Parent-Child Interactions in Behavioral Treatment of Selective Mutism: A Case Study

Christina M. Mele

Selective Mutism (SM) is a childhood anxiety disorder that affects children’s social functioning in a variety of settings. Individuals with Selective Mutism are often talkative with their parents at home, but experience a persistent failure to verbalize in other social environments, such as school. In order to address these impairments, the goal of treatment is for children to speak with various people and in multiple contexts (i.e., generalization). Interestingly, research has suggested that parents’ interaction styles play a role in the maintenance of anxiety symptoms and may interfere with the process of generalization. Recent intervention techniques have also shown that involving parents in treatment may afford them with the necessary skills to foster a positive way of interacting with their children. In order to shed light on the role of parental involvement in the treatment of SM, this case study examined the interactions of one mother-child dyad to determine the ways in which a parent verbally engaged with her child. The parent and her five-year-old daughter attended six therapeutic sessions over a five-week period in a clinical office. Over the course of these sessions, clinical therapists were introduced in the presence, then in the absence, of the parent with the child. Mother-child and therapist-child verbal interactions were analyzed in the context of developmentally appropriate, game-based play activities (e.g., cards, doll play) to determine four trends: (1) the child’s verbal response rate to questions (i.e., yes/no, forced-choice, and open-ended), (2) child’s verbal response rate to commands (i.e., direct and indirect), (3) parent and therapist’s verbal response rate contingent to child’s speech (e.g., verbal reinforcement of child’s talking), and (4) the child’s rate of spontaneous speech (i.e., unprompted verbalizations) over the course of treatment. Results show that the child’s response rate to questions and commands by the mother and therapist increased as a function of time and treatment. The mother and therapist also provided a high rate of contingent responses to the child’s verbalizations over the course of six sessions, suggesting that the mother and child shared verbal exchanges. The child’s rate of spontaneous verbalizations increased four-fold as a function of time and treatment. Results of this case study provide insight into the ways in which parents and therapists can promote, or hinder, the verbalizations of children diagnosed with Selective Mutism. Given these findings, future research should replicate this study with a larger sample and examine the nature of verbal interactions between multiple parent-child dyads.