Selective Mutism

Selective Mutism (SM) is a type of anxiety disorder where a person, usually a school-aged child, is unable to speak in social situations. Often, the only people they speak to are their immediate family. This is different than social anxiety in that people with SM behave appropriately and are interactive in social groups other than their lack of speech. It is also not a developmental disorder, as evidenced by their normal speech at home. SM can be very disruptive to a young person’s development, and it is important that they receive prompt treatment in order to prevent the problem from becoming worse.

The most effective treatment for SM is a behavioral therapy modified for selective mutism with an emphasis on exposure therapy. These include a number of specialized applications of Cognitive Behavioral Therapy (CBT) with exposure therapy as well as Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM). Families should also receive specialized training by a therapist to learn how to support the patient without enabling their SM.

Treatment with Selective-Serotonin Reuptake Inhibitor (SSRI) medication should be considered in cases not progressing at the expected rate, based on clinician comparison to other known cases. For example, after two to three sessions, the patient should be easily talking to the clinician with a parent present, and not exhibit an angry or frightened expression. Medication should be avoided for children that are very young, exhibit less severe symptoms, are successfully achieving CBT benchmarks, or if they not yet attempted therapy. Studies have shown that the administration of SSRI medication combined with specialized therapy for SM has the best chance at providing meaningful results for the patient and family.

It is the philosophy of Youthful Minds Psychiatry to be gentle with our medications and “start low and go slow.” With the right counseling, lifestyle changes, and psychiatric medications, treatment can make a significant positive impact for individuals with selective mutism.