Discover the Best Selective Mutism Treatment Plan for You!

Do you or your child struggle with selective mutism? Discover the best selective mutism treatment plan designed to overcome anxiety.

Selective mutism is a challenging disorder. In many cases, it often goes untreated due to a lack of knowledge and understanding. However, it’s best to start treatment early, as the disorder can persist and in some cases, worsen, without intervention.

So, what is the best selective mutism treatment plan for you? Keep reading to find out.

This post covers all the basics of finding your selective mutism treatment plan like CBT for selective mutism, other evidence-based therapies, treating selective mutsim with medication, selective mutism treatment at home, and treating selective mutism for adults.

This post is all about the best selective mutism treatment plan.

 

What is Selective Mutism?

Selective mutism is an anxiety disorder that causes you to be unable to speak in certain social situations, such as at school or work, while being able to speak in other situations, such as at home. The disorder is most common in children, usually occurring around the age of five, however, it can continue into adulthood as well.

 

Selective Mutism Diagnostic Checklist

• they consistently fail to speak in situations where it is expected
• they can speak in situations where they feel comfortable, like at home
• their inability to speak has lasted at least 1 month, not limited to the first month of school
• their inability to speak affects their ability to function, academically or socially
• the inability to speak is not better explained by another communication, behavioural, or mental disorder

 

How to Treat Selective Mutism

The best way to treat selective mutism is to address the underlying anxiety that causes it. This can include psychotherapy and, in some cases, medication. Some people with selective mutism may also benefit from speech-language therapy if recommended by their treatment provider.

The most common psychotherapies used to treat selective mutism are Behavioural and Cognitive-Behavioural Therapy (CBT).

 

CBT for Selective Mutism

CBT is one of the most commonly used treatments for selective mutism. It helps patients to understand how their thoughts, feelings, and behaviours impact their symptoms. So, for someone with selective mutism, this means examining unhelpful thinking patterns that lead to their lack of communication.

 

Behavioural Strategies

Behavioural strategies include creating a step-by-step plan the patient can follow including gradually more difficult speaking activities, accompanied by positive reinforcement when a task is completed. Multiple behavioural strategies are most effective when combined, such as:

Contingency Management: positive reinforcement to reward verbal behaviour. This may begin with non-verbal communication.

Shaping Reinforcement: rewards are provided for approximations of target verbal behaviours, such as whispering, mouthing words, or talking on the phone.

Stimulus fading interventions: gradually increasing the number of people and places where speech is rewarded. For example, introducing new people the patient has not spoken to before or having them speak in a new environment.

Systematic desensitization: relaxation skills paired with gradual exposure to increasingly more anxiety-inducing situations. This can include both imagined and real-life scenarios.

Social skills training: used to reduce anxiety and facilitate social interaction. It involves learning to initiate conversations, make eye contact, and understand non-verbal cues.

Self-modelling: creating video or audio recordings edited to show the patient speaking in situations where they have found it difficult. The patient then watches these videos at home during a positive verbal exchange so they can become accustomed to hearing themselves speak in these situations.

 

Cognitive Strategies

Cognitive strategies involving identifying anxious thoughts contributing to their selective mutism can also be beneficial. These strategies are most helpful to those aged seven and older, as they maintain better awareness of their thoughts.

Cognitive strategies include:

• Recognize the symptoms of anxiety in your body. e.g., fast heart rate, sweaty palms, and shortness of breath.
• Identify and challenge maladaptive beliefs. e.g., “People will make fun of me” or “I don’t have anything useful to say”.
• Develop coping mechanisms to handle stress. e.g., taking deep breaths, and thinking calm thoughts.

Many people with selective mutism worry about what others will think of them, this reinstates their anxiety about speaking. So, these cognitive techniques will help the patient understand that they have control over their thoughts and remove the sense of threat. These strategies should be added along with the behavioural ones at a time dictated by your treatment provider.

 

Other Evidence-Based Therapies for Selective Mutism

These other evidence-based therapies incorporate a variety of behavioural components found to be effective in treating selective mutism and anxiety:

Integrated Behavior Therapy (IBT): increasing exposure to verbal communication in the clinic, school, and home environments. It incorporates a reward chart, cognitive restructuring, and parent involvement.

Defocused Communication: focusing on a shared activity to foster attention, taking pressure off the patient to speak and allowing them to open up naturally.

Parent-Child Interaction Therapy for SM (PCIT-SM): a behavioural approach that combines multiple elements to improve speech behaviours and reduce anxiety, using individual and group formats. This method involves two phases, Child-Directed Interaction (CDI) and Verbal-Directed Interaction (VDI). These combine positive attention skills to reinforce desired behaviour and prompting for verbalization. This is used alongside gradual exposure.

Social Communication Anxiety Treatment (S-CAT): incorporates cognitive-behavioural and insight-oriented strategies by advancing the patient along their Social Communication Comfort Scale (SCCS). This treatment also includes gradual exposure.

 

Treating Selective Mutsim with Medication

In some cases, your doctor may prescribe medication to help treat the underlying anxiety causing the selective mutism. This is usually in combination with behavioural or other types of therapy to assist the patient in continuing improvement.

Selective serotonin reuptake inhibitors (SSRIs) have particularly been shown to help relieve anxiety disorders in youth. The medication is often prescribed at a low dose and gradually increased to minimize and, in many cases, even avoid side effects. Many adolescents have responded positively to using mediation alongside therapy, making their treatment success rates drastically higher.

In most cases, a child will be prescribed anxiety medication for 12 months in hopes of seeing a decrease in anxiety, greater comfort speaking, and continued improvement after stopping medication. The use of the medication will be tapered off slowly.

Medication is not always needed to treat SM, but it can help to reduce the levels of anxiety and make taking those first steps more comfortable. However, medication may be necessary if the selective mutism has persisted over a long period, if other treatments have not helped, or if symptoms of depression or other anxiety disorders are present.

 

Selective Mutsim Treatment at Home

While it’s important to get professional help to treat selective mutism, there are also things you can do at home.

Educate Yourself & Others 

Selective mutism is a vastly misunderstood disorder, so it’s important to do your research to support yourself or your child best. This way you can advocate for them and teach others how best to help them. Also, be sure to inform teachers at the start of the school year so they can understand your child’s needs.

 

Allow Warm Up Time

Don’t pressure your child to speak right away in new environments. Give them time to get acclimated and let some of their anxiety ease. After some time you can ask them a forced-choice question, giving them two answers to choose from. This will be easier for them to respond to than an open-ended question.

It’s important not to pressure or create more anxiety for the child, as this can reinforce their non-speaking behaviours.

 

Offer Praise When They Communicate

When the child speaks on their own accord be sure to praise them. Tell them you’re proud of them and that they’re doing a good job. Don’t be over the top, just a simple compliment.

 

Don’t Require Them to Speak in Large Groups

Large groups can create more pressure and anxiety for someone with SM, so it’s best not to force them to speak. Instead, create small or one-on-one environments to practice their speaking skills. It may be helpful for them to meet their teacher one-on-one before the start of the school year to feel more comfortable.

 

Play Games With a Speaking Component

Playing a game is a simple way to remove pressure and let the child feel more comfortable speaking. It’s a fun and rewarding way to get them more comfortable and confident using their voice.

 

Practice Brave Talking

Practicing scripts for different social interactions can be a safe way for your child to practice using their voice. Try practicing things like ordering at a restaurant or asking to use the washroom. This will help them to feel more brave implementing these scripts in real life.

 

Selective Mutism Treatment for Adults

Though selective mutism is commonly thought of as a childhood disorder, it does not go away on its own and therefore, can persist into adulthood. Plus, because it’s such an uncommon and misunderstood disorder, it often does go untreated.

So, if you’re an adult who feels completely comfortable talking to family or close friends but freezes and struggles to communicate in other settings, you may have selective mutism.

Selective mutism treatment for adults isn’t that different than for children, the same therapies, such as CBT and exposure therapy are most recommended. You may also find medication to be beneficial.

 

As you can see, there are many treatment options for selective mutism, so be sure to speak with your healthcare provider about what’s best for you. Given proper treatment selective mutism can be overcome, but it’s important to start treatment early so these behaviours aren’t reinforced.

 

By Morgan Peters

 

Sources:

Andi. “Treating Selective Mutism.” Selective Mutism Association, 22 Oct. 2021, www.selectivemutism.org/treating-selective-mutism/.