EDUCATION AND TREATMENT OF CHILDREN Vol. 34, No.

3, 2011

Behavior Observations for Linking Assessment to

Treatment for Selective Mutism
Mark D. Shriver
Munroe-Meyer Institute for Genetics and Rehabilitation
Natasha Segool
University of Hartford
Valerie Gortmaker
Applewood Centers, Inc., Cleveland, Ohio
Abstract
Selective mutism is a childhood disorder that most school psychologists and
educational providers will come across at least once in their careers. Selective
mutism is associated with significant impairment in educational settings
where speaking is necessary for academic and social skill development.
Effective treatments for selective mutism typically involve shaping or stimulus
fading procedures. Choosing an effective treatment strategy for a child with
selective mutism is dependent upon careful analysis of data gathered during
the assessment process. This article focuses on behavior observations as a
primary source of data for effective decision making regarding treatment for
selective mutism. Previous literature on behavior observation and selective
mutism is reviewed and guidelines are presented for decision making based
on observational data. This article presents two case studies that illustrate the
use of observational data for treatment decision making. In addition, the role
of behavioral observations to inform selective mutism treatment decisions in
practice and the need for future research on this topic are discussed.

elective mutism is a disorder that is typically noticed during

childhood and characterized by a childs almost complete lack of
speaking in certain situations or settings but adequate speaking in
other situations and settings, most often at home and/or with family
members. The classroom is often the setting where a childs lack
of speech becomes most noticeable and may be most problematic
due to academic and social expectations in school. In mental health
settings, the prevalence for selective mutism is reportedly low, with
a prevalence of less than 1% (American Psychiatric Association, 2000;
Elizur & Perednik, 2003). It is likely that the observed prevalence of
Correspondence to Mark D. Shriver, Ph.D, Associate Professor, Psychology, Pediatrics
Munroe-Meyer Institute, University of Nebraska Medical Center 985450 Nebraska
Medical Center Omaha, NE 68198-5450; e-mail: mshriver@ unmc.edu.

Pages 389-411

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selective mutism in schools may be higher, however, as the classroom

is the setting in which impairment may be most likely observed
(Bergman, Piacentini, & McKracken, 2002; Kumpulainen, Rasanen,
Raaska, & Somppi, 1998). It seems likely that psychologists working
in schools will come across at least one child with selective mutism
sometime in their careers.
Although etiology is unclear, contemporary research on selective mutism suggests that it is an anxiety-related disorder, or at least
frequently co-occurs with anxiety (Black & Uhde, 1995; Vecchio & Kearney, 2005). Conceptualizing selective mutism as an anxiety disorder
implies that there is an adverse physiological arousal of the autonomic nervous system in response to certain stimuli. For children with
selective mutism, it may be that anxiety (i.e., the averse physiological
response) occurs in the presence of people outside the family context.
It is not clear what the controlling variable(s) is that elicits anxiety for
children with selective mutism. For example, anxiety may be elicited
by the mere presence of other people, or when the attention of others
is directed toward the child (i.e., looking at the child, speaking to the
child) or by the act of actually talking to others. It is more than likely
that the functional variable(s) is different for each individual child.
Although anxiety is a common construct invoked in mainstream psychology, behavioral conceptualizations of anxiety-related disorders
are not yet well established empirically or theoretically since anxiety
as a term encompasses such a broad array of responding (Dymond &
Roche, 2009; Friman, Hayes, & Wilson, 1998). What is clear, however,
is that over time a child learns alternative responses to speech (i.e.,
silence) in the presence of others and/or in the presence of particular
situations and settings.
Treatment for selective mutism has typically focused on behavioral and pharmacological interventions. This article focuses primarily
on behavioral interventions (see Carlson, Mitchell, & Segool, 2008 for
a review of pharmacological treatments for selective mutism). Largely
due to the low prevalence of selective mutism, research on behavioral
interventions has typically employed case studies and single-subject
designs. In addition, although anxiety is often invoked as an aspect
of the conceptualization of why children are selectively mute, behavioral interventions have largely focused on the operant components.
Shaping procedures and stimulus generalization procedures (also
termed programming common stimuli and stimulus fading in previous research) have been identified as the two most common effective
behavioral interventions for promoting speech (Stone, Kratochwill,
Sladezcek, & Serlin, 2002).
Shaping and stimulus fading are two very different treatments.

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Shaping involves reinforcing successive approximations to a target

behavioral goal, often speaking in the presence of others. In short,
the target goal for treatment in a stimulus fading procedure focuses
on the content. For a child with selective mutism, the target goal for
shaping is focused on what the child does to communicate. Stimulus
generalization involves reinforcing verbal communication in the presence of different stimuli, such as new peers, adults, or different environments, such as new situations or settings. In short, the target goal
for treatment in a stimulus fading procedure that focuses on the context in which the child communicates. For a child with selective mutism, the target goal for stimulus fading treatment is focused on where,
when, and/or with whom the child communicates. There are similarities
between the two treatment approaches. Both forms of treatment typically involve the systematic prompting of communicative responses
(vocal or non-vocal) and the subsequent fading of those prompts.
Functional Behavior Assessment: Interviewing and Observational
Techniques
Prior to designing and implementing a behavioral intervention
for the treatment of selective mutism, many decisions must be made
such as determining the verbal behavior to be shaped (e.g., goal, baseline, and successive steps), what prompts to use, how prompts will
be faded, what stimuli (e.g., teacher, other student) need to be introduced and how stimuli will be introduced (i.e., procedure for fading),
and what reinforcement and reinforcement schedule will be used.
These treatment decisions must be individualized to effectively address each childs needs and current functioning. It can readily be argued that effective treatment decisions are most likely to occur when
guided by relevant assessment data. Decisions regarding behavioral
interventions, such as shaping or stimulus generalization, often rely
on data from behavior assessment such as interviews and observations from both clinical and naturalistic settings. Although some behavioral rating scales specific to selective mutism exist (e.g., Hooper
& Linz, 1992), there does not appear to be widespread use of rating
scales in the treatment literature. Such scales may be more commonly
used as part of a diagnostic or screening evaluation.
For treatment purposes, behavior observation has been described as the key lynchpin of assessment and treatment of selective mutism (Kearney & Vecchio, 2006, p. 144). Behavior observations
are typically guided by information gathered from interviews with
significant caregivers in the childs life (i.e., parents, teachers). Kearney and Vecchio (2006) suggest several procedures for the behavioral
assessment of selective mutism, including the use of key questions for

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interviewing parents and structured observations in multiple settings

such as the classroom, playground, and home (see Table 1). Additionally, the use of daily logs to collect data from parents, teachers, and/
or children on speaking is recommended. The procedures described
by Kearney and Vecchio appear very promising for guiding assessment of children with selective mutism. What is missing, however, are
specific guidelines or steps for how to analyze and use these data to
inform treatment decision-making.
Some years ago, Labbe and Williamson (1984) provided some
important guidance for linking assessment and treatment. Specifically, they suggested five links between assessment outcomes and
treatment strategies that were based on a review of selective mutism
research at that time. Table 2 presents an adaptation of Labbe and
Williamsons treatment suggestions. Conceptually the links between
assessment data and treatment decisions prescribed by Labbe and
Williamson seem to make sense, but there has not been any followup research or other literature that has described and applied those
guidelines for linking assessment and treatment for children with selective mutism.
This article expands upon the linkages between assessment and
treatment previously outlined by Labbe and Williamson (1984) and
the assessment procedures described by Kearney and Vecchio (2006)
by more specifically describing guidelines for conducting behavior
observations of children with selective mutism and then explicitly
linking the data from those observations to the design, implementation, and monitoring of behavioral treatment for children with selective mutism. Case studies are presented as examples of the potential
treatment utility of the assessment/observation process. Finally, some
suggestions for future research to establish evidence-based assessment protocols to facilitate the effective behavioral treatment of selective mutism are provided.
Functional Behavior Observation of Children with Selective
Mutism
For the purposes of treatment planning for selective mutism,
behavior observation is conducted for two primary purposes; 1) to
identify the settings and situations in which the child does and does not
speak, and 2) within each setting and situation, to identify what the
child does to communicate. The first purpose refers to where, when,
and with whom the child communicates and the second purpose refers to what the child does to communicate (i.e., whispering, nonverbal gesturing, vocalizing, etc.) within each of the first three contexts.
This has been referred to as the AB (Antecedent-Behavior) model of

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Table 1
Interview and observation techniques for use in designing treatment
Interview Questions

Observation Techniques

Setting/Environment
What settings occasion a childs mutism
Narrative recording of setting variables
(e.g., home, school, community settings, associated with speech and mutism
etc.)?
How long has the mutism occurred in
each setting?
People
With whom will the child speak freely
Record who the child communicates
or become mute?
with spontaneously or following
a prompt. Record prompts that go
unanswered.
When mutism occurs in each situation,
Record who is in the immediate
is the child alone or with others?
environment when speech or mute
behaviors occur.
Quality of Communication
How is the childs mutism manifested
Record the number of words spoken or
in each setting?
type of nonverbal communication used.
What compensatory behaviors does
Record compensatory behaviors
the child show to communicate with
(e.g., whispering, pointing, nodding,
others?
mouthing, crying, frowning, stomping,
temper tantrum, pushing, or pulling)
Narrative recording of childs social
and communication skills in relation to
same-aged peers
Antecedents and Consequences of Mutism
What are the specific antecedents and
Record key antecedents (e.g., demands/
circumstances that surround each
expectations of situation or social
instance of mutism/speech?
approaches from others)
How do others respond to a childs
Record key consequences (e.g.,
mutism (e.g., ordering food or
parent or teacher acquiescence;
completing tasks for the child; allowing
accommodation of a childs mutism)
whispers in the ear or pointing;
rearranging a setting to accommodate a
childs mutism)?
Can the child be enticed to speak
Record any possible reinforcer or
audibly in these situations in any way?
change in environment used to produce
speech.
To what does the child or the family
Record evidence of anxiety as indicated
or the teacher attribute mutism (e.g.,
by visible arousal symptoms (e.g.,
oppositional, anxiety, skill deficit)?
blushing, body tense, eyes cast
downward), escape, withdrawal, or
avoidance behaviors
Adapted from Kearney & Vecchio, 2006, p. 143-4

Limited/ occasional

Typical rate

Typical rate

Limited/ occasional

No speech

No people

One or limited
people

Most people

One or limited
people

Most people

Person Variable

No
environments

One
environment

One
environment

Most
environments

Most
environments

Setting Variable

A) Response initiation, i.e. shaping, avoidance/escape,

reinforcement sampling, modeling, or response cost and
subsequently
B) Stimulus fading of new people and/or environmental
stimuli

A) Stimulus Fading of new people into environment where

speech already occurs and subsequently
B) Stimulus fading of environmental stimuli

A) Stimulus Fading of environmental stimuli

A) Stimulus Fading of new people in target environments

A) Contingency Management for all speech

Treatment Steps

Note: In all treatments described above, contingency management procedures focused on positive reinforcement for speech, reinforcement
fading, and maintenance procedures were also proposed following the implementation of the primary treatment.
Adapted from Labbe & Williamson, 1984, p. 289

Speech Frequency

Recommendation

Table 2
Treatment recommendations linked to assessment outcomes

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functional analysis (Hanley, Iwata, & McCord, 2003).

Typically, in a functional behavior assessment a third purpose
is also identified, namely to identify the relevant consequences for
speaking and not speaking. Consideration of the third purpose has
been referred to as the ABC model (Hanley, Iwata, McCord, 2003).
Identifying the consequences of a behavior, such as silence, is difficult. One could look to identify consequences for the behaviors that
take place instead of vocalizations (e.g., non-vocal behavior), but this
has not been accomplished to this point. Also, one could seek to identify the consequences that function to maintain vocal behavior in the
presence of other stimuli. This has also not been demonstrated in previous research. There has been preliminary work on systematically
manipulating conditions as part of a brief experimental analysis (i.e.,
analog observations using the ABC model of functional analysis) to
determine conditions in which a child will and will not speak (Schill,
Kratochwill, & Gardner, 1996). Such an approach would have the advantage of improved time efficiency relative to the time involved with
conducting naturalistic observations. However, such an approach requires control conditions in which the child will speak or otherwise
communicate in order to have comparisons of differences in rate of
speech between experimental conditions. Additional research using
brief functional analyses with children with selective mutism is needed before such an approach can be recommended for common practice. For this reason the AB model of functional behavior assessment
is the focus of this article.
At least the first two objectives must be met in order to effectively design a treatment that focuses on the individual childs use of
communication skills in different environmental settings, with different people, and across different situations and times. By completing
a functional behavior assessment of a childs baseline functioning, an
individualized treatment program with a reasonable treatment hierarchy and stepped treatment goals can be developed.
Where (Settings)
The hallmark characteristic of selective mutism is that a child
speaks in some settings, typically the home, but not other settings,
such as the classroom or in public places such as restaurants. One of
the first steps in assessment would be determining all the settings
common to a childs daily routine and determining those settings in
which the child speaks and those settings in which the child does not
speak or otherwise communicate. This can largely be accomplished
through interview with the parent and significant others (i.e., teachers). Subsequent observation of the child should take place in a setting

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in which the child talks readily and, of course, in settings where the
child does not talk. Sometimes video recording of the child in these
settings may be used if the clinician is not able to arrange for direct
observation. Obtaining a sample of typical speech in a setting where
speech typically occurs is essential for assessing the childs verbal
skills and to rule out an underlying speech or language disorder or
other diagnosis.
When (Activities/Demands)
Within settings there are situations defined by activities in which
the child participates, and/or demands or expectations to which the
child is expected to respond. There are likely to be particular activities
in which the child is more likely to talk compared to other activities.
It may be that the child more readily talks during a play activity in
the classroom compared to when called upon to answer a question. It
may be that a child is more likely to talk while playing soccer during
recess compared to playing Red Rover. In other words, once the
settings are determined in which a child talks and does not talk, it is
helpful to begin to more specifically analyze activities that occur in
those settings in which the child is more or less likely to talk. Assessing the specific variables inherent with different activities/demands
is important to understanding how these different variables within
a given setting may affect a childs speaking. For example, it may be
that certain variables such as tangible objects, preferred activities, or
needs, (i.e., full bladder), are more likely to be situations in which the
child speaks, whereas other variables such as taking turns reading
aloud in class are not likely to produce talk. It may be that intervention will include programming those variables or stimuli (i.e., activities/demands) likely to produce speaking in settings where speaking
is less likely to occur.
With Whom
Similar to identifying the different activities and demands within settings in which the child is more or less likely to talk, it is also
helpful to identify particular adults, children, and community members with whom the child is more or less likely to talk. Our experience has been that a child may be likely to have one or more peers
in the classroom with whom he or she may communicate in some
capacity (vocally or non-vocally), and that it is the adults in the classroom (teachers, paraprofessionals) with whom the child is less likely
to communicate. It is important to identify all individuals with whom
the child is most likely to talk or communicate and those with whom
the child is least likely to talk and/or communicate.

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What (Vocal and Non-vocal Communication Repertoire)

The ultimate goal of treatment is for the child to be speaking
across all settings, situations, and with all relevant individuals. Therefore, it is important to determine initially the childs typical communication skills in settings in which the child typically talks. It is also
important to determine across all other settings and situations how, or
if, the child typically communicates if the child does not talk. For example, does the child use gestures, pictures, whispers, mouth words,
use others as interpreters, or refrain from communication altogether?
The assessment of current communication skills, particularly in settings in which talk is limited, will help determine the starting point for
intervention. For example, if a child refrains from any communication (i.e., freezes when attended to by others) than the first step may
be to prompt and reinforce any type of communicative response. If
the child occasionally responds non-vocally, but at a very low rate in
particular situations or settings, then the first step may be to increase
the rate of non-vocal communication prior to attempting to shape approximations to speaking. If the child occasionally whispers in some
settings or situations, then the first step may be to increase the decibel
level of speaking. In sum, it is important to identify the type and rate
of communication within the where, when, with whom analysis so that
the clinician knows what communication skill needs to be addressed
first in treatment.
Observation Procedures
A copy of a basic observation form is shown in Figure 1 with
recommended definitions shown in Table 3 and described below. The
settings in which observations would occur are determined based on
parent and teacher interviews. Observation duration would typically
last the extent of the targeted activity (e.g., 20 to 60 minutes). As with
most types of observation, a minimum of two observations in a particular setting and situation to are needed to estimate variability in
data. Multiple observations may be especially important in cases of
selective mutism as a childs reactivity to an observer may be particularly enhanced. Naturalistic observations are recommended, although
clinic rooms with one-way mirrors are also helpful.
Operational Definitions for Observation Coding.
A 15-second partial interval recording system is recommended
for coding behavior. Four basic behavioral codes are recorded within
two categories; 1) Communication behavior and 2) Stimulus condition. The operational definitions for the behavior codes are provided
in Table 3 for use in classroom settings and can be used in conjunction

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School-Based Observation Form for Selective Mutism

Classroom____________________

Observer___________________

Activity______________________

Teacher____________________

Time________________________

Date____________________

15s Partial

Opp

Opp

NV

NV

Vocal

Vocal

Initiate

Initiate

Interval

Peer

Teacher

Peer

Teacher

Peer

Teacher

NV

Vocall

1
2
3
4 [1]
5
6
7
8 [2]
9
10
11
12 [3]
13
14
15
16 [4]
17
18
19
20 [5]
21
22
23
24 [6]
25
26
27
28 [7]
29
30
31
32 [8]
33
34
35
36 [9]
37
38
39
40 [10]
Totals
Include notes below about setting, situation, people information and changes during observation

Figure 1. Observation form for use in school settings.

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399

with Figure 1. Although in current form the definitions target a classroom context; the definitions could readily be tailored for any setting
or activity observed.
The primary point is to observe and record the type of communication exhibited and the opportunities the child is provided to
communicate in the situation being observed. It may be that there are
situations when the child is not communicating, but the child is provided few if any opportunities to communicate in those situations.
Thus, intervention may seek to alter the environment to increase the
frequency of opportunities to communicate or at the very least make
available opportunities more salient (i.e., discriminable) to the child
(and observer). However, as currently written, Prompts (or opportunities to respond) are probably the least well-defined aspect of the
behavior code. Determining a prompt to communicate requires
some clinical judgment on an observers part that a communicative
response is expected in a given situation or interaction. Again, if it
is not clear what opportunities or prompts are in place for a child to
communicate, then one of the key aspects of treatment may be making
prompts for communication more explicit both for the child, but also
for the person initiating interaction and for the observer. Two case
examples are presented to illustrate the use of interviewing and observation in developing effective interventions for selective mutism.
Functional Behavior Assessment Informing Treatment Decisions:
Case Examples
The following two children were seen at an outpatient psychology clinic in a Midwest urban city. After interviewing the parents and
observing each child in the clinic and at school, each child was given
a diagnosis of Selective Mutism.
Case 1: Darren
Darren was a 10-year-old Caucasian male who attended a regular education public school fourth grade classroom in a rural school
district. He lived with his biological mother and her parents. He had
regular visitations with his biological father. There was a reported
history of anxiety on both parents sides of their extended families.
Darren had a long history of not talking with teachers or peers at
school or with adults, including family members, and peers in settings outside the home. He spoke with his mother, his father, and his
grandmother, but not with his grandfather at home. He had been
prescribed 10 mg. of Lexapro prior to being seen in the outpatient
clinic and there were no changes in medication throughout services.
Darren was described as compliant at home and school. No concerns
were noted with academic skills.

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Table 3
Operational Definitions of Observational Codes

Variable

Definition
Communication Behavior

Non-vocal
(NV)

Vocalization
(V)

Nodding or shaking head or gestural response with hands, arms,

or shoulders (e.g., motioning/pointing with hands, shrugging
shoulders) to initiate communication or respond to prompt to
communicate.
Using voice (any volume) to initiate communication or to respond
to prompt to communicate.
Stimulus Condition

Opportunity
(prompts)

Teacher or peer communication (NV or V as defined above) with

target student (or group in which target student is included)
prompting target student to communicate with either vocalization
or non-vocal behavior.

Initiation (no
prompts)

Target student speaks or non-vocally communicates with peer or

teacher (or other) without observable prompting.

Two baseline observations were conducted at the school using

15-second partial interval recording and the behavior codes described
earlier. Observations occurred during small group reading, recess,
lunch, independent reading, and science which included large group
instruction and small group projects. Observations were conducted
across settings in the school environment to determine if there were
specific activities and demands and people within those settings that
appeared to affect the probability of communication.
The results of these two baseline observations are shown in Table 4. In the top half of the table (first two rows) are the percentage
of intervals during the observation in which Darren was provided
opportunities from his teacher or from peers to respond vocally or
non-vocally. In the bottom half of the table (bottom five rows) are the
percentage of intervals that Darren did respond when provided the
opportunity. During the first observation that included small group
reading consisting of Darren and three other peers (duration of 23
minutes), the teacher asked the group questions during 50% of intervals and directly asked Darren questions during 16% of intervals
observed (see first column of table). He responded non-vocally (i.e.,.
nodding his head yes or no) to 11% of the opportunities provided directly to him. In short, out of the 16% of the intervals in which he
was provided an opportunity to respond, he responded non-vocally

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401

in 11% of the intervals. He did not speak throughout the observation.

His teacher reported the observation was typical of his behavior. She
had taught him for 3 years and he had never spoken in the class, although he reportedly responded non-vocally at times when directly
prompted.
The second set of observations had similar findings. Darren did
not respond vocally at recess (17.5 minutes), lunch (20 minutes), independent reading (21 minutes), or during science (31 minutes). He
provided minimal non-vocal responses to some of the opportunities
provided by his peers and teacher. The observation data indicated that
when Darren was provided opportunities from the teacher or peers to
respond, he would respond non-vocally approximately 33% to 37%
of the time. It was clear that there were few opportunities to speak
(see top two rows of Table 4). It is possible that the teachers, staff, and
other students no longer had much expectation for Darren to speak
and did not provide very many opportunities to speak.
Based on these data, it was decided that Darren would benefit
from intervention that initially targeted providing more opportunities to speak and increasing the frequency of non-vocal responses.
This treatment plan was developed based on analysis of observational
data demonstrating minimal prompted communication (low rates of
non-vocal responses and no speaking) across most environments and
people. These data led to consideration of Labbe and Williamsons
recommendation that If child speaks to no one in all environments
then some type of response initiation is needed (Table 2). To do
this, it was determined that it was first important to increase the number of opportunities Darren was provided to speak in the classroom.
Given the low rates of any communication that were occurring, it was
decided first to increase the rate of non-vocal communication that occurred in response to increased opportunities. Once non-vocal communication was occurring more frequently, then intervention could
focus on shaping the form of communication from non-vocal to vocal.
Note here how the functional behavior assessment helped facilitate
the decision-making process relative to establishing the conditions
necessary to implement effective treatment. If shaping of speaking
had been attempted first, it may well have been unsuccessful as there
were so few opportunities for Darren to speak.
In consultation with the school team and caregivers, it was decided that the teacher would provide direct questions to Darren during small group reading time. Although assessment data indicated
that there may have been more opportunities in science for Darren to
respond, science was a whole class activity. The small group reading
activity allowed for more control by the teacher of the questions to be

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Table 4
Percent of intervals Darren was provided opportunities to communicate
and percent of opportunities he did communicate (all percentages are
rounded).
Variables

Small Group
Reading

Recess

Lunch

Independent
Reading

Science

Opportunities
from peers

Opportunities
from teacher/
staff

16

24

N/A

33

N/A

N/A

33

11

N/A

N/A

N/A

37

N/A

N/A

N/A

Vocal response to
teacher/staff

N/A

N/A

Non-vocal
initiation

Vocal Initiation

----------------------Non-vocal
response to peers
Non-vocal
response to
teacher/staff
Vocal response
to peers

asked and the smaller group provided more opportunities for individual attention to be provided to Darren. Darren was given a criterion of responding non-vocally (e.g., nodding or pointing) three times
during small group reading to earn a reward at home. The reward
consisted of a small grab bag of items/privileges chosen by Darren and
his mother. Darren could pull one reward from the grab bag only on
the days that he met criterion for reward. His teacher communicated
to his mother using a school-home note. For a week prior to initiation
of the intervention, Darren practiced with his mother at home and
with the speech/language therapist at school, responding non-vocally
to questions while reading. As Darren demonstrated success with the
intervention, the criterion for earning his reward was increased (i.e.,
five and then seven non-vocal responses). Darrens non-vocal respons-

BEHAVIOR OBSERVATIONS FOR SELECTIVE MUTISM

403

es to teacher prompts during small group reading increased from a

baseline of 11% to 78% over the course of approximately five weeks.
Although the intervention was targeted to small group reading,
opportunities to respond to the teacher were observed in subsequent
observations to increase across class activities (targeted environmental change) and Darrens non-vocal responses to teacher questions
were observed to increase in frequency across classroom activities
(targeted behavioral change). For example, Science was targeted next
and within a few weeks, Darren was non-vocally responding in science and reading to 81% of opportunities provided. By the end of the
school year (approximately 5 months) Darren was responding nonvocally (including some mouthing of words with no sound) to almost
all opportunities from the teacher and peers, suggesting generalization of this skill.
He continued not to exhibit speaking. In the summer, his family
moved and he transferred to a new school for the new school year.
Observation in the new classroom indicated that non-vocal responding was still high and frequent opportunities to respond were present
with peers and teacher. Consistent with earlier consideration of Labbe and Williamsons guidelines, shaping was considered as the most
promising intervention. The intervention was changed to reward only
speaking in response to teacher questions. Shaping of speaking was
included in the intervention as whispering was initially allowed. Once
he was successfully speaking in whispers, the expectation for reward
was increased to a more typical voice decibel. After he was speaking in response to teacher questions, the intervention was changed to
reward initiation of questions by Darren to the teacher. Darren was
speaking to the teacher 80% of opportunities provided. He was readily talking with peers. When criterion to earn reward was changed to
asking questions of the teacher, he improved to asking at least one
question daily. This process took about three months.
Observation and teacher report indicated that Darren continued to progress with increasing frequency of speaking to peers and
teachers with the reward program. Note that the primary intervention
throughout was shaping frequency of communication responses and
form of communication response. He eventually was communicating
freely with students and the reward system was discontinued.
In the next case study, the initial functional behavior assessment
suggested that a different type of intervention was appropriate.
Case 2: Alex
Alex was a seven-year-old Caucasian male in second grade in a
suburban public elementary school. He lived with both biological par-

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ents and two siblings. He reportedly talked freely at home. He rarely

talked in public settings with adults, including his parents, and had
rarely spoken with adults at school. There were no reported health
concerns and he was not prescribed any medication. No concerns
were noted regarding academic skills. No concerns were noted for
compliance at home or at school. Alex was reported to talk with peers
in the classroom, but not so the teacher could readily hear him. His
teacher reported that he would whisper to peers in her presence. He
would respond non-vocally to his teacher (e.g., nodding, gestures).
The school counselor noted that he had responded to her with one to
two spoken word answers on occasion during a one-on-one conversation. In addition, Alex was reported to occasionally respond to the
physical education teacher with one word spoken answers.
In early fall of the school year, two observations were conducted
in the classroom using 15-second partial interval recording and the
observation codes mentioned above. Activities observed at school included center time (8.5 minutes), spelling (23 minutes), reading (15
minutes) and lunch (14 minutes). Physical education was led by a
different teacher. A summary of findings from the first observation
is presented in Table 5. Alex was observed to communicate readily
with peers both with and without speaking. He responded to opportunities from the teacher non-vocally, but was not observed to speak
to her. Data from a second observation compiled across science (15
minutes), math (25 minutes), and physical education (10 minutes) are
also shown in Table 5. The data from the second observation are similar to the first in that Alex communicated readily with peers both vocally and non-vocally. He responded non-vocally to the teacher. He
spoke to his physical education teacher on one occasion. That teacher
reported that Alex readily talked with peers in his presence during
physical education, excelled at athletics and appeared comfortable in
physical education.
A meeting was held with Alexs school team including his parents, teacher, school psychologist, school counselor, principal and
consultant. Based on the information and data collected, it was determined that Alex was speaking to peers in the school setting, but
not consistently to adults. These data led to consideration of Labbe
and Williamsons recommendation (Table 2) that If child speaks to
only one or a few people in most environments then consider stimulus fading of new people in target environments. Alex spoke to peers
across most activities within the school setting, but did not speak with
his teacher or other adults. Therefore, it was decided to implement a
stimulus fading intervention with his teacher as the changing stimulus. As the functional behavior assessment data indicated, physical

BEHAVIOR OBSERVATIONS FOR SELECTIVE MUTISM

405

education was certainly a setting/activity that could be utilized to introduce the teachers presence. But, this was not a time the teacher
was readily available and it was difficult to manipulate steps in the
stimulus fading process with the physical education activities. Also,
there were fewer opportunities for Alex to respond during this activity. Since lunch also appeared to be a time when Alex talked readily
with peers, and there were plenty of opportunities already embedded
in this activity for Alex to respond, it was planned that his teacher
would slowly introduce her presence into this situation. Steps in this
stimulus fading procedure were carefully planned to ensure gradual
exposure of the teacher.
Unfortunately, his teacher found she had less time than expected
over the lunch period to be available with the children and only attempted to implement the intervention weekly. She also may have
moved or inserted herself too quickly into the group with whom Alex
was sitting and Alex did not speak in her presence. Upon further consultation with the school team, it was subsequently decided to conduct stimulus fading with the school psychologist. While the ultimate
goal was speech with the teacher, expanding Alexs use of speech in
the school setting with any adult was considered an important treatment compromise and it was expected that introducing the school
psychologist into an activity where Alex was speaking to peers would
facilitate other stimulus fading procedures. Therefore, the focus of
the stimulus fading intervention changed to having the school psychologist work with Alex and peers in a small group and the school
psychologist gradually increased her presence as part of this small
group. This activity took place in the school hallway. Following implementation of this program, Alexs school psychologist reported that
he talked spontaneously with her during the small group intervention
in the hallway.
In addition, a second stimulus-fading program was started with
the classroom teacher at a time when she had fewer demands and time
constraints. Alexs mother began bringing him to school early to read
and play games in the classroom in the presence of the teacher. The
teacher was asked to increase her proximity to Alex and his mother
over time. Alexs mother reported that he talked and read aloud with
her while his teacher was in close proximity. Once he began talking
more frequently to his mother in the presence of his teacher, a reward
system was implemented to increase the frequency of speaking to his
teacher consistent with Labbe and Williamsons recommendation that
if the child speaks occasionally to most people in most environments
then consider contingency management (Table 2). The reward system consisted of a grab bag procedure similar to the one described for

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SHRIVER, SEGOOL, and GORTMAKER

Table 5
Percent of intervals Alex was provided opportunities to communicate and
percent of opportunities he did communicate
(all percentages are rounded)
Variables

Centers

Spelling

Reading

Lunch

Observation 2

Opportunities
from peers

21

100

Opportunities
from teacher/
staff

N/A

16

Non-vocal
response to
peers

86

N/A

N/A

100

100

Non-vocal
response to
teacher/staff

N/A

100

N/A

N/A

30

Vocal response
to peers

N/A

N/A

100

80

Vocal response
to teacher/staff

N/A

N/A

N/A

Non-vocal
initiation

100 (with
peers)

45

Vocal Initiation

5 (with
peers)

100 (with
peers)

2 (with peer
and PE
teacher)

----------------------

Note: Observation 2 data were compiled across science, math, and physical education

Darren. Follow-up observation in the classroom indicated Alexs oral

responses to the teacher increased to 54% of opportunities provided
by the teacher. This was considered a substantial improvement as he
was not vocally responding to the teacher prior to intervention. Additionally, Alex performed parts in Readers Theatre (a small group
play) for several teachers and students at his school. Finally, toward
the end of the school year, further stimulus fading was conducted by
gradually introducing Alexs teacher for the next year into the small
group led by the school psychologist and Alex began talking spontaneously with this teacher.

BEHAVIOR OBSERVATIONS FOR SELECTIVE MUTISM

407

Summary
It is important to note that these are therapeutic case studies
with only a few repeated observational measurements, and the data
are meant primarily to support particular points respective to linking functional behavior assessment to intervention. The data are not
meant, and should not be used, as empirical demonstrations of the
efficacy of these particular interventions. However, the data are consistent with what may typically be collected as part of the day-to-day
activities by educators and school psychologists to measure the effects
of an intervention. Also, this article focuses almost solely on the observational process in keeping with Kearney and Vecchio (2006) that
observation is the key linchpin to effective treatment for children
with selective mutism. Interview data are highly important in guiding
observation and providing additional information to guide treatment
decisions, but interview data alone are not typically reliable and valid
for treatment decisions (McConaughy, 2000). Using the observational
and interview data collected following a treatment referral, it was possible to use data-based decision making to guide intervention design
in each of these cases.
Linking Assessment Data to Treatment
As illustrated by the cases presented, consideration of the 4 Ws:
Where (settings), When (activities and demands), With Whom (people), and What (vocal and non-vocal communication), as a structured
part of an interview and observation process provides the data to
make decisions regarding effective treatment for children with selective mutism. The resulting data can then be meaningfully linked with
effective intervention as recommended by Labbe and Williamson
(1984) and Stone et al. (2002). Psychologists working in schools with
children with selective mutism are advised to complete a functional
behavior assessment by gathering observational and interview data
across settings, activities, and individuals with consideration for the
types of communication the child exhibits and the opportunities provided to the child to communicate.
Consider Opportunities Available
As noted in the case examples presented here, it is very important to consider the opportunities present for children to respond. Assessing the opportunities to vocally or non-vocally respond has not
been previously discussed in any of the literature on assessment or
intervention for children with Selective Mutism. If a child does not
have opportunities to communicate, there is no reason to expect

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SHRIVER, SEGOOL, and GORTMAKER

that the child will communicate. Without opportunities or prompts

to communicate, communication largely becomes a response by the
child due to motivating operations that may be more difficult to assess (e.g., hunger, full bladder). Assessing the frequency, or rate, and/
or type of opportunities available within the contexts, settings and
activities the child vocally and non-vocally communicates is vitally
important to designing effective treatment and monitoring progress.
AB vs. ABC Functional Behavior Assessment
The emphasis of this article as been on the assessment of antecedent-behavior relations. Evaluating the reinforcing and punishing
consequences of Selective Mutism may be very difficult as this is a
behavior that is defined by its antecedent relations (i.e., occurs selectively in the presence of some stimuli but not others). The consequences maintaining these stimulus-behavior relations may be negatively
reinforcing (i.e., escape from aversive stimuli) or positively reinforcing (i.e., increased social attention or access to preferred items and
activities). On the other hand, vocal behavior may be punished in the
presence of some stimuli (i.e., social attention, expectation to complete
a task). Identification and manipulation of punishing or reinforcing
stimuli for mute or vocal behavior is difficult and an area that requires
additional consideration and research. It is possible that assessment
of the ABC contingency will lead to more effective treatment than current AB assessments.
Future Research Directions
Additional empirical support is needed to demonstrate the
treatment validity of the functional behavior assessment procedures
described here for designing treatments. Such treatment validity evidence may come from carefully controlled single-subject experimental designs demonstrating the effectiveness of treatment following
detailed assessment procedures including observation and interviews
or from other experimental designs tailored to clarify the effects of
different treatment decisions based on individual clients assessment
data using this type of observation process (Hayes, Nelson, & Jarrett,
1987).
Also, other types of observational procedures that assist with
decision-making regarding treatment need to be developed and
evaluated for their efficacy and efficiency. The current recommended
observation procedure uses interval recording. We chose partial-interval recording primarily for ease of use by the observer and to avoid
trying to discern discrete events of communicative behavior as part
of a frequency count. Partial interval recording may overestimate ac-

BEHAVIOR OBSERVATIONS FOR SELECTIVE MUTISM

409

tual responding (Johnston & Pennypacker, 1993). Given the low rate
of responding inherent in selective mutism, this was not perceived as
a problem, however, the clinician/educator needs to be aware of the
advantages and disadvantages of any observational procedure being
used.
In classroom settings, it is not always clear what should be the
expectations for frequency or rate of speaking. Gathering data on
classmates speaking as comparisons may be beneficial in determining the discrepancy between a childs current and expected communication behavior. In addition, it may be helpful to have information
on the frequency or rate of opportunities typically provided to other
children in the classroom to speak. Additional research on the most
effective and efficient methods of observation of communicative behaviors is needed.
Researchers generally are most interested in determining the efficacy of various treatments, and continued research on the efficacy
of treatments for selective mutism is clearly needed. However, it is
also imperative that research on valid assessment processes linked to
effective treatment decisions be conducted to help guide practitioners
in effective data-based decision making. It is hoped that this article
in attempting to delineate more clearly the link between observation
and treatment decisions will help facilitate additional research on this
topic.
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