Selective mutism is a complex anxiety disorder that is characterized by a child’s consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations (e.g., at home).

As this is primarily an anxiety disorder, treatment for selective mutism should be conducted by a full team that includes a mental health provider along with the speech-language pathologist, the child’s caregivers, and the child’s teachers. This program should be completed with that full team.

Sample Goal for Selective Mutism Treatment:

By the end of the IEP cycle, Client will increase spoken communication in the classroom by achieving at least a 4 out of 5 on the following rubric scale as reported by her classroom teacher:

Rubric Scale: Over the past two weeks in the classroom, the student…
1 = Did not speak or communicate in other ways (pointing, gesturing, making sounds)
2 = Did not speak but did communicate in other ways (pointing, gesturing, making sounds)
3 = Spoke every once in a while and also communicated in other ways
4 = Sometimes spoke to participate in school/social activities, but not often
5 = Spoke frequently in the classroom, enough to participate in many school and social activities

Overview of Selective Mutism Treatment

Since selective mutism is primarily an anxiety-based communication disorder, we can support children with selective mutism by modifying their environment to make them feel more comfortable.

Increasing Predictability: Children with anxiety and selective mutism often do better when they know what is going to happen. We can help by increasing the predictability of their day.

Increasing Sense of Control: Children with selective mutism may be choosing not to speak because they feel that they don’t have control over many other aspects of their life. Feeling like your anxiety and emotions are out of your control is a scary feeling! We can help by showing the child ways that they can feel more control in their day.

Increasing Independence: The more a child is able to do things independently, the more confident they will feel. We can help children with selective mutism feel more confident throughout their day by increasing their ability to do things independently. In turn, this will increase the likelihood that they will be willing to try hard things, like speaking to others.

Talking is a great way to connect with the people around us. We can tell other people our ideas and they can tell us theirs. We can let others know what we need and participate in activities that we enjoy. But sometimes, talking to other people can be uncomfortable. We can work on gradually becoming more comfortable with talking to others.

In this phase of therapy, we will work with the child to identify their own reasons for why they may want to speak to others. We can also help them learn calming strategies that they can use if they start to feel overwhelmed.

Here’s the part of this plan where it’s going to change depending on each child’s needs. The goal here is to gradually increase their ability to speak in progressively more challenging situations. Since each child is different, you will start in different places and progress at different rates.

The key is to push the child a tiny bit out of their comfort zone at each new step, but not so far that you cause high levels of anxiety. Think of it like a bullseye. If we push too hard, we hit the outer ring where we may cause meltdowns or shut downs. We want to push them slightly out of their comfort zone but not too far.

1. Identify what the child can do right now – What type of communication is the child successful with right
   now? Is there one adult that the child will talk to at school? Or is the child able to gesture or use some
   other non-speech communication with others?
2. Take that and make it one tiny step farther – Take a look at the example progressions below. How can
   you take the child’s successful interaction and move up one step? Only change one aspect of the
   interaction at a time. For example, if the child can nod yes/no in the speech room, you could either have
   them move up toward making sounds OR you could have them nod yes/no with another adult in the
   room. But you wouldn’t try to change both at once. Keep in mind that you may have to try several
   different things before you find one the child can do. Also, keep in mind that a child may not follow these
   progressions in this order. They may find a different order easier. Go with what the child needs.

Would you like a pre-made curriculum that covers all of these steps?

Our Selective Mutism Curriculum by Speech and Language Kids is a structured program that will walk you through these steps with a child with selective mutism.

Whether you’re a speech-language professional, parent, or other therapist, this Curriculum has everything you need to support gradual, confident communication for children with selective mutism.