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Background Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes. Methods We analyzed transcripts from semi‐structured qualitative interviews with 62 emerging adults (age 18‐24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience. Results We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a “normal” life with T1D, benefit‐finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non‐diabetes activities, and using diabetes‐specific and general technologies to support self‐management. Conclusions The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths‐based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.

Selective mutism refers to a persistent and debilitating condition in which a child fails or refuses to speak in public situations. Research on treatment for selective mutism has progressed in recent years toward a more personalized model based on clinical profiles unique to a given child. Such profiles may include aspects of anxiety, oppositional behaviors, and communication problems as well as operant factors that maintain selective mutism. The present case represents a 6-yearold child with selective mutism with a multifaceted clinical profile that included internalizing and externalizing behavior problems with multiple operant factors. Initial personalized individual therapy focused on anxiety and contingency management procedures to address school refusal behavior and to lay the groundwork for later treatment of selective mutism. Group therapy with parent and child components focused on these procedures in more detail in addition to social skills development. Each component included detailed hierarchies for increasing frequency and audibility of speech in a clinic setting as well as in community and school settings. Keywords selective mutism, personalized treatment 1 Theoretical and Research Basis for Treatment Selective mutism is a persistent and debilitating condition in which a child fails to speak in public situations where speaking is expected. Children with selective mutism often speak well in familiar situations such as home but less so if at all in public situations, especially school. Failure to speak must last at least 1 month. Selective mutism does not generally apply to youths with a communication disorder or to youths who lack comfort or knowledge with the primary language spoken in public situations (American Psychiatric Association [APA], 2013). Selective mutism affects 0.2% to 2.0% of children and commonly begins during preschool years. Selective mutism may have a chronic course for some children because treatment is often delayed. As such, selective mutism has been linked to peer rejection and inadequate academic, language, and social skills (Viana, Beidel, & Rabian, 2009).

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