Treatment Options For Selective Mutism

Selective mutism is a severe anxiety disorder that usually develops between ages three and five. A child with selective mutism is anxious to the point they cannot speak. Girls are more often affected than boys. Typically, patients are paralyzed by fear and are worried about embarrassment when speaking. Patients with selective mutism are often also diagnosed with social anxiety. The earlier selective mutism is treated the better. Treatment is necessary because it does not go away and can continue through adolescence and adulthood. It can lead to academic underachievement and social isolation later on in life.

Remove Immediate Pressure To Speak


Oddly, a child with selective mutism can actually be a chatterbox at home and with a few selected relatives and friends, as they are typically less anxious in familiar environments and with family. Parents are very often not aware of their child's silence in school until a teacher contacts them. While more talking is the goal, parents and teaching should not force a child with selective mutism to immediately speak more. Pushing a child with selective mutism to speak raises their anxiety level and actually makes talking less likely. When a parent takes the child out and encounters an acquaintance, the child may hide behind the parent's legs. The acquaintance may try to speak to the child, causing them to freeze. 

It is tempting for the parent to answer because it relieves anxiety in both the child and parent but will not help the child in the long run when it comes to their communication skills. It is best to change the subject instead and avoid bombarding the child with questions. It is, however, appropriate for a child with selective mutism to be given the opportunity to respond, so parents and teachers can leave a short time between a question and a response before moving on. A child should not be bombarded with questions. While many parents push hard for their children to say please, thank you, and other polite words, they should still not press too hard if their child is dealing with selective mutism, as it could cause regression.

Acknowledge Difficulties And Frustrations


Selective mutism impairs a child's school performance and social life. A child may be so anxious that they cannot raise their hand and say they need to go to the bathroom, leading to accidents in the classroom, which lead to embarrassment and shame, and, in turn, greater anxiety and lower self-esteem. Parents and teachers must acknowledge difficulties and frustrations for the child with selective mutism, and praise them when they make improvements, even small ones, in anxious situations. Every improvement is a major accomplishment for children with selective mutism, even attempts to communicate verbally that fall a little short.

Therapy With An Understanding Psychiatrist


The first trip to a doctor should be to the child's pediatrician who will check for developmental issues or speech problems. The physician should then provide a referral to a psychiatrist or psychologist who treats selective mutism. Treatment with an understanding psychiatrist who has experience in this specific condition is crucial for the best results. The most common treatment these psychiatrists use is behavioral therapy. The goal is to gradually lower the child's anxiety. At first, they are asked to complete simple verbal and are rewarded with either praise or small gifts. Gradually, the child is given slightly harder tasks with rewards. 

As the difficulty rises, the child's anxiety should diminish as success increases. Eventually, the child will respond when spoken to. Medication can be given to a child making very slow progress, but therapy should come first, and the child should not stay on medications too long. Teens who have not been treated previously are more difficult to deal with because they have learned ways of avoiding stressful situations. They also may have developed depression and generalized anxiety, which will require treatment for as well, and medications may come into play more significantly here, along with social skills building.

Praise All Accomplishments


As mentioned briefly before, the parents of a child with selective mutism should praise all accomplishments no matter how small. Parents can ask questions at home to encourage self-expression. Start off with choice questions, then gradually work up to open-ended questions. Praise all along the way.

If the child is mute around strangers, have an adult acquaintance visit one day, and have the visitor sit away from the child at first. Keep the child busy and gradually move the adult closer and closer. While preoccupied, have the adult speak softly to one of the parents and then the child. Encourage and praise the child. Some rewards can be a special day trip, more play time with a parent or friend, or special privileges like staying up later.

Encourage Other Communication Methods


A child with selective mutism can still communicate nonverbally, and encouraging communication methods such as this is crucial, particularly during treatment for selective mutism. Children with this condition can point, nod or shake their head, use other gestures, or even write what they want to say down on paper. Hopefully, teachers and parents can develop a supportive relationship with the child even though it is nonverbal, and can encourage other communication methods. The child can also use these skills with other adults she does not know well. It is important to have a team effort to help the child. Good communication between the parent and teacher, and also between parent and therapist, is key here.


    HealthPrep Staff