How do you get a child to talk who is literally frozen with fear, or who has been silent so long that they have become an expert mime? The answer may seem elusive, but it is not as complicated as you may think.
Effective treatment lies in decreasing the child’s anxiety and gradually exposing them to their fear of speaking until they are able to tolerate speaking without being overwhelmed with anxiety. Below is a list of some specific methods that are being used successfully to help kids overcome their fear of speaking. Each child with selective mutism is unique and requires treatment tailored to their individual needs. These therapies can be combined and individualized to ensure the best fit for the child and their family. If your child has other diagnoses beyond selective mutism, their treatment plan should take into account those issues as well.
Parents can, and should, become proficient in applying these methods. You may choose to seek the help of a professional competent in treating SM or experienced in Cognitive Behavioral Therapy. There are also some great free online training videos by Kurtz Psychology Consulting PC at Selective Mutism Learning University to get you started. These videos model Parent-Child Interaction Therapy.
We have used most of these techniques on our journey to help my girls. I will give a brief explanation of each therapy and then follow-up in later posts with examples of how we have implemented each one with Buttercup and Petunia.
Stimulus Fading
Gradually exposes the child to the feared person or location while providing positive reinforcement for their continued speaking. It is also called fading in or sliding in. Read more: Fading In: Our Go-To Technique.
- Video – Understanding and Managing Selective Mutism (AnxietyBC)
- Video – How to Fade In a New Adult with PCIT-SM (Kurtz Psychology)
Systematic Desensitization
A step-by-step approach in which the child starts with an exposure to the least anxiety provoking situation and moves up a hierarchy of increasingly difficult speaking challenges. Also called exposure therapy or exposure practice. Read more: Exposure Therapy: Climbing the Ladder
- Free Guide to Summer Exposures (Striving to Speak)
- Brave Talking Exposure (Anxiety BC)
- Video – Selective Mutism Community Exposures (Sheila Lepkin, NCSP, MFT-C)
- Video – CBT Exposure Therapy Selective Mutism (Jennifer Lish, Ph.D)
Self-modeling
A video or audio tape of the child speaking in a comfortable environment is re-played in an environment where the child does not speak, allowing the child to become accustomed to hearing their voice in that setting and believe in their ability to speak there.
Shaping
Provides reinforcement for any attempt at communication, starting with gestures or non-verbal communication that is gradually shaped to audible speech. It may include mouthing, making noises, making letter sounds and eventually leads to the child saying words and sentences. Read more: How Shaping is Used to Treat Selective Mutism
Positive reinforcement/contingency management
This is often used in conjunction with other therapies to encourage the child’s participation. The child may receive verbal praise or earn rewards for facing their fears.
Intensive therapy
Provides an intensive dose of behavior therapy over the course of several hours and/or days. These intensives may be individual or in a small group setting, usually structured to mimic a typical school day and provide the child with one-on-one counselors. There are several selective mutism treatment centers that offer individual intensive therapy and summer camps. Some of these camps are listed on the Selective Mutism Association website.
Cognitive therapy
Involves identifying anxious thoughts and feelings and learning coping skills. Cognitive strategies are most helpful for older children, age 7 and up, who are becoming aware of their own thoughts. Cognitive therapy may be added to behavioral therapy techniques when the child is developmentally ready.
Medication
Used in combination with behavioral therapy to decrease the child’s baseline anxiety. If a child is unable to make gains with therapy alone, a medical doctor may prescribe medications, usually SSRI (selective serotonin reuptake inhibitors), which have been effective in helping youth with anxiety disorders.
Brave Voices 