Intensive Treatment of Childhood Selective Mutism

Selective mutism (SM) is a highly impairing anxiety disorder, characterized by a persistent inability to speak in unfamiliar settings and significant impairment in social and academic functioning. Although cognitive-behavioral therapy (CBT) is effective in treating childhood SM, traditional outpatient CBT for SM is inaccessible, relative to treatments for more common anxiety disorders. Intensive group behavioral treatment for SM (IGBT-SM) has garnered support for targeting the specific fears inherent to SM, mimicking the settings where youth with SM have most difficulty verbalizing, and increasing the availability of providers trained in specialty services for SM. This chapter provides a synthesis of current research on IGBT-SM and a description of the core components and skills used within the model. Special considerations are provided to effectively simulate the school environment within IGBTs, tailor skills to diverse presentations and verbal behaviors, and conduct treatment practices in non-therapeutic contexts. Case examples are provided throughout to illustrate the application and tailoring of skills. Finally, guidance is provided to support caregivers in implementing treatment skills with youth to support the generalization and sustainability of treatment gains.