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Selective Mutism

Selective Mutism (SM) is a disorder characterized by the inability to speak in select settings. These children understand spoken language and have the ability to speak normally. Typically, they speak to their parents and a few selected others. Most are unable to speak in school, and in other major social situations. Generally, most function normally in other ways, although some may have additional disabilities.

Signs and Symptoms of Selective Mutism

  • Extreme shyness
  • Reluctance to speak in some settings
  • Fear of people
  • Lack of eye contact
  • Lack of facial expressions
  • Immobility
  • Nervous fidgeting in social situations
  • Withdrawn when approached or touched
  • Exhibits different forms of body language

Non-Verbal Communication

Although there may be a predisposition to selective mutism at birth, the symptoms become obvious when the child is requested to respond verbally or interact in social situations, including preschool, elementary school, and community environments.   

These children may respond by nodding their heads, pointing, remaining expressionless or motionless until someone correctly guesses what they want, or non-verbally participating in activities.

Treatment of Selective Mutism

It is important to realize that with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is excellent! Treatment approaches should be individualized, but the majority of children are treated using a combination of:

  • Behavioral Therapy: Positive Reinforcement and Desensitization Emphasis should be on understanding the child and acknowledging their anxiety. Introducing the child to social environments in subtle and non-threatening ways is an excellent way to help the child feel more comfortable, i.e., Parents can take the child into school when few people are around to get the child to ‘practice speaking.’ Eventually, bring a friend or two to school and allow the children to play when other children are not present. Small groups with only a small number of children help, as well as allowing parents to spend time with the child within the class. After the child is speaking quite normally, the teacher, and then the students, are gradually introduced into the group setting. Positive reinforcement for verbalization should be introduced when, and only when, anxiety is lowered and the child feels comfortable and is obviously ready for some subtle encouragement.
  • Play Therapy, Psychotherapy, and other psychological approaches: These can be effective if all pressure for verbalization is removed and emphasis is on helping the child relax and open up. These children are SCARED, and the focus should be to help them identify their level of ‘being scared' in a particular situation. Helping them to realize that you understand and are there to help them relieves tremendous pressure.
  • Cognitive Behavioral Therapy (CBT): Trained therapists help children modify their behavior by helping them redirect their fears and worries into positive thoughts. CBT needs to incorporate awareness and acknowledgement of anxiety and mutism. Most children with Selective Mutism ‘worry’ about others hearing their voice, asking them questions about ‘why they do not talk’ and trying to force them to speak. The focus should be on emphasizing the child’s positive attributes, building confidence in social settings, and lowering overall anxiety and worries.
  • Medication: Studies indicate that the most effective approach to treatment is a combination of behavioral techniques and medication. If children are not making enough progress with behavioral therapy alone, medication may be recommended to reduce the anxiety level. Serotonin reuptake inhibitors (SSRI’s) such as Prozac, Paxil, Celexa, Luvox, and Zoloft are very effective in the treatment of anxiety disorders. Similar to the SSRI’s, there are other drugs that affect one or more neurotransmitters such as serotonin, norepinephrine, GABA, and dopamine, etc. which are also proving to be affective. Examples are Effexor XR and Buspar. Both classes of drugs work well in children who have a true biochemical imbalance. This seems to be the case in the majority of children with Selective Mutism. Medication is used as a ‘jump start’ with the hope that, as we lower anxiety via medication, we can implement behavioral techniques more easily and successfully. Goals for the duration of treatment with medication are usually 9-12 months.
  • Self-esteem boosters: Parents should emphasize their child’s positive attributes. For example, if your child is artistic, then by all means show off the artwork! Have them ‘explain’ their artwork to family members and close friends. This promotes more verbalization practice, as well as helps with confidence!
  • Frequent socialization: Encourage as much socialization as possible without ‘pushing’ your child. Arrange frequent play dates with classmates or even small group interactions with individuals the child knows well. The goal is for your child to feel comfortable enough with the classmates so that verbalization will occur. Most children with Selective Mutism will talk to friends in their own home. As the child gets increasingly comfortable speaking to one child, invite another child over, and then have two or three children at a time. Transfer speaking into the school via set tactics/techniques. For some children, Social Skill therapy is necessary and often helpful in accomplishing increased communication.
  • School involvement: The school needs to understand that children with Selective Mutism are not being defiant or stubborn by not speaking—that they truly CANNOT speak. Explain to the teacher that a child needs to feel that it is ‘alright’ for them not to speak. Nonverbal communication is acceptable in the beginning. As the child progresses with treatment, the teacher should be involved in the treatment plan with verbalization being encouraged in subtle, non-threatening ways. An Individualized Educational Plan (IEP) or 504 Plan may be necessary to help accommodate your child’s inability to communicate verbally and to help the child progress communicatively, as well as build social comfort.
  • Family involvement and parental acceptance: Family members must be involved in the entire treatment process. Very often, changes in parenting styles and expectations are necessary to accommodate the needs of the child. Remember, never pressure or force your child to speak. This will only cause more anxiety. Convey to your child that you are there for them. Spend one- on-one time, especially at night, when all pressure is off, and engage your child in discussions about their feelings. Allowing your child to ‘open up’ helps relieve stress. A parent’s acceptance and understanding is crucial for the child!
  • Social- Communication Anxiety Therapy (S-CAT): This is the philosophy of treatment implemented at the Selective Mutism Anxiety Research and Treatment Center (SMart Center). This treatment includes development of an individualized treatment plan that focuses on the whole child and incorporates a TEAM approach involving the child, parent, school personnel, and treating professional. A combination of the above recommended therapeutic tactics/techniques are implemented to enable social comfort and progression of communication comfort in various social settings in and out of school. Because anxiety levels change from situation to situation, and often from one person to the next, methods often change from one social situation to another. Therefore, by lowering anxiety, increasing self-esteem, and increasing communication and social confidence within a variety of REAL WORLD settings, the child suffering in silence will develop necessary coping skills to enable proper social, emotional, developmental, and academic functioning.

For more information about helping your child, check out this article from Mirror about treating selective mutism!

If you have concerns about your child’s development, please contact us online, send us an email or call us at (609) 924-7080 to set up a consultation in our office. When appropriate, we will conduct an individualized evaluation of your child to determine the most appropriate therapy and recommendations.

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