Integrated Behavior Therapy for Exclusively Anxious Selective Mutism: A Nonconcurrent Multiple-Baseline Design across Five Participants

Round 1

Reviewer 1 Report

The authors have done very good job. It is not so easy to work with children who have this type of problems. The reviewed article covers a very interesting, and also specialized topic that is being frequently discussed by child psychiatrists, psychologists and special educators,because this station is not only problem for the children, but also for their parents and family.

Author Response

Reviewer 1

1. The authors have done very good job. It is not so easy to work with children who have this type of problems. The reviewed article covers a very interesting, and also specialized topic that is being frequently discussed by child psychiatrists, psychologists and special educators, because this station is not only problem for the children, but also for their parents and family.

Authors’ Response to Reviewer 1, Comment 1: Thank you for your kind and positive review of our manuscript. We are delighted to know that you see the value in our manuscript’s contribution to Pediatric Reports and the broader body of pediatric psychology literature. Our revised draft includes track changes to clearly show where we addressed each reviewer’s feedback.

Reviewer 2 Report

I have no major suggestions for authors. The manuscript can be accepted in its current wording. It is a very interesting manuscript, given the scant systematic research on the treatment of selective mutism, in general, and psychological treatment in particular. The use of a single subject (multiple baseline) experimental design is correct. The use of multiple assessment procedures (measurements) is appropriate, as is the use of visual and statistical data analysis methods. The procedure is meticulously described, which allows the study to be replicated. The results are valuable in their different dimensions and the discussion is adjusted to the results obtained and their possible limitations.

For formal reasons, it would be advisable to make a small modification to the submitted manuscript, including the score of 0 on the y-axis of the five graphs in Figure 1 (SASC-FNE Subscale Score levels).

Author Response

Reviewer 2

1. The manuscript can be accepted in its current wording. It is a very interesting manuscript, given the scant systematic research on the treatment of selective mutism, in general, and psychological treatment in particular. The use of a single subject (multiple baseline) experimental design is correct. The use of multiple assessment procedures (measurements) is appropriate, as is the use of visual and statistical data analysis methods. The procedure is meticulously described, which allows the study to be replicated. The results are valuable in their different dimensions and the discussion is adjusted to the results obtained and their possible limitations.

Authors’ Response to Reviewer 2, Comment 1: Thank you for your strong endorsement of the appropriateness and value of this manuscript, as well as the detail with which we describe the procedures to allow for replicability.

Reviewer 3 Report

Dear author:

Choosing to improve Selective Mutism (SM) is a meaningful study. Although the author has obtained sufficient literature to support this topic, the manuscript still needs to be strengthened, which will help improve the reading clarity of the manuscript. Suggestions are as follows:

1. Abstract

Although the author provides the background of the manuscript, it would be clearer if the purpose could be supplemented.

2. Research process

Although the author emphasizes the practices in the literature and explains the process. However, if the experimental flowchart can be supplemented, it will enhance readers' understanding of the experimental process and the timing of intervention in improvement measures.

3. IRB

Although this manuscript was conducted in a medical institution, if the author can provide the approval authority for this experiment or proof of exemption from review proposed by the local government or authoritative institutions, it will increase the credibility of this literature. If so, please reply or supplement in the manuscript.

4. Regarding "Implications for Research and Implications for Practice"

The manuscript points out the intervention time, limitations, and potential issues of using therapy. This is a great contribution. However, if the author could use this as a diagram to illustrate, it would be clearer.

5. The "Conclusion" chapter that disappeared?

Finally, although the manuscript positively explains the analysis results and future research recommendations. However, for the manuscript, there seems to be a lack of a strong and concise summary. Please supplement.

I look forward to the author submitting a revised manuscript.

Author Response

Please forgive me for also including one of the points from Reviewer 2 as our response to one of their points accidentally was left off the response copied/pasted into Reviewer 2 feedback. 

Reviewer 2 Feedback (accidentally not included in the response to Reviewer 2, including it here and in the space provided to responding to the editor):

1. For formal reasons, it would be advisable to make a small modification to the submitted manuscript, including the score of 0 on the y-axis of the five graphs in Figure 1 (SASC-FNE Subscale Score levels).

Authors’ Response to Reviewer 2, Comment 2: We appreciate your careful attention to our data and the way they are represented. We were purposeful in using 8 as the minimum for the y-axis on Figure 1. The SASC-R response options range from 1 (not at all) to 5 (all the time), so the minimum possible score for the SASC-FNE is 8. Thus, it would not be possible to earn a SASC-FNE score of 7 or lower and we felt that a graph with a minimum of 0 on the y-axis would not accurately represent what the data reflect. We note that Figure 1 within our revised manuscript remains the same as the initial manuscript submission reviewed. 

Reviewer 3

 

1. Abstract – Although the author provides the background of the manuscript, it would be clearer if the purpose could be supplemented.

 

Authors’ Response to Reviewer 3, Comment 1: This is an excellent suggestion, and we have edited the Abstract to include a statement related to the purpose of the study. Other minor edits were made within the Abstract to ensure that it was still consistent with the recommended limit of 200 words.

2. Research Process – Although the author emphasizes the practices in the literature and explains the process. However, if the experimental flowchart can be supplemented, it will enhance readers' understanding of the experimental process and the timing of intervention in improvement measures.

Authors’ Response to Reviewer 3, Comment 2: We are in agreement with Reviewer 3 that a visual aid may help with understanding the timeline of the experimental process and which measures were administered at specific points of time throughout the study. We have included a new table (Table 3, and adjusted the Table numbering) that outlines this process.

3. IRB – Although this manuscript was conducted in a medical institution, if the author can provide the approval authority for this experiment or proof of exemption from review proposed by the local government or authoritative institutions, it will increase the credibility of this literature. If so, please reply or supplement in the manuscript.

Authors’ Response to Reviewer 3, Comment 3: Thank you for calling this to our attention. In addition to the Ethical Compliance and Institutional Review Statement (which was included in the initially submitted draft), which can be found after the final chapter of the manuscript and before the References section, we have now also included a brief IRB approval statement within the body of the manuscript as a part of the Study Design (Chapter 2.2) section.

4. Implications – The manuscript points out the intervention time, limitations, and potential issues of using therapy. This is a great contribution. However, if the author could use this as a diagram to illustrate, it would be clearer.

Authors’ Response to Reviewer 3, Comment 4: We appreciate your positive feedback on this section of our manuscript. After closely rereviewing the intervention timeline, limitations, and potential issues of this therapy it was not clear to all three of us, how adding a diagram would further contribute to the manuscript as we believe the narrative description of each is clearly presented. If after reviewing our revised manuscript this Reviewer suggested edit is still believed to be necessary before publishing our manuscript, we would appreciate further clarification (and maybe a template example of such a diagram from a recent issue of Children) about the type of information you feel could be made clearer using a diagram (e.g., the specific timeline for each child, a summary of all limitations of the present study, limitations of IBTSM/the intervention itself).

5. Conclusions Chapter – Finally, although the manuscript positively explains the analysis results and future research recommendations. However, for the manuscript, there seems to be a lack of a strong and concise summary. Please supplement.

Authors’ Response to Reviewer 3, Comment 5: We have included a Conclusions chapter at the end of the manuscript, which we feel is a succinct but comprehensive summary of the purpose and findings from our study. Thank you for that recommendation as we believe that addition will be helpful for readers.

 

Round 2

Reviewer 3 Report

I thank the authors for agreeing to revisions to the manuscript. This revised manuscript greatly improves the visualization of tables and pictures, and the content is more focused, which can help readers understand the significance of this manuscript more quickly. I suggest that the editor consider moving the manuscript to the next submission process.

kind regards,