Childhood Mental Disorders and Illnesses
Basic Information
Introduction to Disorders of ChildhoodForms and Causes of Childhood DisordersDiagnostic Criteria for Childhood DisordersIntellectual DisabilitiesThe Causes and Prevention of Intellectual DisabilitySigns and Symptoms of Intellectual DisabilitySupport & Help for Children with Intellectual DisabilitiesSupport & Help for Families with Intellectually Disabled ChildrenDisorders of Childhood: Motor Skills DisordersMotor Skills Disorder Treatment and Recommended ReadingDisorders of Childhood: Learning DisordersLearning Disorders DiagnosisLearning Disorders Treatment and Recommended ReadingDisorders of Childhood: Communication DisordersCommunication Disorders: Stuttering and Prevalence / Diagnosis of Communication DisordersTreatment of Communication Disorders and Recommended ReadingDisorders of Childhood: Pervasive Developmental DisordersDisorders of Childhood: Attention-Deficit and Disruptive Behavior DisordersDiagnosis of Conduct DisorderTreatment of Conduct DisorderTreatment of Conduct Disorder ContinuedIntroduction to Oppositional Defiant DisorderTreatment of Oppositional Defiant DisorderDisruptive Behavior Disorder NOS and Recommended Reading for Conduct Disorder / ODDFeeding and Eating Disorders of Infancy or Early Childhood: PicaRumination DisorderFeeding Disorder of Early Childhood Disorders of Childhood: Tic DisordersTreatment of Tic Disorders and Recommended ReadingElimination Disorders: EnuresisEnuresis Assessment and TreatmentElimination Disorders: EncopresisSelective MutismTreatment of Selective MutismDisorders of Childhood: Separation Anxiety DisorderSeparation Anxiety Disorder Assessment and TreatmentReactive Attachment Disorder of Infancy or Early ChildhoodReactive Attachment Disorder Assessment and TreatmentDisorders of Childhood: Stereotypic Movement DisorderTreatment of Stereotyped Movement DisordersDisorder of Infancy, Childhood, or Adolescence Not Otherwise Specified
More InformationLatest NewsQuestions and AnswersLinksBook Reviews
Related Topics

Child & Adolescent Development: Overview
Child Development and Parenting: Infants
Child Development and Parenting: Early Childhood

Treatment of Selective Mutism

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Treating Selective Mutism is difficult, likely because the behavior is an effective strategy for reducing children's anxiety feelings. Children's mutism reduces their profile in threatening settings. From a behavioral perspective, this behavior is often negatively reinforced by people around the child. In other words, as children continue to refrain from speaking in threatening settings, the people they interact with start to accept the mutism and stop expecting the children to speak. Children quickly learn that they can get people to stop bothering them simply by being persistent in their muteness. For a more detailed explanation of negative reinforcement and other principles of learning theory, please click here.

Many effective anxiety treatment strategies are also useful for treating Selective Mutism. In particular, behavioral modification plans can be quite effective. A clinician creating a behavior modification plan for treating Selective Mutism would first identify and differentiate settings and people with whom the child refuses to speak. Next, the clinician would develop a reinforcement/reward system that would reward appropriate behavior (any effort to speak in appropriate settings/situations). The behavior plan might use a token system, where the child receives tickets or stickers for desirable behaviors. Later on, the children can trade tickets or stickers for candy, toys, or privileges of their choosing.

Desensitization strategies (such as those we described in the discussion on Pica) are also likely to be included in the behavior plan to help children feel more relaxed and able to tolerate situations and settings that they find particularly threatening. Through these procedures, children gradually learn that an object or person is not actually a threat. At this point, Mutism should decrease, as there is no longer a need to use this type of behavior to cope with anxiety (i.e., the child has more adaptive stress-coping skills).

Antidepressant and anti-anxiety (anxiolytic) medications have also been used to treat Selective Mutism. Tricyclic antidepressants such as Clomipramine and Imipramine (i.e., members of the older generation of antidepressants that existed before SSRIs like Prozac), and anxiolytics such as Clonazepam (a habit-forming benzodiazepine) and Buspirone (another kind of anxiolytic) are often tried. All of these medications have side effects associated with them and must be taken with care and as prescribed by a licensed physician. In addition, antidepressants currently carry a "black box" warning because their use with children has been linked to a small increase in the risk of suicidal behavior and completed suicides. Because of this small but elevated risk of suicide, children who are prescribed antidepressant medications should also be meeting regularly with a mental health clinician experienced in the treatment of children in order to monitor their potential for suicidal thoughts and behaviors. It is always a good idea to talk with your doctor about the full range of potential risks and benefits associated with recommended medications before agreeing to allow your child to take them.

For more information or support, you may want to visit the website of the Selective Mutism Group Childhood Anxiety Network.

Recommended reading:

The Silence Within by Gail Kervatt

Is It "Just a Phase"? by Susan Anderson Swedo and Henrietta L. Leonard

Helping your Anxious Child by Sue Spence, Vanessa Cobham, and Ann Wignall