Training, Practice and Service Provision for Selective Mutism: Findings From a UK-Wide Survey of Therapists.

The sample was built by snowballing: the survey went out through professional bodies, selective mutism networks, a charity forum and social media, and respondents passed it on. It is not a random or representative group of UK therapists and the authors say the distribution of professions is unlikely to match the wider workforce. Four out of five respondents were speech and language therapists, which the authors say is probably a result of how people were recruited. The figures for clinical psychologists (22 people) and educational psychologists (10 people) rest on very small numbers, so they should not be treated as estimates for those professions. People who answered were recruited partly through specialist selective mutism networks, so they were likely already interested in the condition. Even in this motivated group only 59% had any training, which means the picture for therapists generally is probably worse, not better. Everything here is self-report, and respondents were describing caseloads and practice going back five years, so memory is imperfect. Giving everyone a fixed list of intervention components with definitions drawn from a systematic review may have nudged people towards reporting what they think is best practice rather than what they did. Only 13 people gave free-text answers, so the experiences quoted are individual accounts rather than a systematic picture of services, and the authors abandoned their planned content analysis for this reason. Education staff such as specialist teachers, who the survey itself found are often involved in supporting these children, were not eligible to take part, so their views are missing.

Both named sources of funding are public research bodies, not companies with a stake in selective mutism treatment: the first author is funded by an NIHR Clinical Doctoral Research Fellowship (NIHR302167), and another author by the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust and the Oxford Health Biomedical Research Centre. The authors declare no conflicts of interest, and the paper states the views expressed are the authors' own and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.

Do not read the intervention figures as evidence these approaches work. This survey records what 151 therapists said they did; it measured no outcomes for any child, and the authors note that whether indirect work through parents and teachers is effective has not been established. Equally, do not treat the percentages as a picture of UK practice in general: the sample was self-selected through selective mutism networks and social media and was four-fifths speech and language therapists, so therapists with an interest in the condition are over-represented.