(PS9-C58) Evaluating Intensive Group Behavioral Treatment for Selective Mutism

Selective mutism (SM) is a childhood anxiety disorder characterized by consistent failure to speak in specific social situations in which speech is normally expected, despite speaking fluently in other social situations (APA, 2013). Typically, SM is treated via weekly individual treatment sessions utilizing cognitive behavioral and Parent Child Interaction Therapy for SM strategies (Cohan et al., 2006; Furr et al., 2020; Muris & Ollendick, 2015). While seemingly effective, this mode of treatment possesses limitations, including the availability, accessibility, and acceptability of treatment. Clinicians have long attempted to address these issues by implementing intensive group behavioral treatment (IGBT; Cornacchio et al., 2019; Kurtz, 2016; Lorenzo et al., 2021) for children with SM. While clinicians have anecdotally reported IGBT as highly effective in reducing SM symptoms, only one research study to date has examined the preliminary feasibility and efficacy of an IGBT for SM (Cornacchio et al., 2019). The primary aim of the current study was to add to this literature by evaluating the feasibility, acceptability, and accessibility of Camp CHAT (Challenging High Anxiety of Talking), a hybrid in-person and telehealth 5-day IGBT hosted at a university-based community clinic. A secondary aim was to preliminarily examine the effectiveness of Camp CHAT.

Participants included seven children aged 7-9 who met criteria for SM and their primary caregivers. Caregivers engaged in four 2-hour caregiver-only group sessions focused on reducing family accommodation (FA), while children engaged in 1-week of five 6-hour IGBT sessions. IGBT sessions mirrored typical school environments and emphasized exposures. Data was analyzed using visual inspection and the Reliable Change Index, and changes were primarily examined from pre-treatment to school year follow-up (SYFU).

Across treatment, six participants increased their verbalizations during the behavioral approach task, Verbal Output during Interactions in the Classroom Environment. At SYFU, four caregivers and three teachers reported meaningful improvement in participants’ SM symptoms and verbal behaviors according to the Selective Mutism Questionnaire and School Speech Questionnaire. At least three caregivers reported meaningful decreases in FA according to the Family Accommodation Scale – Anxiety. Additionally, at SYFU, four participants experienced remission of at least one anxiety disorder according to the Anxiety Disorders Interview Schedule for the DSM-5, and two of these participants no longer met criteria for SM. Overall, caregivers expressed extremely high satisfaction with Camp CHAT according to the Client Satisfaction Questionnaire and a qualitative debriefing questionnaire. These findings suggest that Camp CHAT is a feasible, acceptable, and accessible IGBT program for children with SM. Furthermore, the findings provide promising support for the effectiveness of Camp CHAT. By establishing Camp CHAT as an efficacious IGBT program generalizable to community treatment settings, more children may receive intensive, brief, effective treatment, thus reducing the detrimental long-term effects of SM on children’s social, emotional, and academic development.