By Susha Cheriyedath, MSc
With early and appropriate treatment, selective mutism can be successfully treated. Prognosis is excellent in children and adolescents who receive timely treatment for the disorder. However, in the absence of medical intervention, the condition will persist and get complicated as affected children get older.
Successful Approaches to Treatment
Behavior therapy is found to be very effective in treating selective mutism. In this approach, the child is gradually exposed to increasingly tough tasks involving speaking. Therapy starts with easier steps and becomes progressively harder. The affected child is often asked to carry out speaking tasks that he or she will be able to complete successfully.
On completion of tasks, the child is rewarded verbally as well as with small prizes. Over time, the kids realize that they do not have to avoid a stressful situation in order to deal with their anxiety. They get more comfortable with speaking and feel less anxious when there is a demand to speak.
In some children, selective mutism is managed using medication. A group of drugs called selective serotonin reuptake inhibitors (SSRIs) are widely used to treat selective mutism. Fluoxetine is an SSRI mostly used and reduces symptoms in 75% of affected children. Drugs used in treating anxiety disorders are also used in the treatment of some cases of selective mutism. Medications are usually more effective in younger children.
A pilot study published in the Canadian Journal of Psychiatry examined the outcome of medical and non-medical management of selective mutism in severely affected children. The study found that kids treated with SSRIs showed higher overall improvement in speech and functioning than children treated non-medically.
Importance of Timely Diagnosis and Intervention
According to studies, the earlier the diagnosis of selective mutism is done, the faster is the response to treatment. Early diagnosis and timely treatment also improves the overall prognosis. Older children or teens may need more intensive behavior therapy as selective mutism gets worse with increasing age and children get used to avoiding situations that demand them to speak. Some studies even suggest that cognitive behavior therapy is effective in treating older children suffering from the condition.
If left untreated, selective mutism can negatively affect the child by interfering with social, academic, and emotional aspects of the child’s life. Over time, the child may experience depression, social isolation, low self-esteem, poor academic performance, underachievement at school or work place. Older children may even resort to self-medication and drug abuse, which might lead to suicidal thoughts. Thus, early diagnosis of selective mutism is very crucial so that the children receive adequate treatment that helps them cope with anxiety.
Very little information is available about the long-term outcome of the disorder. Although children receiving treatment for selective mutism show considerable improvement in the clinical setting, more studies are needed to analyze the course of selective mutism post treatment in these children. Some research does show that while there is improvement in speech, the anxiety experienced by the children in certain settings persists.
Selective mutism is a rare and challenging disorder with many different dimensions. It is also associated with other disorders related to social anxiety and social phobia, which makes it difficult to diagnose and treat. Despite this, the condition has garnered a lot of attention as a childhood disorder that can have immense repercussions on the children and their families. Due to this potential impact of selective mutism, the various psychotherapeutic and pharmacotherapeutic management approaches of the disorder are extensively studied. More research on the biological and psychological aspects of selective mutism and the long-term outcome of the available treatment options is needed.
Reviewed by Jonas Wilson, Ing. Med.
Last Updated: Aug 19, 2016