Selective Mutism

Definition of Selective Mutism

Children with Selective Mutism (SM) demonstrate a persistent failure to speak in specific social situations when speaking is expected (e.g., school, extra-curricular activities, play dates), but speak fluently in other situations. Children with SM are NOT choosing not to speak or being purposefully defiant. Instead, they are highly anxious about speaking in certain social settings, which causes them to avoid speaking. They may be biologically pre-disposed to be behaviorally inhibited and have likely experienced numerous situations in the environment that shaped their inhibited stance.

Myths about Selective Mutism

In order to better understand children with SM, it is important to dispel a few myths related to SM. Children with SM are NOT necessarily
• “just shy”
• on the Autism Spectrum
• victims of trauma
• individuals with cognitive deficits
• children with or language disorders

Furthermore, it is not common for children with SM to “grow out” of not speaking in certain situations and leaving SM untreated can lead to poorer outcomes and more severe anxiety in the future. Therefore, it is important that children with SM receive help to overcome their fear of talking.

Understanding Selective Mutism

Children are exposed to hundreds of opportunities/prompts to speak throughout the course of the day. For children with SM, this means that they are being rapidly exposed to opportunities to avoid speaking on a daily basis. When children with SM are prompted to speak, they become anxious and their anxiety inhibits them from speaking, which leads them to avoid speaking in these anxiety-provoking settings. At times, an adult may “rescue” the child with SM in order to prevent the child with SM from having to talk. When we see someone in distress, it is our natural reaction to offer help/save them. Unfortunately, the adult “rescue” this case is an example of good intentions gone wrong, because the adult’s assistance in this setting ends up playing a role in maintaining the child’s silence. Specifically, the process of “rescuing” a child with SM serves to decrease the child’s anxiety as well as the anxiety of the adult, who may want to prevent the child from experiencing distress. The removal of both the child’s and the adult’s anxiety leads the child’s behavior of avoiding speaking to be negatively reinforced. This cycle continues and creates a long series of negatively reinforced interactions such that, eventually, inhibiting speech becomes automatic for a child with SM.

Treatment Goals for a Child with SM

Treating Selective Mutism

Based on this conceptualization, our goals for treatment are to have the child:
1. Verbalize to more people, across more settings, and activities
2. Develop distress tolerance

Notably, it is NOT necessarily our goal for the child to no longer be anxious about speaking to certain people, during certain activities, or in certain places. The goal is not to remove the child’s anxiety, but to make the anxiety and the distress the child feels in these situations manageable. This is done through gradually exposing the child to tasks involving verbalizations. Therefore, our interventions should look like this:

Reasonable accommodations may be needed for children with SM in the school setting as they work toward generalizing their brave talking skills. Below is a list of sample accommodations that may be beneficial at different points in treatment:

  • Allow the child with SM to arrive early in order to allow “warm-up time” before the school
  • Give the child preferential seating so the teacher is more accessible
  • Set-up and utilize a daily behavior plan in order to track the child’s talking behavior at school
  • Reinforce the child for progress on their brave talking tracker both at school and at home
  • Maintain open lines of communication between the school and the child’s parents in order to facilitate treatment gains and problem-solve as needed. Sending the child’s behavior plan home each day is an important part of this process.
  • Increase the number of small group activities and partner-work used in the classroom
  • Provide 1:1 support during key activities
  • Establish non-verbal cues for safety (bathroom, eating, health)
  • Normalize and validate “worries” with entire class
  • Build on strengths and areas of interest (e.g., practice talking during activities the child enjoys)
  • If the child is not yet speaking at all at school, allow the child to videotape himself completing verbal assignments at home to demonstrate knowledge to the teacher
  • Create a transition plan for the next school year at the end of each school year
  • Carefully consider the teacher and peers that the child with SM will be placed with each school year in order to facilitate growth and generalization of brave talking skills