Treatment of selective mutism: A best-evidence synthesis.

Abstract

A major goal of treatment of children with selective mutism has been to help them speak in situations to people with whom they did not previously speak. A systematic analysis examining the effectiveness of treatment models, assessed by treatment outcomes (e.g., speaking) and methodological quality of the studies, has not been conducted on the existing selective mutism literature. Further, most treatment outcome studies have utilized case studies or single-case designs, which, until recently, were more difficult to examine systematically (e.g., meta-analysis). Thus, this study represents the first systematic analysis of the major treatment approaches used for selective mutism with the goal of drawing conclusions about selecting evidence-based procedures for practice. Based on nonparametric statistical tests of effect sizes, the major findings include the following: (a) treatment of selective mutism is more effective than no treatment, (b) behaviorally oriented treatment approaches are more effective than no treatment, and (c) no differential effectiveness was found between two common models of behavior therapy (i.e., applied behavior analysis and combined behavioral approaches). In addition, researchers have given minimal attention to the impact of selective mutism on educational performance. In this study, which reviewed existing research, information regarding academic achievement was evaluated qualitatively. Recommendations are made for improving the methodologi-