Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

A Single-Session Workshop to Enhance Emotional Awareness and Emotion Regulation for Graduate Students: A Pilot Study

Emerging adults are at substantial risk for developing or worsening psychopathology and university students appear to be particularly vulnerable. Interventions targeted at these young adults that can mitigate transdiagnostic causal risk factors or burgeoning mental health problems have the potential to make a large impact. We aimed to develop and pilot test an accessible, single-session, transdiagnostic group intervention with the goals of enhancing emotion regulation skills and reducing risk for mental health problems in graduate students. The intervention included psychoeducation, skills instruction (e.g., mindful emotion awareness, cognitive flexibility, countering emotion-driven behaviors), group discussion, and supervised practice based on content from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. The pilot program demonstrated strong feasibility and acceptability. Baseline, 1-month, and 3-month follow-up surveys also suggested benefits for reducing emotional avoidance and suppression, increasing use of cognitive reappraisal, and reducing symptoms of depression and neuroticism. Graduate students have seldom been the beneficiaries of university-based intervention and prevention research. Furthermore, most college and university mental health centers do not have the capacity to provide psychoeducation, preventative, or early intervention services to the many students who need or could benefit from them. Results suggest that future iterations of this intervention could address such barriers to meaningfully supporting emerging adults in graduate school.     

Assessing interactional competencies: The early social-communication scales

Interactional competencies that develop in the first two years of life provide a foundation for all further social and communicative developments. Their normal acquisition, especially in the handicapped, can not be taken for granted. If delays in social-communicative development can be identified early in life and changes made in how the social environment interacts with the child, intervention may effectively facilitate social development. However, to accomplish this, both a model for describing and an instrument for assessing interactional competencies are needed. A recently developed set of scales, organized according to a cognitive-developmental framework and drawing upon recent research literature, is described in terms of its organization and content. Results that support the cognitive model underlying the set of scales are reported. The paper concludes with a consideration of potential criticisms that may apply to such a theoretically based instrument.     

Mothers' Perceptions of Infants Labelled ‘Depressed’

Forty-four depressed and non-depressed mothers participated in a videotaped interaction with their own infant and then rated the videotape using the Infant Stereotyping Scale and the Interaction Rating Scale. In addition, one half of the mothers rated a videotape of an unfamiliar infant who was labelled psychologically ‘depressed’ and the other half rated a videotape of the same infant with no label given. Both the depressed and non-depressed mothers rated the ‘depressed’ labelled infant more negatively than the non-labelled infant on the attributes of physical potency, cognitive competence, sociability and difficult behaviour. Physical appearance was the only rating that was not biased by the ‘depressed’ label. Mothers' ratings of their own infants were more positive than their ratings of the non-labelled stimulus infant. Depressed mothers did not see their infants more negatively except on one rating. They rated the physical appearance of their own infant more negatively than non-depressed mothers.     

Infants of “depressed” mothers interact better with their nondepressed fathers

To determine whether infants of “depressed” mothers interact better with their nondepressed fathers, twenty-six 3- to 6-month-old infants were videotaped during face-to-face interactions with their parents. The “depressed” mother group consisted of twelve 3- to 6-month-old infants and their “depressed” mothers and nondepressed fathers. The control group was composed of 14 nondepressed mothers and nondepressed fathers and their 3- to 6-month-old infants. In the “depressed” mother group, the nondepressed fathers received better interaction ratings than the “depressed” mothers. In turn, the infants received better interaction ratings when they interacted with their nondepressed fathers than with their “depressed” mothers. In contrast, nondepressed fathers and mothers and their infants in the control group did not differ on any of their interaction ratings. These findings suggest that infants' difficult interaction behaviors noted during interactions with their “depressed” mothers may not extend to their nondepressed fathers. The data are discussed with respect to the notion that nondepressed fathers may “buffer” the effects of maternal depression on infant interaction behavior.     

A comparison of accumulated and distributed reinforcement periods with children exhibiting escape-maintained problem behavior

Differential reinforcement is a common treatment for escape-maintained problem behavior in which compliance is reinforced on a fixed-ratio (FR) 1 schedule with brief access to positive and/or negative reinforcement. Recent research suggests some individuals prefer to complete longer work requirements culminating in prolonged (i.e. accumulated) reinforcement periods relative to brief (i.e. distributed) periods, but prolonged work exposure may evoke problem behavior and prevent compliance from contacting reinforcement when treating escape-maintained problem behavior. We exposed 3 children with escape-maintained problem behavior to both distributed (FR 1 resulting in 30 s of reinforcement) and accumulated (FR 15 resulting in 7.5 min of reinforcement) arrangements to compare their efficacy in maintaining low levels of problem behavior. We then assessed participants' preferences for these conditions in a concurrent-chains arrangement. Accumulated-reinforcement arrangements did not occasion additional problem behavior, but rather resulted in consistently lower levels of problem behavior for 2 of 3 participants. Participants demonstrated idiosyncratic preferences.     

Providing noncontingent,alternative, functional reinforcers during delays following functional communication training

Functional Communication Training (FCT) involves arranging extinction for problem behavior and reinforcement for a more desirable, functionally equivalent, communicative response (FCR). Although effective under ideal arrangements, the introduction of delays to reinforcement following the FCR can result in increased problem behavior. Austin and Tiger (2015) showed that for individuals whose problem behavior was sensitive to multiple sources of reinforcement, providing access to alternative, functional reinforcers during delays mitigated this increase in problem behavior during delay fading. The current study replicated the procedures of Austin and Tiger with 2 individuals displaying multiply controlled problem behavior. Providing alternative functional reinforcers reduced problem behavior during 10-min delays for both participants without requiring delay fading.     

Re-exposure to reinforcement in Context A during treatment in Context B reduces ABC renewal

Previous work from our laboratory showed that intermittently re-exposing rats to reinforcement for lever pressing in a training (A) context, while eliminating lever pressing in a second (B) context, increased ABA renewal of lever pressing relative to rats that experienced only Context B during response elimination. In the current study, we replicated these procedures while assessing renewal in the presence of a novel context (i.e., ABC renewal). Unlike the findings described above, renewal was reduced in the group that experienced re-exposure to Context A during lever-press elimination relative to rats that experienced only Context B. These findings suggest that alternating between contexts associated with reinforcement and extinction during treatment reduces the probability that organisms will respond in novel contexts. These outcomes may be the result of discrimination and/or generalization processes. Moreover, this training procedure may offer a potential mitigation strategy for ABC renewal.     

Assessment and treatment of elopement maintained by chase

Elopement can have serious or fatal consequences associated with leaving the presence of an adult or getting lost (e.g., traffic injury and drowning). Given the dangers associated with elopement, caregivers are likely to chase after their child when elopement occurs. Like other forms of attention that follow problem behavior, chasing and retrieving the child may serve as a reinforcer and therefore maintain elopement. However, no study to date has evaluated whether elopement is sensitive to positive reinforcement in the form of chase. We evaluated the effects of chase on elopement with an 8‐year old boy diagnosed with autism. Elopement was maintained, at least in part, by chase. We then conducted a treatment evaluation in which we tested the effects of various antecedent‐ and consequence‐based treatment components within a multiple schedule.