Children with selective mutism (SM) are able to speak at home, but are unable to speak in other settings such as school or public places due to intense anxiety. In those settings where the child is unable to speak, they may be inadvertently reinforced in using alternative communication strategies such as gestures or having others speak for them. Others may simply not communicate at all. SM typically presents itself in preschool around ages three or four, but may persist into upper adolescence or adulthood if left untreated. SM is different from typical shyness that most experience when meeting new people or going to new places; it is pervasive and may negatively impact a child's ability to build age-appropriate friendships, participate in the workplace and extracurricular activities, and get basic needs met.
Effective treatment of SM begins with a thorough evaluation to determine the function of the speech avoidance and whether or not there are any comorbid conditions. In particular, social anxiety and separation anxiety are commonly occurring comorbid conditions of which SM might even be considered a variant. Treatment is highly behavioral in nature including increased prompting of speech while reinforcing successive approximations of speech or speech attempts (mouthing or sounds) using specific praise and small incentives. Children are taken systematically through the process by bringing the clinician closer while the parent and child play, then gradually fading the parent out of the room. As the child progresses we work to generalize the skills, which means taking therapy “on the road” – like going into the classroom, stores, or restaurants so that the skills learned in the office are able to be transferred to the settings where SM has been most disruptive. As part of the treatment program we will collaborate with the child’s school, providing consultation on classroom based strategies and supports that will promote maintenance of acquired skills, as well as future growth.