Reinforce, shape, expose, and fade: a review of treatments for selective mutism (2005-2015)

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.