Treatment of Comorbid Selective Mutism and Procedural Anxiety in a Child With Pediatric Common Variable Immunodeficiency Disease: A Case Study

The purpose of this case report is to describe the conceptualization and treatment of comorbid anxiety diagnoses, selective mutism, and procedural anxiety in a young female presenting to a pediatric family therapy clinic with common variable immunodeficiency disease (CVID) and behavioral concerns. Treatment included a comprehensive interview assessing domains of functioning. Treatment plans for both selective mutism and procedural anxiety were informed by behavior learning theories. In collaboration with parents and teachers, evidence-based interventions were implemented concurrently across the clinic, home, and school settings to facilitate generalization. Over the course of 8 sessions, coping skills were successfully employed in the home setting to decrease procedural anxiety. Behavioral techniques implemented by clinician, parents, and the patient’s teacher to reinforce functional communication resulted in the reestablishment of speech in the school setting. Comorbid treatment of anxiety disorders proved successful and was effectively applied within an academic medical setting in a child with CVID. Application of evidence-based interventions informed by behavioral learning theories brought about improvements in both functional communication and procedural anxiety. Close collaboration among pediatric psychologists, school personnel, and parents was critical to achieving positive treatment outcomes across multiple settings.