Understanding Selective Mutism

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Understanding Selective Mutism by Dr. Jemma Helfman, DClinPsy – Clinical Psychologist

What is Selective Mutism?

Selective mutism is an anxiety disorder which affects someone’s ability to speak with certain people and in new situations despite being able to talk freely and age-appropriately when comfortable (usually at home).  Selective mutism is most commonly identified in childhood.

Selective mutism is more than just being shy (shy kids warm up without intervention).  It is not a child being manipulative or oppositional and it is not due to trauma (as if commonly mis-believed). 


Will Kids Grow Out Of It?

While there are kids who grow out of selective mutism, the risk is that the behaviour becomes harder to change the older the child gets.  Interventions are positive and playful and we typically see the biggest gains when we intervene young.


How Do You Help Kids With Selective Mutism?

For most children (typically age 4 and up), we provide psycho-education to parents about the intervention.  We then start with a “fade-in” or “slide-in” where we join the parent and child playing in a slow and specific way in order to “transfer” speech from the parent to the therapist.  Once the child is playing and speaking with the therapist, the parent backs away.  This typically takes 1-3 sessions. 

Once the child is talking to their therapist there may be some education about anxiety and “brave talking” and we work on goals such as giving longer answers, asking questions and talking to new people. 

At the same time, we look for parents and someone in school to consult with us to continue “brave practices” at school and in the community. This means establishing speech with someone in school who then facilitates speech with teachers/other teachers and peers and practicing things like ordering and asking for things in shops in the community.  Practices need to be planned in order for them to be successful. 


What are Your Outcomes Like?

There are never any guarantees.  However, the gross majority of children and adolescents I have worked with have made progress.  Some end up indistinguishable from their peers.  Others need to continually work at it and there have been a handful who have not progressed significantly.  Children who are not making progress with behavioural therapy alone may benefit from a consultation with a paediatrician or psychiatrist about anxiety medication. 


Dr. Jemma Helfman, DClinPsy

Clinical Psychologist