Q | I have a kindergarten student with selective mutism. Right now, we are focusing on building her confidence and lowering her anxiety. Any other ideas?

A | Selective mutism (SM) is an anxiety disorder that renders a child who is likely a chatterbox at home speechless and frozen in most social situations. These settings often include school, parties, groups, and family gatherings. A child with SM is not refusing to speak. She simply cannot speak, even if she wants to, in high-demand situations.

The treatment begins with a diagnostic evaluation that clarifies that SM is indeed the right diagnosis and identifies any coexisting disorders, such as separation anxiety. The most effective treatment for anxiety disorders, specifically SM, involves behavioral techniques. These techniques include very gradual exposure to anxiety-provoking situations, and reinforcement and praise for successes.

For example, a child who cannot answer the teacher in class but can talk to her parent in a classroom setting may come in before or after school, talk with the parent, and have the teacher gradually “fade in.” Families should work with treatment providers who specialize in SM to help their child speak in other high-stress situations. Treatment should involve a high degree of collaboration and will likely include out-of-office sessions.

For teachers, the best way to support a child with SM is to understand it as an anxiety disorder, work with the treatment providers, and appreciate that success comes in small steps.


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Illustration: Brian Rea; Photo: Courtesy of the Child Mind Institute