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The Treatment of Selective Mutism: a Case Control Alternating Treatments Design UNLV Retrospective Theses & Dissertations 1-1-2008 The treatment of selective mutism: A case control alternating treatments design Jennifer L Vecchio University of Nevada, Las Vegas Follow this and additional works at: https://digitalscholarship.unlv.edu/rtds Repository Citation Vecchio, Jennifer L, "The treatment of selective mutism: A case control alternating treatments design" (2008). UNLV Retrospective Theses & Dissertations. 2818. http://dx.doi.org/10.25669/udes-96xv This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Retrospective Theses & Dissertations by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. THE TREATMENT OF SELECTIVE MUTISM: A CASE CONTROL ALTERNATING TREATMENTS DESIGN by Jennifer L. Vecchio Bachelor of Arts University of Nevada, Las Vegas 1998 Master of Arts University of Nevada, Las Vegas 2003 a dissertation submitted in partial fulfillment of the requirements for the Doctor of Philosophy Degree in Psychology Department of Psychology College of Liberal Arts Graduate College University of Nevada, Las Vegas August 2008 UMI Number: 3338188 Copyright 2008 by Vecchio, Jennifer L. All rights reserved. INFORMATION TO USERS The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. UMI UMI Microform 3338188 Copyright 2009 by ProQuest LLC. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 E. Eisenhower Parkway PC Box 1346 Ann Arbor, Ml 48106-1346 Copyright by Jennifer L. Vecchio 2008 All Rights Reserved Dissertation Approval The Graduate College University of Nevada, Las Vegas June 28 07 20___ The Dissertation prepared by Jennifer L. Vecchio Entitled The Treatment of Selective Mutism: A Case Control Alternating Treatments Design is approved in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology Examination Committee Chair Dean of the Graduate College me. inatwn Committee Member mittee Member Graduate College Faculty Representative 1017-52 11 ABSTRACT The Treatment of Selective Mutism: A Case Control Alternating Treatments Design by Jennifer L. Vecchio Dr. Christopher Kearney, Examination Committee Chair Professor of Psychology University of Nevada, Las Vegas This was the first study to examine the differential effectiveness of two behavioral interventions for selective mutism while employing a single-case alternating treatments design with documentation of treatment outcomes, calculation of effect size, and measures of treatment integrity. Participants were recruited via press release to the local media and the Clark County School District. Interested participants were initially screened over the telephone. If the screening indicated that a child met diagnostic criteria for selective mutism and did not meet exclusionary criteria, an assessment was scheduled. Each participant was assessed by the Anxiety Disorders Interview Schedule for Children for DSM-IV Child and Parent versions. Child Behavior Checklist, and Teacher Report Form. In addition, daily logs were collected from parents, children, and teachers to evaluate degree of mutism. The present study included nine children age 4-9 years. Five participants started with treatment A (exposure therapy) and followed the ABBABAAB pattern and four participants started with treatment B (contingency management) and followed the BAABABBA pattern. The results indicated that exposure-based therapy and 111 contingency management are effective behavioral interventions for selective mutism. The majority of children (86%) met criteria for treatment success at post-treatment. Rates of speech increased over 600% from baseline to end of treatment. Child ratings of speech indicated a large treatment effect size and parent ratings of speech indicated a moderate treatment effect size. Furthermore, the results indicated that exposure-based therapy was more effective than contingency management. The study provides additional support for the use of behavioral interventions for selective mutism. More specifically, the study provides empirical support for the differential effectiveness of exposure-based therapy. Several clinical implications for identification, assessment, and treatment of selective mutism were presented. IV TABLE OF CONTENTS ABSTRACT................................................................................................................................. iii ACKNOWLEDGEMENTS...................................................................................................... vii CHAPTER 1 INTRODUCTION............................................................................................I Classification.....................................................................................................................2 CHAPTER 2 REVIEW OF RELATED LITERATURE.................................................... 4 Historical Overview .........................................................................................................4 Classification of Selective Mutism................................................................................9 Epidemiology..................................................................................................................10 Characteristics of Children with Selective Mutism...................................................13 Familial Characteristics of Children with Selective Mutism...................................29 Differential Diagnosis of Selective Mutism.............................................................. 33 Theories of Selective Mutism...................................................................................... 34 Assessment......................................................................................................................44 Treatment........................................................................................................................53 Suggestions for Future Research and Purpose of the Present Study......................80 Hypotheses......................................................................................................................82 CHAPTER 3 METHODOLOGY........................................................................................ 83 Participants......................................................................................................................83 Child Measures.............................................................................................................. 83 Parent Measures............................................................................................................. 84 Teacher Measures..........................................................................................................86 Clinician Measures.........................................................................................................87 Participant Screening.................................................................................................... 88 Procedure........................................................................................................................91 Data Analyses................................................................................................................ 96 CHAPTER 4 Results.............................................................................................................. 98 Case Studies....................................................................................................................98 Clinical Diagnoses.......................................................................................................143 Associated Symptomatology..................................................................................... 145 Daily Measures........................................ 146 Within-group Comparisons.........................................................................................146 Treatment Effect Size................................................................................................. 147 Reliability, Integrity, and Credibility ....................................................... 148 V CHAPTER 5 DISCUSSION............................................................................................... 149 APPENDIX I. Figures and Tables................................................................................... 161 APPENDIX 11. Child Daily Ratings..................................................................................223 APPENDIX 111. Demographic
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