3 - (SYM 5) Get Comfortable Being Uncomfortable: PCIT Adapted for Selective Mutism

Selective mutism (SM) is an anxiety disorder characterized by a child’s inability to speak in specific situations despite having knowledge of or comfort with the spoken language required (APA, 2013). Children with SM often avoid responding when prompted; this avoidance is inadvertently negatively reinforced by carers who either speak for the child or remove the expectation to speak. As this cycle of avoidance continues, the child’s habit of avoidance strengthens and their self-efficacy diminishes. The delay or absence of treatment confer considerable risk for worsening functional impairment. Parent-Child Interaction Therapy Adapted for Selective Mutism (PCIT-SM; Carpenter et al., 2014; Kurtz, 2015) is a behavioral treatment for SM using carers as key agents of change. Carers are coached live applying behavioral techniques to scaffold approach behaviors, shape successive approximations of talking and help generalize gains across settings and situations. In a waitlist-controlled study of 16 weekly PCIT-SM sessions, treatment completers had significant improvements in frequency of speaking across home, school, and community settings; gains were maintained 1-year later (Catchpole et al., 2019). This sample included a high proportion of children with a primary language other than English (32.3%) and children who had never spoken in public or community settings at baseline (46.7%). In an RCT of a 5-day PCIT-SM intensive group treatment, a significantly greater proportion of treated children (50.0%, p </em>= .006) were rated “responders” compared to children in the waitlist control group (0%) (Cornacchio et al., 2019). Further, 45.8% of children who completed treatment no longer met criteria for SM 8-weeks into the subsequent academic year. Findings from these trials are particularly notable due to the high degree of racial and ethnic minority representation included in each (34.5 – 54.8%). Camp CHAT, a group PCIT-SM model, featured a hybrid model of in-person and telehealth services; 57.1% of children were coded as “responders” at post-treatment (Webb, 2022). A study of remote group PCIT-SM (Hong et al., 2022) indicated 44.4% “responders” at post-treatment; parents reported high levels of treatment satisfaction and low levels of burden associated with participation at follow-up. Together, these studies demonstrate the efficacy of PCIT-SM when delivered in either a family or group format or when delivered in-person, via telehealth, or via a hybrid model. Clinical implications and future directions for research will be discussed.