Personalized Individual and Group Therapy for Multifaceted Selective Mutism

Selective mutism refers to a persistent and debilitating condition in which a child fails or refuses to speak in public situations. Research on treatment for selective mutism has progressed in recent years toward a more personalized model based on clinical profiles unique to a given child. Such profiles may include aspects of anxiety, oppositional behaviors, and communication problems as well as operant factors that maintain selective mutism. The present case represents a 6-year-old child with selective mutism with a multifaceted clinical profile that included internalizing and externalizing behavior problems with multiple operant factors. Initial personalized individual therapy focused on anxiety and contingency management procedures to address school refusal behavior and to lay the groundwork for later treatment of selective mutism. Group therapy with parent and child components focused on these procedures in more detail in addition to social skills development. Each component included detailed hierarchies for increasing frequency and audibility of speech in a clinic setting as well as in community and school settings.