Selective mutism treatment

A severe and complex anxiety disorder, selective mutism (previously known as ‘elective mutism’) relates to a child or adult who feels consistently unable to speak in specific social situations, perhaps with relatives that they rarely see, or peers at school or work that they may not know as well as others. It is not a conscious decision, whereby they're choosing not to talk or are refusing outright; moreover, they are physically unable to speak. 

We understand that selective mutism can be debilitating for either yourself or your child, which is why our nationwide network of hospitals and wellbeing centres are able to offer specialist therapeutic care across all age groups. Focused on lowering the associated anxiety symptoms of the disorder, a wide range of behavioural and play therapies can help to conquer fears of certain social settings and provide coping techniques to reduce the impact that this condition has on quality of life. 

It is thought that the pressure and expectation to talk and engage with certain people makes individuals with selective mutism completely freeze, with feelings of panic and anxiety being overwhelming enough to prevent individuals from speaking. This distressing response can lead to pattern of anticipating and ultimately avoiding situations where symptoms of the disorder may occur.

Usually developed during childhood (often between the ages of two and four - a crucial stage of social development when nursery and school settings expand the child’s social network), if selective mutism is left untreated by professional mental health experts, this condition can continue into adulthood and increase the risk of developing other anxiety disorders. While you or your child will be able to speak freely to people that you know, such as immediate family and close friends, triggers at school, work or certain social events can make functioning in everyday life incredibly difficult.

As the disorder is more common in childhood, throughout the rest of this page, we refer to selective mutism in children.

Treatment for selective mutism

If you believe that your child may have selective mutism, it is important that you seek help and support from mental health professionals as soon as possible. Early diagnosis and mental health treatment for the disorder can increase the chances of your child overcoming or vastly improving related symptoms.

If you are an adult with selective mutism, treatment can still be effective, although the process may take longer due to behaviours of the condition having become deep-seated over time.

If your child has a co-existing mental health condition alongside selective mutism, such as depression or an anxiety disorder, or a learning disability that affects their ability to communicate, then this may affect how long or complex the treatment programme will be.

Treatment options at Priory focus on reducing associated anxiety symptoms surrounding speaking in certain situations, as opposed to simply focusing on the speech itself. Whether triggering scenarios are found during nursery, school, work or social settings, the aim of talking and behavioural therapies will be a progressive, step-by-step process to gradually reduce the pressure to speak, which is at the core of symptoms of selective mutism.

Ensuring that your child’s self-confidence is built up over time and teaching them coping mechanisms and techniques can ultimately lead to successful conversations in group situations and the ability to speak freely to all manner of people within a variety of settings.

In order to reach this stage, therapies used in the treatment of selective mutism in both children and adults include:

Cognitive behavioural therapy (CBT) 

Among the most effective methods of treating symptoms of selective mutism is CBT.

This action-based and problem-solving talking therapy is carried out by highly trained therapists, where you or your older child can benefit from further understanding of the disorder and anxiety in general. The therapist will provide a range of techniques for managing anxiety during triggering situations, focusing on how negative thoughts and feelings may be contributing to anxiety symptoms.

Younger children can still benefit from CBT, although the focus will be less on detailed understanding of anxiety and how your child feels they fit in with the world around them, and more about assessing their general wellbeing.

Stimulus fading

The child may talk at ease with someone, such as a parent. In stimulus fading, another person is introduced to the situation. Then, as they become included in talking, the parent withdraws and talking continues.

Desensitisation

This method attempts to reduce the fear of certain people hearing the sound of you or your child’s voice.

Many people with social anxiety and selective mutism will feel more comfortable through non-vocal means of communication such as instant messaging or emailing, which can be used before increased exposure. Exchange of voice recordings and voicemail messages builds to more direct forms of communication such as telephone or video conversations.       

Shaping

With two-way communication among people other than close friends and family being the desired goal, shaping uses techniques which steadily move towards this through activities such as reading aloud or taking part in interactive reading games. This is before graduating to face-to-face conversation when ready, and is particularly useful for treating young children with the condition as an entertaining form of engagement.

Graded exposure

This involves gradual exposure to scenarios which cause increasing levels of anxiety. Increasing a child's exposure to these scenarios can create positive reinforcement from positive experiences.

Positive reinforcement 

Selective mutism usually stems from your child associating pressured talking with a negative experience. In order to reinforce that all forms of communication can be acceptable, responding positively to any type of communication can help your child learn to feel under less pressure to speak and not have to feel relief every time such a moment passes.

Family therapy

Due to the fact that families and friends can have a significant impact on whether treatment for selective mutism is successful, family therapy can help you as parents to learn how to manage the condition and support your child with verbal and emotional encouragement when needed.

Medication for selective mutism       

There is no specific medication for the treatment of selective mutism. However, medication may be appropriate for the treatment of other disorders associated with selective mutism, including anxiety or depression, usually only suitable for older children, adolescents and adults. Antidepressants can help to relieve anxiety and depression symptoms enough for therapy to be effective, especially if you or your child have not initially responded well to therapeutic techniques.    

If depression symptoms are particularly extreme during your first assessment at Priory, then this may need to be treated initially, which may also have a positive impact on symptoms of selective mutism.

This page was clinically reviewed by Dr Josephine Neale (MBBS,BSc, MRCPsych) in October 2021.