Siroky Allison K, Carlson John S, Kotrba Aimee
Nationwide Children's Hospital Big Lots Behavioral Health Services, Columbus, OH 43215, USA.
Department of Counseling, Educational Psychology & Special Education, College of Education, Michigan State University, East Lansing, MI 48224, USA.
Pediatr Rep. 2023 Oct 16;15(4):617-635. doi: 10.3390/pediatric15040057.
Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child's academic and social functioning if left untreated. Cognitive-behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16-22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.
选择性缄默症（SM）是一种罕见的儿童焦虑症，如果不进行治疗，可能会对儿童的学业和社交功能产生显著不利影响。认知行为疗法已被证明对社交焦虑症有效，对选择性缄默症也有效，但鲜有已发表的研究探讨新手临床医生实施的手册化治疗方法。本研究的目的是检验一种精简版的、共16节的选择性缄默症综合行为疗法（IBTSM；伯格曼，2013年）的依从性、有效性和可接受性，这是第一种针对选择性缄默症的手册化治疗方法。对五名被诊断为选择性缄默症（仅焦虑亚型）的儿童采用了非同期多基线单病例设计。IBTSM的实施依从性良好（M = 98%），平均持续19周（范围 = 16 - 22周）。对每周照顾者对社交焦虑和言语行为的评分进行视觉分析，未显示出重复的干预效果；然而，Tau-U效应量和可靠变化指数（RCI）计算表明，随着时间的推移，在多项测量中，社交焦虑和言语行为有显著的个体改善。三名儿童（60%）在治疗后不再符合选择性缄默症的诊断标准。所有照顾者都认为IBTSM是可接受的，并特别认可在所需时间和治疗质量方面的可接受性。
