How to Help Children with Selective Mutism

Three Methods:Getting Help for Your ChildWorking with Your Child’s SLPWorking with Your Child’s Teacher

Selective mutism is a social anxiety disorder that causes a child to stop speaking in certain situations and around certain people. If left untreated, selective mutism can interfere with a child’s academic performance and social life. If your child has selective mutism or if you suspect that he or she may have selective mutism, then you will need to take your child to see a pediatrician and a specialist, such as a speech language pathologist and, in some cases, a psychiatrist. Your child’s speech language pathologist can design a treatment plan for your child that can help you to support your child at home and make it easier for your teacher to support your child at school.

Method 1
Getting Help for Your Child

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    Watch for symptoms. Selective mutism is rare, but it often starts when a child is around the age of five and may first be noticed when she starts school;[1] however, older children can also develop selective mutism. In order for a child to receive a diagnosis of selective mutism, she must have symptoms that interfere with normal activities, are not related to another disorder, and that last for at least one month (the first month of school does not count).[2] Children who have selective mutism may:[3]
    • Act extremely shy
    • Be able to speak at home or with people they know well
    • Get anxious around new people or in certain settings
    • Not be able to speak in certain social situations
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    Make an appointment with a pediatrician. Children do not outgrow selective mutism. It requires treatment.[4] It may even become worse over time if left untreated, so it is important to seek help for your child if you suspect that he may have this disorder.[5] Call your child’s pediatrician and make an appointment.
    • Your child’s pediatrician can do a physical exam to rule out any other potential causes and then refer you to the appropriate specialists as needed.
    • The pediatrician may perform a hearing screening to rule out a middle ear infection or decreased hearing ability.[6]
    • The doctor may also perform or refer your child for an oral-motor examination. This can help determine if all the muscles and body parts involved in speech — lips, tongue, jaw, etc. — are strong and work together in coordination.[7]
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    Take the child to see a Speech Language Pathologist (SLP). Since selective mutism is considered a speech disorder, seeing a SLP is essential for your child’s treatment. A SLP can diagnose your child and recommend a treatment plan that can you can put into practice at home and share with your child’s teacher.[8]
    • The SLP will need a lot of information to begin treating your child, from both the family members and teachers. The SLP will have to evaluate the child's expressive language ability, language comprehension, and verbal and non-verbal communication.[9]
    • In addition, it will be necessary to look at any academic reports, the results of any standardized testing, any comments from teachers.[10] The SLP may need to observe the child in the classroom and in other settings, such as on the playground with other children and adults. A family medical history, symptom history for the child, and information about environmental factors will all be helpful in diagnosing your child and developing a treatment plan.[11]
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    Consider additional psychotherapeutic treatment. In addition to working with a SLP, there are other mental health professionals who may be able to help your child. Consider psychodynamic therapy, behavioral therapy, and speaking with a psychiatrist who may suggest medication to support treatment.[12]
    • Your child should undergo a psychiatric evaluation to rule out any other potential psychiatric issues that may have symptoms in common with selective mutism.[13] Psychiatric help may benefit your child, especially if the selective mutism is related to some form of trauma.[14]
    • In some cases, a psychiatrist may prescribe fluoxetine (Prozac) for selective mutism. Fluoxetine has been found to be effective in some cases and is generally considered safe for children;[15] however, it does carry a black box warning. Certain antidepressants, including fluoxetine, may increase the risk of suicidal behavior or thinking in children.[16] Closely monitor your child for any signs of depression or suicidal behavior.[17]
    • A common therapy to help with selective mutism is behavioral therapy.[18] The therapist will work with your child to develop a step-by-step plan to slowly introduce speaking-type behaviors. Using a reward system, your child will gradually tackle larger and more daunting speaking behaviors.[19]
    • Look for a mental health professional trained in cognitive behavioral therapy (CBT) to help your child. This may help if your child is suffering from a social anxiety disorder. It is more effective for older kids and teens.<ref</ref>[20]
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    Get the whole family involved. Family members including parents, siblings, and grandparents can provide some much needed support to a child with selective mutism. By helping the whole family to understand the condition and how to respond, family members can increase the child’s chances of recovery.[21]
    • Try to educate your family members so that they will know what the condition means and how to respond to it. Provide them with literature, guide them to helpful websites, or simply sit down and have a conversation with them explaining what is going on and how you are approaching treatment.
    • Teaching family members what is and is not helpful (yelling at the child or pushing too hard for him not to be shy, for instance) and how they can help build your child's confidence and self-esteem may help support your child. Maybe grandpa can help teach the child a new skill, or a sibling can participate in a sport with the child with selective mutism to help him feel a sense of belonging and acceptance.[22]
    • Talk to the family about creating a healthy environment in which your child is praised for all attempts to communicate with others (and not punished for not communicating), is not made aware that anyone else is worried or anxious about whether or not he is speaking, you concentrate on play and having fun together, and in which you reassure the child that he'll be able to speak when he's ready.[23]

Method 2
Working with Your Child’s SLP

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    Pay attention to what makes the mutism worse/better. Start keeping a record of your child’s behavior to provide more information to your child’s speech language therapist. By paying attention to the situations and people that cause your child to go silent, you may be able to identify patterns and these patterns can help your child’s SLP come up with ways to make your child more comfortable.[24]
    • For example, you might find that your child will talk to new people if you are present, or that your child will not speak in groups of more than three people, no matter who is present.
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    Ask about stimulus fading. Stimulus fading is when you put your child into a situation that will make her feel comfortable enough to talk, and then slowly change something.[25] Making gradual changes should help your child to adjust to any discomfort she is feeling and this may make it easier for her to speak in the same situations in the future.
    • For example, if you notice that your child is comfortable speaking to a new person with you in the room, then you might start by sitting in the room and then slowly leave after a little time has passed.
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    Look into shaping. With shaping, your child will have the opportunity to use nonverbal communication methods first, such as gestures, writing, or drawing. Then, the speech language therapist will start to encourage your child to make sounds, such as a single consonant sound or a whispering a single word. [26]
    • For example, the SLP might begin by having your child draw something, such as a horse. Then, the SLP might as your child what noise a horse makes.
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    Include self-modeling techniques. Showing your child videos of herself speaking may help to encourage her to speak as well. To use self-modeling, your speech language therapist may ask you to provide a home video where your child is speaking. Then, the SLP may watch the video with your child to help build up her confidence and encourage her to speak again.[27]
    • Make sure that the video portrays the type of behavior that you want your child to display. For example, you might choose a home movie where she is laughing and speaking with some other children.
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    Provide positive reinforcement. Pressuring your child to speak may cause her to feel uncomfortable and she may associate this feeling with speaking. Instead, do not pressure your child to speak. Just respond warmly when she does speak.[28]
    • Do not overreact when your child speaks, but praise her for communicating.
    • Do not praise your child in public, as this may embarrass her. Instead, wait until you get home and then reward her.[29]

Method 3
Working with Your Child’s Teacher

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    Make sure that your child’s teacher is aware of your child’s condition. Some educators and health care professionals may downplay the seriousness of selective mutism, or even suggest that your child will grow out of it; however, selective mutism is a serious problem that requires treatment. It is important for you to advocate for your child. Make sure that your child’s teacher is on the same page as your SLP regarding your child’s needs in the classroom, and that the teacher is encouraging, supportive, and willing to work with you and your child's SLP.[30]
    • For example, make sure that your child’s teacher knows not to gush or overreact if your child speaks in class.[31]
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    Request communication options. Some children will communicate using special devices, such as a voice recorder, a computer, or even just a pen and paper. Ask your child’s teacher what options are available for your child to use in the classroom.[32]
    • Your child might have a method of communicating that she prefers. Pay attention to how your child communicates when she is feeling anxious for clues on how to provide communication options to your child at school.
    • For example, if your child tends to draw when she is feeling anxious, then sending her with a special notepad and crayon set may help.
    • Your child and teacher may work out a way to communicate with non-verbal methods, such as signals or cards, before working up to speech.[33]
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    Look into placing your child in a smaller group. Some children with selective mutism will speak only in small group settings, so you may want to talk to your child’s teacher about this possibility.[34]
    • For example, if the students sometimes work in small groups to complete tasks, then perhaps your child’s teacher could ensure that your child is placed with the smallest size group or even just with one partner.


  • Do not believe anyone who tells you that your child will grow out of selective mutism. Left untreated, selective mutism can become worse.[35]

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Categories: Overcoming Shyness & Insecurities