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My Child Doesn’t Speak in Public Settings. Could They Have Selective Mutism?

Updated: Sep 20, 2023


What is Selective Mutism?


Selective mutism is an anxiety disorder characterized by failing to speak in certain social situations in which speaking is expected, despite speaking in other situations. For many kids with selective mutism, they are “chatterboxes” at home, but they do not speak at school, in the community, or in the presence of unfamiliar people. Children with selective mutism are not being oppositional by refusing to speak. Instead, they are experiencing extreme anxiety about speaking in certain situations.


Kids with selective mutism often freeze when they are prompted to speak. For example, your child may look like “a deer in headlights,” hide behind you, and not respond when the cashier at the grocery store asks them how old they are. In these situations, parents often respond on behalf of their child to ease their child’s anxiety (as well as their own!). Other common examples include not speaking to extended family members, including grandparents, aunts and uncles, or cousins, and not speaking to teachers or classmates, despite familiarity with these individuals.


How is Selective Mutism Diagnosed?


Selective mutism is best diagnosed through a combination of an intake assessment, an observation, and behavior rating scales. During the intake session, the therapist meets with the child’s parents or caregivers to discuss their concerns. Specifically, the therapist will want to know if your child speaks in various settings, such as at home, at school, and in the community. The therapist will also ask about your child’s level of speaking with various people, including family, teachers, friends or classmates, and unfamiliar adults and peers.


At the second intake session, the therapist will observe you and your child playing in the therapy office. The therapist will give you specific instructions prior to the session to help your child ease into the new situation. Ideally, the therapist observes the interaction from another room through a one-way mirror or video system, allowing your child to become comfortable more quickly.


The final component of assessing selective mutism consists of behavior rating scales completed by the child’s parents or caregivers, as well as their teacher. Through this multi-method, multi-rater assessment approach, the therapist will determine if your child has selective mutism.


How is Selective Mutism Treated?


Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM) is a research-supported approach that systematically changes a child’s avoidance of speaking into approach. It involves helping children with selective mutism first warm up to people and then increase their speaking through increasingly difficult exposure tasks. The exposure tasks are tailored to your child’s individual needs, and your child receives positive reinforcement (praise and small prizes) for engaging in the exposures.


Treatment begins with increasing your child’s verbalizations with you in the therapy office through play, with guidance from the therapist. Then, the verbal relationship is gradually transferred to the therapist. This is accomplished by the therapist systematically entering into the interactions while you are fading out. Once your child is sufficiently verbal with the therapist, progress is generalized to other settings and people. This could include having sessions at a local park or library, as well as the therapist consulting with your child’s teacher. Throughout treatment, you are provided with guidance on how to support your child’s progress outside of therapy sessions.


What Can I Do?


If you think your child or teen may have selective mutism, contact us today to schedule an appointment with Dr. Anna Martinez-Snyder, who is completing her certification in PCIT-SM and specializes in treating selective mutism and other anxiety disorders.





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