(PS3-9) Exploring the Feasibility of Puppets in an Intensive Group Behavioral Treatment Program for Selective Mutism (IGBT-SM): An Exploratory Study

Abstract Text: Anxiety disorders are among the most common emotional problems and mental health disorders seen in children. One type of childhood anxiety disorder, Selective Mutism (SM), is characterized by a “consistent failure to speak in social situations in which there is an expectation to speak, such as school, despite speaking in other situations,” (APA, 2022, p. 189). While SM is an anxiety disorder, traditional Cognitive Behavioral Therapy (CBT) methods, that are useful with other child anxiety disorders, are not as effective when it comes to SM, due to the clinical and developmental challenges of this population. Although there are a handful of established interventions for the treatment of children with SM, such as Parent Child Interaction Therapy for SM (PCIT-SM), this disorder can present challenges for clinicians, as it often takes time for this population to become verbal, even with the range of techniques employed to engage the child. Prior research highlights the challenges of treating children with SM, commenting on their slowness to warm up and initial silence, the salient features of other disorders with communication challenges such as autism spectrum disorder (ASD). Research has addressed the successful use of puppets with helping expressive and receptive capabilities of children on the autism spectrum. For children with communication challenges, puppets can help provide effective communication strategies that align with the child’s cognitive, motor, and emotional development. This current study is the first to incorporate the addition of puppets in the treatment of children with SM. As a pilot study, this study seeks to assess the extent to which puppets are a feasible addition to the treatment of SM, through an intensive group behavioral treatment (IGBT) format. The primary purpose of this study is to see if there is an element of treatment that clinicians can take better advantage of, such as a puppet, in the early phases of treatment, to help tap into a more developmentally appropriate approach for the successive shaping of communication. Participants (n=14) consisted of children between the ages of 4 to 8 years and their primary caregivers. For study eligibility, children met DSM-5 criteria for SM according to the ADIS-5. Camp CHAT (Challenging High Anxiety of Talking), an intensive group behavioral treatment program for children with SM (IGBT-SM), ran through a university clinic, was the basis for this intervention. The program utilized cognitive behavioral therapy, PCIT-SM, and exposure therapy techniques to reduce SM symptoms. This study included three phases: pre-treatment, treatment, and post-treatment. Report measures, qualitative and quantitative, were collected throughout all phases of treatment to monitor change. Data collection is nearing completion, and preliminary data analysis suggests a feasibility of puppets in the treatment of individuals with SM, based on qualitative daily counselor report. Once data collection is complete, a series of single subject pre and post t-tests will be run, as well as qualitative thematic analysis.