Treating Selective Mutism

August 22, 2021By: VocoVision

Selective Mutism is a somewhat uncommon disorder that is often found in patients who also have social anxiety or a social phobia. With selective mutism, the child is able to speak and communicate effectively in setting that makes them feel comfortable and secure. When they are in social settings such as school, church, or play groups, they may be unable to communicate or speak effectively.

What Is Selective Mutism?

This disorder is especially debilitating for children because the fear of speaking makes it impossible for them to engage with peers or educators even though they are able to understand what is going on around them. Selective mutism in children causes them to be unable to respond in a nonverbal manner when in social settings, making communication that much more difficult.

As with most speech disorders, there are varying levels of severity. The most severe occurrences manifest as a complete inability to speak at all. Other patients may be able to whisper or say a few words to those around them. They might be able to talk to one or two people even in the social setting, yet be unable to respond to a teacher or a peer with whom they are not comfortable. Unsurprisingly, this can lead to self imposed isolation as the child tries to avoid the situations which makes them feel the most vulnerable.

What Causes Selective Mutism?

There is no single known cause of selective mutism, but there are factors that make it more likely to develop. The majority of children with selective mutism have a genetic predisposition to anxiety. In other words, they have inherited a tendency to be anxious from family members. Selective mutism causes children to have severe anxiety, sleep problems, sensory processing disorder, inhibited temperaments, speech abnormalities, language delays, and auditory processing disorder.  Other potential causes include temperament and the environment. Children with language difficulties may be more prone to developing the condition.

Interestingly, there is a small percentage of patients with selective mutism that do not exhibit any indications of shyness. These children will often seek out interaction and communicate with gestures with little or no reservations.

The difference between selective and traumatic mutism, is that those with selective mutism will speak in at least one setting. Children with traumatic mutism will refuse to speak in all settings.

Selective Mutism Symptoms

If you believe that your child may be struggling with selective mutism, look for the following symptoms:

  • Talking freely at home but becoming nonverbal around strangers
  • Inability to speak even to familiar adults
  • Seeming to “shut down” or become “paralyzed” in social situations
  • Using gestures, nodding and facial expressions in place of verbal communication

How To Treat Selective Mutism

Treatment of selective mutism often involves a combination of psychotherapy and medication, though psychotherapy is generally the first recommendation. Selective mutism treatment often begins with introducing techniques to reduce the anxiety associated with speaking with others, enhancing self-esteem, and building social confidence. Treatment may involve several components delivered by a group of professionals, including behavior modification, play therapy, cognitive behavioral therapy, socialization, drug therapy, school accommodations, a supportive home environment. Speech therapists are best suited to work with behavior modification to improve functional communication. For those schools that don’t offer on-site Speech Language Pathologists, then there’s telepractice speech therapy, where you’ll be connected to highly qualified live SLP’s who interact with the child via technology.

Stimulus fading or acclimation is one approach that has been effective with some patients. To begin, the child is introduced into a social situation with a person with whom he or she is comfortable speaking. The individual is slowly pulled back and interaction increases with other members in the social setting. This is not something that will happen in a single session; it must occur slowly as the child’s anxiety decreases.

Reinforcing is another option. With this, the child is given something he or she really wants when they attempt communication. The greater the attempt, the more of the reinforcement the child receives. For this to be effective, it must be something that truly motivates the child, and that they are only given to reinforce speech and communication efforts.

It is important to be aware that because there have been very few studies into the most effective treatment of selective mutism. Therefore, gathering data and being adaptive in treatment will play a significant role in the efficacy of therapy.


Treatment for selective mutism should focus on reducing anxiety, increasing self-esteem, and increasing social confidence. With lowered anxiety, gained confidence, and the use of appropriate tactics/techniques, communication will increase as the child progresses from nonverbal to verbal communication. 

The needs of every child are unique, so an individualized treatment plan must be designed to accommodate those needs, along with modifications at home and school. As anxiety is lowered, self-esteem is raised, communication is improved, and confidence is increased in real-world situations, the child struggling in silence will develop the necessary coping skills for proper social and academic functioning. 

If your child talks freely at home but freezes up in public settings, they may be struggling with selective mutism. With the proper diagnosis and treatment, the prognosis for overcoming selective mutism is excellent! Connect with a Speech Language Pathologist to learn more about how to help a child with selective mutism. 

Related Articles