Therapeutic Techniques for Selective Mutism

Introduction

Selective mutism (SM) is an anxiety disorder characterized by an individual’s consistent inability to speak in certain social situations, despite communicating verbally in other environments (American Speech-Language-Hearing Association [ASHA], n.d.). SM can affect children’s social interactions, academic participation, and daily functioning. Behavioral therapy and cognitive-behavioral therapy (CBT) are common treatment approaches that aim to reduce anxiety and gradually increase verbal communication (Boneff-Peng et al., 2025). These approaches often incorporate techniques such as gradual exposure, positive reinforcement, and collaboration with the child’s support system. The following sections explore several behavioral techniques used to support children with selective mutism.

Fade-Ins

Fade-ins, also known as stimulus fading, involve gradually introducing a new person into an environment where a child already feels comfortable speaking (Zakszeski & DuPaul, 2017). Every child is different, so some may need more time to “warm up” than others. For example, a child who feels comfortable speaking with a parent may initially play with them while a clinician sits nearby. As the child becomes more comfortable, the clinician can gradually move closer, begin interacting, and eventually join the activity. These small steps help children become more comfortable speaking with unfamiliar individuals while minimizing anxiety.

Forced-Choice Questions

Forced-choice questions offer children a limited number of response options, allowing them to choose between answers instead of generating a response independently (Rocha & Briere, 2013). Despite the name, the goal is not to force children to speak but to make communication feel more manageable. Instead of asking, “What would you like to play?” a clinician may ask, “Would you like to play with the blocks or the dollhouse?” Having options can make responding feel less overwhelming and provide opportunities for verbal communication. Questions should be presented calmly and supportively, without pressuring children to speak before they are ready.

Exposures (“Brave Practices”)

Exposure-based interventions, sometimes called “brave practices,” involve gradually introducing children to speaking in situations that may cause anxiety while helping them develop confidence and communication skills. Clinicians and children can work together to create a hierarchy of speaking situations, starting with environments where the child feels comfortable and gradually progressing toward more challenging interactions. For example, a child may begin by speaking with a familiar adult in a new setting, then practice communicating with a new person, eventually working towards more challenging conversations. When children complete brave practices, they often receive positive reinforcement, such as stickers, to celebrate their progress and encourage continued participation (Peterson, 2015). The goal is to help children build confidence at their own pace rather than expecting them to overcome their anxiety all at once.

Parent Support

Parents play an important role in supporting children with selective mutism, both during treatment and in everyday situations. Clinicians can help parents better understand SM and provide strategies for encouraging communication without adding pressure or anxiety. Parents can practice these techniques at home and collaborate with clinicians and school personnel to create consistent opportunities for communication across environments. Most importantly, supporting a child with SM means celebrating the small victories, being patient when speaking feels difficult, and recognizing that progress looks different for every child. With encouragement and understanding, parents can help their children build confidence and feel more comfortable communicating.

References

American Speech-Language-Hearing Association. (n.d.). Selective mutism. ASHA Practice Portal. https://www.asha.org/practice-portal/clinical-topics/selective-mutism/

Boneff-Peng, K., Lasutschinkow, P. C., Colton, Z. A., & Freedman-Doan, C. R. (2025). An Updated Characterization of Childhood Selective Mutism: Exploring Clinical Features, Treatment Utilization, and School Services. Child psychiatry and human development, 56(3), 683–695. https://doi.org/10.1007/s10578-023-01589-8

Petersen, A. (2015). When a Child Doesn’t Speak; Treating Selective Mutism. The Wall Street Journal. Eastern Edition.

Rocha, E. M., Marche, T. A., & Briere, J. L. (2013). The Effect of Forced-Choice Questions on Children’s Suggestibility: A Comparison of Multiple-Choice and Yes/No Questions. Canadian Journal of Behavioural Science, 45(1), 1–11. https://doi.org/10.1037/a0028507

Zakszeski, B. N., & DuPaul, G. J. (2017). Reinforce, shape, expose, and fade: a review of treatments for selective mutism (2005–2015). School Mental Health, 9(1), 1–15. https://doi.org/10.1007/s12310-016-9198-8