Treatment of selective mutism mainly involves behavioral therapy. Affected children need the help of a multidisciplinary team of health care professionals that includes a pediatrician, child psychologist or psychiatrist, and a speech- language pathologist (SLP).
The school and family of the affected child should work closely with the health care team on the therapy. Every child's therapy uses a different strategy or a blend of strategies based on individual needs. The SLP usually creates a behavioral treatment plan that aims to address specific speech and language issues the child faces. The therapist may also work with the child’s teacher in the classroom.
In behavior therapy, the child is gradually exposed to increasingly tough tasks involving speaking. Therapy starts with easier steps and it 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, children realize that they do not have to avoid a stressful situation in order to cope with the anxiety. They get more comfortable with speaking and feel there is a reduction in their anxiety when there is a demand to speak.
VIDEO The Treatment Plan
A behavioral treatment plan usually involves the following approaches:
reinforce the child’s efforts to communicate using gestures or whispering sounds until the child is audible
engage the child in a relaxed atmosphere with someone who the child is familiar and compatible with and gradually introduce a stranger into this setting
use videotapes of the child communicating effectively to instill confidence in the child to speak freely in a classroom or other settings where the child becomes mute
In case of a child with speech and language issues, the SLP needs to target issues that make mutism worse by using role-play activities that aid in making the child confident in speaking with different people in various settings and helping out children who don’t feel good about their own voice. Children who are multilingual might need specific help to deal with the stress created while having to speak in a specific language the child is not comfortable with.
Role of Teachers
The medical team can work with the child's teachers to promote communication and reduce anxiety related to speaking in the classroom. The teacher can also form small groups, which help the child to feel less intimidated. Encouraging the child to use non-verbal methods to communicate with other children in the group to start with and gradually adding speaking-related goals can be very effective. When behavior therapy is in progress, the child should be encouraged to apply the learned behaviors in all settings, which can be achieved only with the close cooperation of the child’s family and teachers.
Therapy in Older Children
Older children or teens may need more intensive behavior therapy, because selective mutism gets worse with increasing age and these individuals 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 selective mutism. They might also need specific interventions that are aimed at developing the social skills. Measures also need to be taken to address any other disorders present, including general anxiety disorder or depression. This can usually be achieved with the help of an SLP and will need to be on the basis of the varying needs of individual children and their family background.
Reviewed by Jonas Wilson, Ing. Med. Further Reading