Integrated Behavior Therapy for Exclusively Anxious Selective Mutism: A Nonconcurrent Multiple-Baseline Design across Five Participants
A fast 16-session package run by new staff can knock out selective mutism for most anxious kids.
01Research in Context
What this study did
Five children who spoke only at home got a short, 16-session therapy package. Novice clinicians ran the sessions after a quick training.
The team used a multiple-baseline design. They tracked how often each child spoke at school and how anxious they felt.
What they found
Most kids talked more and felt less anxious. Three out of five no longer met the rules for selective mutism.
The numbers looked good, but the pictures did not line up for every child. Some gains were clear, others were shaky.
How this fits with other research
Shin et al. (2021) and Ampuero et al. (2025) also used brief BST to get new helpers to 90 % fidelity. AK et al. show the same trick works outside autism and inside anxiety clinics.
Pettingell et al. (2022) say exposure works best when you add surprise and variety. AK’s team did not test those bells, so we do not know if extra ILT moves would boost the win rate.
Stokes et al. (1980) got kids to behave at the dentist with modeling and candy. AK got kids to talk at school with a fuller CBT-plus-exposure mix. Both used baseline logic, but AK’s target was talking, not sitting still.
Why it matters
You can train a new hire in one afternoon and still cut selective mutism in half. Keep the 16-session script handy, track talk at school, and watch for the one-in-three who may need extra rounds or ILT twists.
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02At a glance
03Original abstract
Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.
, 2023 · doi:10.3390/pediatric15040057