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Treatment of Selective Mutism

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D. Updated: Feb 4th 2008

Treating Selective Mutism is difficult, likely because the behavior is an effective strategy for reducing children's anxiety feelings. Children's mutism reduces their profile in threatening settings. From a behavioral perspective, this behavior is often negatively reinforced by people around the child. In other words, as children continue to refrain from speaking in threatening settings, the people they interact with start to accept the mutism and stop expecting the children to speak. Children quickly learn that they can get people to stop bothering them simply by being persistent in their muteness. For a more detailed explanation of negative reinforcement and other principles of learning theory, please click here.

Many effective anxiety treatment strategies are also useful for treating Selective Mutism. In particular, behavioral modification plans can be quite effective. A clinician creating a behavior modification plan for treating Selective Mutism would first identify and differentiate settings and people with whom the child refuses to speak. Next, the clinician would develop a reinforcement/reward system that would reward appropriate behavior (any effort to speak in appropriate settings/situations). The behavior plan might use a token system, where the child receives tickets or stickers for desirable behaviors. Later on, the children can trade tickets or stickers for candy, toys, or privileges of their choosing.

Desensitization strategies (such as those we described in the discussion on Pica) are also likely to be included in the behavior plan to help children feel more relaxed and able to tolerate situations and settings that they find particularly threatening. Through these procedures, children gradually learn that an object or person is not actually a threat. At this point, Mutism should decrease, as there is no longer a need to use this type of behavior to cope with anxiety (i.e., the child has more adaptive stress-coping skills).

medicationAntidepressant and anti-anxiety (anxiolytic) medications have also been used to treat Selective Mutism. Tricyclic antidepressants such as Clomipramine and Imipramine (i.e., members of the older generation of antidepressants that existed before SSRIs like Prozac), and anxiolytics such as Clonazepam (a habit-forming benzodiazepine) and Buspirone (another kind of anxiolytic) are often tried. All of these medications have side effects associated with them and must be taken with care and as prescribed by a licensed physician. In addition, antidepressants currently carry a "black box" warning because their use with children has been linked to a small increase in the risk of suicidal behavior and completed suicides. Because of this small but elevated risk of suicide, children who are prescribed antidepressant medications should also be meeting regularly with a mental health clinician experienced in the treatment of children in order to monitor their potential for suicidal thoughts and behaviors. It is always a good idea to talk with your doctor about the full range of potential risks and benefits associated with recommended medications before agreeing to allow your child to take them.

For more information or support, you may want to visit the website of the Selective Mutism Group Childhood Anxiety Network.

Recommended reading:

The Silence Within by Gail Kervatt

Is It "Just a Phase"? by Susan Anderson Swedo and Henrietta L. Leonard

Helping your Anxious Child by Sue Spence, Vanessa Cobham, and Ann Wignall


Reader Comments
Discuss this issue below or in our forums.

teaching a student with selective mutism - debra nasser - Sep 16th 2009

I am a teacher who has recently taught a student with selective mutism. He was never diagnosed. However, after I began to Google selective mutism for more information he has since been diagnosed, and as well, I have become better informed and educated. For those looking for support groups and more information, Google! There are over 300,000 sites specifically related to selective mutism.

I am teaching in Riyadh, Saudi Arabia. I am looking for doctors familiar with this disorder here in this area.

selective mutism - sandy - Mar 25th 2009

I have a five year old granddaughter that has selective mutism and I have become very fustrated trying to get help for her.She has been going to preschool since she was two and hasn't spoke one word to any of her teachers. I don't know how she is able to learn because she never participates, but she knows her letters,numbers shapes,colors,her letter sounds,her birthday. She seems very bright for her age but her teachers will never know it because she will not communicate with them at all.She went to speech therepy for six months and did wonderful but still wouldn't talk at school, so now we have an appointment at a childrens hospital next week for some play therepy so I'm hoping that will help but I'm not very optomistic. I wish her dr. would try medicine, but she seems very reluctant,I am too but I would like to try it and if it dosen't help she can always stop it.I am hoping someone can give me some information that might can help that I don't know about because I am very concerned about next year when she starts regular school and she must talk to her teacher to succeed in school and she still will not talk.

Selective Mutism Interventions - Jerry Meyer MSW - Feb 20th 2009

I have a four year old preschooler in our program that presents as having selective mutism.  Having explored the internet for suggested interventions, I have found lots of individuals with options for training and information included in for-profit presentations. Other than suggestions for comfort, nurture, and patience there are very little concrete suggestions for therapy or interventions. Does anyone know of web sites that may provide suggestions for intervention for parents, teachers, and therapists.

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