Selective mutism is an anxiety disorder. It usually begins in early childhood but it can continue into adulthood if it is not treated.
Children do not usually grow out of selective mutism on their own. They need treatment.
Treatment for selective mutism aims to reduce the anxiety associated with speaking.
How well they respond to treatment depends on:
- how long they’ve had selective mutism
- if they have other communication or learning difficulties or anxieties
- how family, speech and language therapists (SLTs), psychologists and schools work together
Children with selective mutism often overcome their fear of speaking. But it can take a long time - sometimes years.
Non-urgent advice: Contact your GP if:
- you think your child has selective mutism
They can refer your child to a speech and language therapist (SLT) or a psychologist for treatment.
About selective mutism treatment
When an SLT or psychologist diagnoses your child, they will talk to you about a treatment plan.
Treatment must include educating parents and teachers about how to reduce the child’s anxiety around talking.
It may involve using techniques to reduce your child's fear of talking.
They will tell you:
- who will help
- the ways they work with you and your child
- what to expect in treatment
- how you can help
Treatment techniques
Some treatment techniques for selective mutism are based around cognitive behavioural therapy (CBT). CBT helps your child to understand the link between their thoughts, feelings and behaviours. This can help them to solve problems and feel more in control of their lives.
An SLT or psychologist may use a CBT tool called graded exposure.
Graded exposure allows your child to slowly confront their anxiety and build confidence.
Graded exposure
The SLT or psychologist exposes your child to situations that cause a small amount of anxiety, to start. For example, they may ask your child to communicate in a way they find easiest, such as nodding or pointing.
The SLT or psychologist changes the situation gradually. They aim to slowly increase the level of anxiety your child is exposed to.
Your child’s anxiety may not disappear completely. But they are likely to become more able to manage their distress.
They will need regular practice sessions at their preschool or school.
Other techniques
There are other techniques the SLT or psychologist may use. They will use techniques that best suit your child.
Stimulus fading or ‘sliding in’
Someone gradually joins you and your child for easy talking games. When your child gets comfortable you ‘slide out’.
Shaping
Shaping can help your child make one small change at a time, such as moving from mouthing a word to whispering a word.
Positive reinforcement
A child is rewarded for making attempts to talk or communicate in challenging situations. Rewards can encourage your child to keep trying.
Desensitisation
Desensitisation aims to reduce your child’s sensitivity to other people hearing their voice.
Working with others
SLTs and psychologists sometimes work as a team. This means you may have more than 1 person working with your child.
They may also work with you and your child's school or preschool. They often visit the school and put intervention plans and practice sessions in place to help your child.
The therapist or psychologist may visit your home. They try to build trust with your child.
Treatment is often based around fun and games, and activities your child likes.
This all aims to build their confidence and reduce their anxiety.
Medicine
Medicine is not usually the first treatment for selective mutism.
It is only really appropriate for older children, teenagers and adults who have not made progress in therapy.
Sometimes medicine is used if their anxiety has led to other mental health difficulties. It may be prescribed as part of a treatment programme. Your treating professional can talk to you about this.
Treatment for adults
Selective mutism does not usually start in adulthood. If it is not treated in childhood, it can progress into adulthood.
If you are an adult with selective mutism, you can get help. Because it is a phobia, selective mutism can be treated at any age.
You may also choose to seek help if you have developed other issues arising from living with an anxiety disorder for a long time. For example, your fear of talking or social anxiety may have held you back from doing ordinary daily tasks or succeeding in college or work.
When seeking help, involve a friend or family member to support you to take the first step.
Contact your GP to find out about treatments and supports. They may refer you to a professional who knows about selective mutism. This may be a speech and language therapist or a psychologist who can develop a treatment plan with you.
Sometimes they start with techniques such as graded exposure or desensitisation.