and findings. Proceedings of the American Academy of Child and Adolescent Psychiatry Meeting, 48, 163.
Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 938–946. doi:10.1097/00004583-200208000-00012.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.
Bulotsky-Shearer, R. J., Fantuzzo, J. W., & McDermott, P. A. (2008). An investigation of classroom situational dimensions of emotional and behavioral adjustment and cognitive and social outcomes for Head Start children. Developmental Psychology, 44, 139–154. doi:10.1037/0012-1649.44.1.139.
Busse, R. T., & Downey, J. (2011). Selective mutism: A three-tiered approach to prevention and intervention. Contemporary School Psychology, 15, 53–63.
Carlson, J. S., Mitchell, A. D., & Segool, N. (2008). The current state of empirical support for the psychopharmacological treatment of selective mutism. School Psychology Quarterly, 23, 354–372. doi:10.1037/1045-3830.23.3.354.
Cohan, S. L., Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Roesch, S. C., & Stein, M. B. (2008). Refining the classification of children with selective mutism: A latent profile analysis. Journal of Clinical Child & Adolescent Psychiatry, 37, 370–384. doi:10.1080/15374410802359759.
Cohan, S. L., Chavira, D. A., & Stein, M. B. (2006). Practitioner review: Psychosocial interventions for children with selective mutism. A critical evaluation of the literature from 1990–2005. Journal of Child Psychology and Psychiatry, 47, 1085–1097. doi:10.1111/j.1469-7610.2006.01662.x.
*Conn, B. M., & Coyne, L. W. (2014). Selective mutism in childhood: Assessment and treatment of an African American preschool boy. Clinical Case Studies, 13, 487–500. doi:10.1177/1534650114522912.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Crundwell, R. M. A. (2006). Identifying and teaching children with selective mutism. Teaching Exceptional Children, 38, 48–54.
Dummit, E. S., Klein, R. G., Tancer, N. K., Asche, B., Martin, J., & Fairbanks, J. A. (1997). Systematic assessment of 50 children with selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 36(5), 653–660.
Ford, M. A., Sladeczeck, I. E., Carlson, J., & Kratochwill, T. R. (1998). Selective mutism: Phenomenological characteristics. School Psychology Quarterly, 13, 192–227. doi:10.1037/h0088982.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. doi:10.1111/j.1469-7610.1997.tb01545.x.
*Howe, H., & Barnett, D. (2013). Accountability steps for highly reluctant speech: Tiered-services consultation in a Head Start classroom. Journal of Educational and Psychological Consultation, 23, 165–184. doi:10.1080/10474412.2013.813805.
*Jackson, M. F., Allen, R. S., Boothe, A. B., Nava, M. L., & Coates, A. (2005). Innovative analyses and interventions in the treatment of selective mutism. Clinical Case Studies, 4, 81–112. doi:10.1177/534650103259676.
Kazdin, A. E. (1982). Single-case research designs: Methods for clinical and applied settings. New York: Oxford University Press.
Kehle, T. J., & Bray, M. A. (2009). Self-modeling. In A. Akin-Little, S. Little, M. A. Bray, & T. J. Kehle (Eds.), Behavioral intervention in schools: Evidence-based positive strategies (pp. 231–244). Washington, DC: National Association of School Psychologists.
Kehle, T. J., Bray, M. A., Byer-Alcorace, G. F., Theodore, L. A., & Kovac, L. M. (2012). Augmented self-modeling as an intervention for selective mutism. Psychology in the Schools, 49, 93–103. doi:10.1002/pits.21589.
*Kern, L., Starosta, K. M., Cook, C. R., Bambara, L. M., & Gresham, F. R. (2007). Functional assessment-based intervention for selective mutism. Behavioral Disorders, 32, 94–108.
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174. doi:10.2307/2529310.
*Lang, R., Regester, A., Mulloy, A., Rispoli, M., & Botout, A. (2011). Behavioral intervention to treat selective mutism across multiple social situations and community settings. Journal of Applied Behavior Analysis, 44, 623–628. doi:10.1901/jaba.2011.44-623.
*Lang, C., Ziv, N., Gothelf, A., Domachevsky, S., Ginton, L., Kuhsnir, J., et al. (2016). The outcome of children with selective mutism following cognitive behavioral intervention: A follow-up. European Journal of Pediatrics, 75, 481–487. doi:10.1007/s00431-015-2651-0.
Loades, M. E., & Mastroyannopoulou, K. (2010). Teachers’ recognition of children’s mental health problems. Child and Adolescent Mental Health, 15, 150–156. doi:10.1111/j.1475-3588.2009.00551.x.
Manassis, K., Oerbeck, B., & Overgaard, K. R. (2016). The use of medication in selective mutism: A systematic review. European Child and Adolescent Psychiatry, 25, 571–578. doi:10.1007/s00787-015-0794-1.
*Manassis, K., & Tannock, R. (2008). Comparing interventions for selective mutism: A pilot study. Canadian Journal of Psychiatry, 53, 700–703.
*Mayworm, A. M., Dowdy, E., Knights, K., & Rebelez, J. (2015). Assessment and treatment of selective mutism with English language learners. Contemporary School Psychology, 19, 193–204. doi:10.1007/s40688-014-0035-5.
*Mitchell, A. D., & Kratochwill, T. R. (2013). Treatment of selective mutism: Applications in the clinic and school through conjoint consultation. Journal of Educational and Psychological Consultation, 23, 36–62. doi:10.1080/10474412.2013.757151.
Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: A review on selective mutism, the new anxiety disorder in the DSM-5. Clinical Child and Family Psychology Review, 18, 151–169. doi:10.1007/s10567-015-0181-y.
Nail, J. E., Christofferson, J., Ginsburg, G. S., Drake, K., Kendall, P. C., McCracken, J. T., et al. (2015). Academic impairment and impact of treatments among youth with anxiety disorders. Child & Youth Care Forum, 44(3), 327–342.
*O’Reilly, M., McNally, D., Sigafoos, J., Lancioni, G. E., Green, V., Edrisinha, C., et al. (2008). Examination of a social problem-solving intervention to treat selective mutism. Behavior Modification, 32, 182–195. doi:10.1177/0145445507309018.
*Oerbeck, B., Johansen, J., Lundahl, K., & Kristensen, H. (2012). Selective mutism: A home- and kindergarten-based intervention for children 3–5 years: A pilot study. Clinical Child Psychology and Psychiatry, 17(3), 370–383. doi:10.1177/1359104511415174.
*Oerbeck, B., Stein, M. B., Pripp, A. H., & Kristensen, H. (2015). Selective mutism: Follow-up study 1 year after end of treatment. European Child and Adolescent Psychiatry, 24, 757–766. doi:10.1007/s00787-014-0620-1.
*Oerbeck, B., Stein, M. B., Wentzel-Larsen, T., Langsrud, O., & Kristensen, H. (2014). A randomized controlled trial of a home- and school-based intervention for selective mutism—defocused communication and behavioural techniques. Child and Adolescent Mental Health, 19, 192–198. doi:10.1111/camh.12045.
*Ooi, Y. P., Raja, M., Sung, S. C., Fung, D. S. S., & Koh, J. B. K. (2012). Application of a web-based cognitive-behavioral therapy programme for the treatment of selective mutism in Singapore: A case series study. Singapore Medicine Journal, 53, 446–450.
Phillips, B. M., Clancy-Menchetti, J., & Lonigan, C. J. (2008). Successful phonological awareness instruction with preschool children. Topics in Early Childhood Special Education, 28, 3–17. doi:10.1177/0271121407313813.
Pionek Stone, B., Kratochwill, T. R., Sladezcek, I., & Serlin, R. C. (2002). Treatment of selective mutism: A best-evidence synthesis. School Psychology Quarterly, 17, 168–190. doi:10.1521/scpq.17.2.168.20857.
*Plener, P. L., Gatz, S. A., Schuetz, C., Ludolph, A. G., & Kolch, M. (2012). A case of selective mutism in an 8-year-old girl with thalassaemia major after bone marrow transplantation. Pharmacopsychiatry, 45, 37–39. doi:10.1055/s-0031-1287776.
*Reuther, E. T., Davis, T. E., Moree, B. N., & Matson, J. L. (2011). Treating selective mutism using modular CBT for child anxiety: A case study. Journal of Clinical Child & Adolescent Psychiatry, 40, 156–163. doi:10.1080/15374416.2011.533415.
*Sanetti, L. M. H., & Luiselli, J. K. (2009). Evidence-based practices for selective mutism: Implementation by a school team. School Psychology Forum, 3, 27–42.
*Sharkey, L., McNicholas, F., Barry, E., Begley, M., & Ahern, S. (2008). Group therapy for selective mutism: A parents’ and children’s treatment group. Journal of Behavior Therapy and Experimental Psychiatry, 39, 538–545. doi:10.1016/j.jbtep.2007.12.002.
Shriver, M. D., Segool, N., & Gortmaker, V. (2011). Behavior observations for linking assessment to treatment for selective mutism. Education and Treatment of Children, 34, 389–411. doi:10.1353/etc.2011.0023.
Sluckin, A., Foreman, N., & Herbert, M. (1991). Behavioural treatment programs and selectivity of speaking at follow-up in a sample of 25 selective mutes. Australian Psychologist, 26, 132–137. doi:10.1080/00050069108258851.
Standart, S., & Couteur, A. L. (2003). The quiet child: A literature review of selective mutism. Child and Adolescent Mental Health, 8(4), 154–160.
Steinhausen, H.-C., Wachter, M., Laimbock, K., & Metzke, C. W. (2006). A long-term outcome study of selective mutism in childhood. Journal of Child Psychology and Psychiatry, 47(7), 751–756.
*Vecchio, J., & Kearney, C. A. (2009). Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management. Behavior Therapy, 40, 380–392. doi:10.1016/j.beth.2008.10.005.
Viana, A. G., Beidel, D. C., & Rabian, B. (2009). Selective mutism: A review and integration of the last 15 years. Clinical Psychology Review, 29, 57–67. doi:10.1016/j.cpr.2008.09.009.
Watson, T., & Kramer, J. (1992). Multimethod behavioral treatment of long-term selective mutism. Psychology in the Schools, 29, 359–366. doi:10.1002/1520-6807(199210)29:4<359::AID-PITS2310290409>3.0.CO;2-6.
Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology, 56, 337–363. doi:10.1146/annurev.psych.55.090902.141449.
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Zakszeski, B.N., DuPaul, G.J. Reinforce, shape, expose, and fade: a review of treatments for selective mutism (2005–2015). School Mental Health 9, 1–15 (2017). https://doi.org/10.1007/s12310-016-9198-8
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DOI: https://doi.org/10.1007/s12310-016-9198-8