Family Accommodation and Selective Mutism: Evaluating the Survey of Accommodation in Verbal Encounters (SAVE)

Family accommodation is a key environmental factor that can maintain and reinforce child anxiety disorders, but research on accommodation specific to childhood selective mutism (SM) is limited and inconsistent. The absence of a supported measure of accommodation specifically in verbal contexts may explain, in part, why research on accommodation in the families of youth with SM has lagged. In a sample of 412 treatment-seeking anxious youth ages 2-18 years (52.7% with SM; 56.7% female; ~50% Hispanic and/or Latinx), the present study examined the psychometric properties of the Survey of Accommodation in Verbal Encounters (SAVE) - a newly developed caregiver-report scale assessing the frequency of parental accommodation specifically in situations in which child verbal communication is expected. Confirmatory factor analysis supported an 18-item, four-factor structure corresponding to four SAVE subscales: Surrogate Speaking, Permitting of Whispered Communication, Permitting of Nonverbal Communication, and Instrumental Accommodation. The SAVE also demonstrated strong reliability, concurrent and divergent validity, incremental utility, and clinical relevance to SM. These findings offer support for the SAVE as the first measure of parental accommodation in contexts in which child speech is expected. Results also provide empirical insight into the frequency, patterns, and correlates of such accommodation among families of anxious children with and without SM. The SAVE appears to offer a useful tool for researchers and clinicians to assess SM-specific accommodation and key family dynamics associated with verbal reticence in youth.