Parent–Child Interaction Therapy for Children with Selective Mutism (PCIT-SM)

  • Allison CotterEmail author
  • Mitchell Todd
  • Elizabeth Brestan-Knight


Selective mutism is a psychological disorder in which children do not speak to others in certain social settings (e.g., school, daycare) even though they are able to speak in other settings, such as at home with family. Treatment options are often limited for children with this disorder due to the young age of onset, low prevalence rate, and type of problematic behavior displayed by the child (e.g., non-disruptive, lack of speech to clinicians). Parent-child interaction therapy (PCIT) has been adapted to fill this gap and to provide appropriate treatment for children with selective mutism. The current chapter includes a description of the clinical presentation of selective mutism as well as the etiology and maintenance of this disorder. Following a discussion of the need for a lateral extension of the original protocol for this population, the chapter describes the adapted PCIT model, including the altered assessment procedures and treatment phases. Information is also provided about medication use for selective mutism. Finally, future areas for research and clinical development regarding the adapted treatment model are discussed.


Parent-child interaction therapy Selective mutism Assessment Treatment Young children Anxiety disorders 


  1. Albano, A. M., & Silverman, W. K. (1996). The anxiety disorders interview schedule for DSM-IV: Child and parent versions. Oxford: Graywind Publications.Google Scholar
  2. American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  3. Bergman, R. L., Keller, M. L., Piacentini, J., & Bergman, A. J. (2008). The development and psychometric properties of the Selective Mutism Questionnaire. Journal of Clinical Child and Adolescent Psychology, 37, 456–464. Scholar
  4. Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 938–946 Scholar
  5. Busse, R. T., & Downey, J. (2011). Selective mutism: A three-tiered approach to prevention and intervention. Contemporary School Psychology, 15, 53–63. Scholar
  6. Carlson, J. S., Mitchell, A. D., & Segool, N. (2008). The current state of empirical support for the pharmacological treatment of selective mutism. School Psychology Quarterly, 23, 354–372. Scholar
  7. Carpenter, A. L., Puliafico, A. C., Kurtz, S. M. S., Pincus, D. B., & Comer, J. S. (2014). Extending parent-child interaction therapy for early childhood internalizing problems: New advances for an overlooked population. Clinical Child and Family Psychology Review, 17, 340–356. Scholar
  8. Comer, J. S., Puliafico, A. C., Aschenbrand, S. G., McKnight, K., Robin, J. A., Goldfine, M. E., & Albano, A. M. (2012). A pilot feasibility evaluation of the CALM program for anxiety disorders in early childhood. Journal of Anxiety Disorders, 26, 40–49. Scholar
  9. Cotter, A. (2016). Psychometric properties of the dyadic parent-child interaction coding system (DPICS): Investigating updated versions across diagnostic subgroups. Unpublished master’s thesis, Auburn Univeristy, AL.Google Scholar
  10. Edison, S. C., Evans, M. A., McHolm, A. E., Cunningham, C. E., Nowakowski, M. E., Boyle, M., & Schmidt, L. A. (2011). An investigation of control among parents of selectively mute, anxious, and non-anxious children. Child Psychiatry and Human Development, 42, 270–290. Scholar
  11. Eyberg, S., Chase, R., Fernandez, M., & Nelson, M. (2014). Dyadic parent-child interaction coding system (DPICS) clinical manual (4th ed.). Gainsville, FL: PCIT International.Google Scholar
  12. Eyberg, S., & Funderburk, B. (2011). Parent-child interaction therapy protocol. Gainesville, FL: PCIT International.Google Scholar
  13. Eyberg, S. M. (2005). Tailoring and adapting parent-child interaction therapy to new populations. Education and Treatment of Children, 28, 197–201.Google Scholar
  14. Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory/sutter-eyberg student behavior inventory-revised manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  15. Fernandez, M. A., Gold, D. C., Hirsch, E., & Miller, S. P. (2015). From the clinics to the classrooms: A review of teacher-child interaction training in primary, secondary, and tertiary prevention settings. Cognitive and Behavioral Practice, 22, 217–229. Scholar
  16. Ford, M. A., Sladeczek, I. E., Carlson, J., & Kratochwill, T. R. (1998). Selective mutism: Phenomenological characteristics. School Psychology Quarterly, 13(3), 192–227. Scholar
  17. Kingery, J. N., Roblek, T. L., Suveg, C., Grover, R. L., Sherrill, J. T., & Bergman, R. L. (2006). They’re not just “little adults”: Developmental considerations for implementing cognitive-behavioral therapy with anxious youth. Journal of Cognitive Psychotherapy, 20, 263–273. Scholar
  18. Kurtz Psychology Consulting PC. (2015). Selective mutism 101: A primer for parents, therapists & educators [Video File]. Retrieved from
  19. Kurtz Psychology Consulting PC. (2018). Welcome to Selective Mutism Learning University. Retrieved from
  20. Kurtz, S. M. S. (2008). Selective mutism behavioral observation task (SM-BOT). Unpublished manuscript.Google Scholar
  21. Kurtz, S. M. S. (2015). PCIT adapted for selective mutism [Video File]. New York City, NY: PCIT International Retrieved from Scholar
  22. Kurtz, S. M. S., Comer, J., & Masty, J. (2007). Selective mutism interaction coding system revised. Unpublished manuscript.Google Scholar
  23. Kurtz, S. M. S., Comer, J. S., Gallagher, R., Hudson, J. L., & Kendall, P. C. (2013). Parental solicitations for child verbal behaviors across anxious and non-anxious youth. Poster presented at the meeting of the Anxiety Disorders Association of America, La Jolla, CA.Google Scholar
  24. Kussmaul, A. (1887). Disturbances of speech: An attempt in the pathology of speech. In H. Ziemssen (Ed.), Cyclopedia of the practice of medicine (pp. 581–875). New York, NY: Wood.Google Scholar
  25. Leonard, H. L., & Dow, S. (1995). Selective mutism. In J. S. March (Ed.), Anxiety disorders in children and adolescents (pp. 235–250). New York, NY: Guilford Press.Google Scholar
  26. Letamendi, A. M., Chavira, D. A., Hitchcock, C. A., Roesch, S. C., Shipon-Blum, E., & Stein, M. B. (2008). Selective Mutism Questionnaire: Measurement structure and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1197–1204 Scholar
  27. Manassis, K., Oerbeck, B., & Overgaard, K. R. (2016). The use of medication in selective mutism: A systematic review. European Child & Adolescent Psychiatry, 25, 571–578. Scholar
  28. Masty, J. K., Kurtz, S. M. S., Tryon, W. W., & Gallagher, R. (2009). Conditional probabilities of selectively mute children responding to parental questions. Poster presented at the meeting of the Anxiety Disorders Association of America, Santa Ana Pueblo, NM.Google Scholar
  29. McCabe, K., & Yeh, M. (2009). Parent-child interaction therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child and Adolescent Psychology, 38, 753–759. Scholar
  30. McLeod, B. D., Wood, J. J., & Weisz, J. R. (2007). Examining the association between parenting and childhood anxiety: A meta-analysis. Clinical Psychology Review, 27, 155–172. Scholar
  31. Mele, C. M., & Kurtz, S. M. S. (2013). Parent-child interactions in behavioral treatment of selective mutism: A case study. Poster presented at the meeting of the Anxiety Disorders Association of America, La Jolla, CA.Google Scholar
  32. Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: A review on selective mutism, the new anxiety disorder in DSM-5. Clinical Child and Family Psychology Review, 18, 151–169. Scholar
  33. Niec, L. N., Barnett, M. L., Prewett, M. S., & Chatham, J. R. S. (2016). Group parent-child interaction therapy: A randomized control trial for the treatment of conduct problems in young children. Journal of Consulting and Clinical Psychology, 84, 682–698. Scholar
  34. Perednik, R. (2011). The selective mutism treatment guide: Manuals for parents, teachers, and therapists. Still Waters Run Deep: Oakland, CA.Google Scholar
  35. Remschmidt, H., Poller, M., Herpertz-Dahlmann, B., Hennighausen, K., & Gutenbrunner, C. (2001). A follow-up study of 45 patients with elective mutism. European Archives of Psychiatry and Clinical Neuroscience, 251, 284–296. Scholar
  36. Silverman, W. K., Saavedra, L. M., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 937–944. Scholar
  37. Standart, S., & Le Couteur, A. (2003). The quiet child: A literature review of selective mutism. Child and Adolescent Mental Health, 8, 154–160. Scholar
  38. Steinhausen, H.-C., & Juzi, C. (1996). Elective mutism: An analysis of 100 cases. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 606–614. Scholar
  39. Steinhausen, H.-C., Wachter, M., Laimböck, K., & Metzke, W. C. (2006). A long-term outcome study of selective mutism in childhood. Journal of Child Psychology and Psychiatry, 47, 751–756. Scholar
  40. Tramer, M. (1934). Elektiver Mutismus bei Kindern. [Selective mutism of children]. Zeitschrift für Kinderpsychiatrie, 1, 30–35.Google Scholar
  41. Van der Bruggen, C. O., Stams, G. J. J. M., & Bögels, S. M. (2008). Research review: The relation between child and parent anxiety and parental control: A meta-analytic review. Journal of Child Psychology and Psychiatry, 49, 1257–1269. Scholar
  42. Viana, A. G., Beidel, D. C., & Rabian, B. (2009). Selective mutism: A review and integration of the last 15 years. Clinical Psychology Review, 29, 57–67. Scholar
  43. Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child & Adolescent Psychology, 31, 335–342. Scholar
  44. Zakszeski, B. N., & DuPaul, G. J. (2017). Reinforce, shape, expose, and fade: a review of treatments for selective mutism (2005–2015). School Mental Health, 9, 1–15. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Allison Cotter
    • 1
    Email author
  • Mitchell Todd
    • 2
  • Elizabeth Brestan-Knight
    • 1
  1. 1.Auburn UniversityAuburnUSA
  2. 2.Department of PsychologyCenter for Children, Families, and Communities, Central Michigan UniversityMt PleasantUSA

Personalised recommendations