Facon et al. (2008)



Single Subject Designs


SOURCE:  Facon, B., Sahiri, S., & Riviére, V.  (2008).  A controlled single-case treatment of severe long-term selective mutism in a child with mental retardation.  Behavior Therapy, 39, 313-321.  doi: 10 1016/j.beth.2007.09.004


REVIEWER(S):  Jessica Jones  (Minnesota State University, Mankato), Amy Anderson (Minnesota State University, Mankato), pmh


DATE:  1.23.09



TAKE AWAY:  A promising strategy with good support for the effectiveness of this behavioral program for increasing loudness and utterance length in this child diagnosed with selective mutism and cognitive impairment.


1.  What was the focus of the research?  Clinical Research


2.  What type of evidence was identified?  Case Study: Single Subject Experimental Design with Specific Client –Changing Criterion


b.  What was the level of support associated with the type of evidence?  Level = _A-___          


3.  Was phase of treatment concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from data analyzers?  No


4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study? 1

b.  The following characteristics were described?:

•  List characteristics controlled:

•  List characteristics described:

•  age:  12 years

•  gender:  m                                    

•  cognitive skills:  developmental delay; at 10 years functioned at the 5 year level on a French intelligence scale        

•  expressive language:  spoke Arabic fluently and interacted at home; usually used only gestures at school;  when he at school he was inaudible                                 

•  educational level of participant:  day-care center rather than academic program.

•  other:  prenatal problems; diagnosed developmental delay; walked at 4 years; performed below peers in initial academic placement


c.  Were the communication problems adequately described? No _x_     

•  List the disorder type(s):  selective mutism

•  List other aspects of communication that were described:  First language was Arabic; moved to France at age 8.


5.  Was membership in treatment maintained throughout the study?  Not applicable, only one P.


6.  Did the design include appropriate controls?  Yes

a.  Were baseline/preintervention data collected on all behaviors?  Yes

b.  Did probes include untrained data?  No

c.  Did probes include trained data?  Yes

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Does not apply.


7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcome was to produce sentences at the 70 dB level or better

b.  Was the outcome subjective?  No

c.  Was the outcome objective?  Yes

d.   Were reliability data provided”  No, measurement via sound pressure level meter that C held near P’s mouth,


8.  Results:

a.  Did the target behavior (outcome) improve when it was treated?  Yes

b.  The overall quality of improvement for the outcome was Strong


9.  Description of baseline:

a.  Were baseline data provided?  Yes

b.  Was baseline low and stable?  Yes

c.  What was the percentage of nonoverlapping data (PND)?  Approximately 99%, calculated by reviewers.

d.  Does inspection of data suggest that the treatment was effective?  Yes, highly effective.


10.  What was the magnitude of the treatment effect?  NA.  The investigators did not provide these data.


11.  Was information about treatment fidelity adequate?  Not Provided


12.  Were maintenance data reported?  Yes.  Six months after completion of treatment, four follow-up sessions indicated that loudness was softer (at about 64-68 dB) than at the end of therapy.  Nevertheless, speech was markedly louder than baseline.



13.  Were generalization data reported? Yes.  Intervention targeted generalization by changing contexts and the reinforcement schedule.  Several changes were noted:

•  increased interaction with peers

•  increased interest in others

•  responded to roll call using an audible loudness level

•  took roll call

•  with his peers, played with a microphone and appeared to enjoy hearing his voice

•  interacted with peers using an audible loudness level during party games








PURPOSE:  To investigate the effectiveness of an intervention using fading and shaping to increase the loudness of a child with selective mutism.

POPULATION:  selective mutism, second language learner (first- Arabic; second- French), developmental delay




ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):  loudness

DOSAGE:  15 minutes a session, four times a week, approximately 90 sessions


ADMINISTRATOR:  therapist (type of therapist is not clear; perhaps behavior or SLP


STIMULI:  auditory





•  The long-term target was to produce speech at the 70 dB or louder.  The target  was selected by determining the mean loudness level of his peers in the classroom.

•  To achieve the long-term target,  short-term targets were selected.  The initial target was 43 dB, which was the mean for probes during baseline.

•  Once P achieved criterion for a short-term target (80% utterance equal to or greater than short-term target for 3 consecutive sessions), the target was increased to the mean loudness of the 5 loudest trials during the last session (i.e., shaping).

Reinforcement and Instruction Procedures:

•  C did NOT provide instruction about loudness and did not provide P access to the information from the sound pressure level meter.

•  C provided raise and tokens for correct responses

•  For incorrect responses, C

– ignored response,

– waited,

– modeled (i.e., asked a question and answered it using the appropriate loudness), and

– directed P to imitate the response

–  if P’s response was acceptable, C provided praise and a token

Phases of Intervention:

Phase 1:

•  Therapy was administered in a small private room with C and P.

•  C asked questions.

•  P responded with at least one word at the designated (short-term target) loudness level.

•  The short-term targets were

–  43 dB,

–  approximately 47 dB,

–  approximately 50 dB,

–  approximately 54 dB,

–  approximately 60 dB,

–  approximately 64 dB,

–  approximately 68 dB,

–  approximately 72 dB.

Phase 2:

•  Therapy was administered in a small private room with C and P.

•  C asked questions.

•  P responded with multiword utterances at the highest loudness level.

Phase 3:

•  Therapy was administered in a small private room with C and P with one to four other people present.  Initially, there was one other person but the number gradually increased to four.

•  The other people did not interact with the C and P during the session.

•  C asked questions.

•  P responded with multiword utterances at the highest loudness level.

Phase 4:

•  Therapy was administered in a small private room with C and P with four other person present.

•  One of the other people asked questions.

•  P responded with multiword utterances at the highest loudness level.

Phase 5:

•  Therapy was administered in a classroom with other people present.

•  One of the other people asked questions.

•  P responded with multiword utterances at the highest loudness level.

Phase 6 (Maintenance):

•  Same procedures as Phase 5 except reinforcement changed from Fixed Ratio 1 to Fixed Ratio 10.

Follow-up Phase:

•  Same procedures as Phase 6 for four sessions.

•  Occurred 6  months after termination of therapy.


•  To produce sentences at the 70 dB level or better


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