By: Allison Salk, Natalie El Alam, Suzi Naguib, Psy.D.                                                   BLOG  PDF

At home, Ella is a talkative and fun-loving toddler. She is a chatterbox with her father, her sister, and me. But when we leave the house, she avoids interacting with others and is uncomfortable speaking to those outside of our immediate family. I thought that Ella was just shy, maybe a little nervous meeting new people. But now, after two months of starting preschool, her teacher has contacted me expressing concern that she does not speak at all when at school. I know that not all children make friends quickly or like to speak up in class, but when should I start to be concerned?

What is Selective Mutism?
Selective Mutism (SM), is a rare condition that often begins during the preschool years and affects less than one percent of children1. It is characterized by a consistent failure to speak in specific situations where speaking is expected. The symptoms last for at least one month, not limited to the first month of school2. The onset of SM typically occurs between the ages of three-five years, and it is most often diagnosed following entry into school2,3. Similar to other anxiety disorders, it has been found that SM may be more common in females than in males4,5. Children with SM may also have accompanying symptoms including excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, temper tantrums, or mild oppositional behavior2. A diagnosis of SM does not mean that the child has a language or communication problem; in fact, children with SM typically have normal language skills and are competent in other environments where language is used2,4. But because SM reduces communication in certain areas, there may be significant impairment in academic and social areas of functioning2,4.

Treatment Options
It is not uncommon for children with Selective Mutism to go undiagnosed for months or even years after symptoms first arise because adults often believe that children will outgrow their symptoms with continued social exposure, maturity, and age6. However, the course of SM is variable and depends on the specific child as well as the treatment plan the child is exposed to. Long-term studies reveal that 39-100% of SM patients achieve complete remission, but that many individuals continue to exhibit deficits of communication and social withdrawal into their teenage and adult years7. Thus, it is important to diagnose and treat children with SM in order to increase the chance of remission as well as to reduce future risks6,7.

There are many treatment options available for children with Selective Mutism including behavioral intervention, cognitive-behavioral therapy, family therapy, medication and multimodal treatments1,6,7. Behavioral treatment programs are the most effective of the psychological interventions, and often incorporate multiple approaches that can be tailored to the individual child’s needs. For example, stimulus fading is an approach in which a child initiates a relaxed conversation and then gradually new individuals are introduced into the room. Shaping is a structured approach to reinforce all efforts by the child to communicate until audible speech is achieved. Systematic desensitization utilizes the use of relaxation strategies while a child is exposed to anxiety-provoking speaking scenarios1,6,7.

Sunfield Center psychologists are available to help identify and effectively treat SM and other anxiety disorders using evidence based treatment protocols. To schedule an appointment, please call us at (734) 222-9277. For more information about Sunfield Center, and our Anxiety Disorders Service, please visit our website at


  1. Dombrowski, S. C., Gischlar, K. L., & Mrazik, M. (2011). Selective mutism. In Assessing and Treating Low Incidence/High Severity Psychological Disorders of Childhood (pp. 161-180). New York: Springer.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. Hung, S., Spencer, M. S., & Dronamraju, R. (2012). Selective mutism: Practice and intervention strategies for children. Children & Schools, 34(4), 222-230. doi: 10.1093/cs/cds006
  4. Sharkey, L., McNicholas. F., Barry, E., Begley, M., & Ahern, S. (2008). Group therapy for selective mutism-A parent’s and children’s treatment group. Journal of Behavior Therapy and Experimental Psychiarty, 39(4), 538-545. doi: 10.1016/j.jbtep.2007.12.002
  5. Standart, S. & Le Couteur, A. (2003). The quiet child: A literature review of selective mustism. Child and Adolescent Mental Health, 8(4), 154-160. doi: 10.1111/1475-3588.00065
  6. Perednik, R., & Shaughnessy, M. F. (2012). An interview with Ruth Perednik: Treating selective Mutism. North American Journal of Psychology, 14(2), 365-370.
  7. Kearney, C.A., Haight, C., & Day, T.L. (2011). Selective mutism. In D. McKay & E. Storch (Eds.), Handbook of child and adolescent anxiety disorders (pp. 275-287). New York: Springer.