| Selective mutism is a debilitating disorder with academic and social consequences, yet little research is available regarding psychopharmacological interventions (Carlson et al., 2008). This dissertation study examined the utility of fluoxetine (Prozac) for the treatment of five children, ages 5 to 14, diagnosed with selective mutism, who also demonstrated elevated levels of social anxiety symptomology. A non-concurrent multiple-baseline design with a single-blind placebo-controlled procedure was used to examine treatment outcomes. Effectiveness was evaluated by a multi-gate analysis process, including: a) visual analysis (Kratochwill et al., 2010); b) the Wampold and Worsham (1986) randomization test; and c) the Kendall's Tau + Mann-Whitney U (Tau-U; Parker, Vannest, Davis, & Sauber, 2011) effect size calculation. Multiple methods of assessment including Direct Behavior Ratings (DBR; Chafouleas, Riley-Tillman, & Christ, 2009) and standardized measures [e.g., the Multidimensional Anxiety Scale for Children -- Second Edition (MASC-2; March, 2012)] were used. Information regarding adverse effects with an emphasis on behavioral disinhibition and ratings of parental acceptance of the intervention were also gathered. Visual analysis of all five cases indicated fluoxetine did not demonstrate utility for the reduction of social anxiety symptoms and was ineffective in increasing spontaneous speech. However, as predicted a significant increase in responsive speech with unfamiliar adults (p = .03; Tau-U: .44, p < .01) was noted. Two of the five children experienced some acute occurrences of minor behavioral disinhibition, but did not experience any other side effects during the course of treatment. Behavioral disinhibition did not correspond to changes in social anxiety symptoms, responsive speech, or spontaneous speech. Parents found the use of fluoxetine for the treatment of selective mutism highly acceptable. |
