New to this topic? Start with our companion article: What Is Selective Mutism? Understanding This Anxiety-Based Communication Difference
Once you understand that selective mutism is anxiety rather than stubbornness, a lot of the usual advice falls away. Coaxing, rewarding and reminding a child to "use your words" are the tools most of us reach for, and they backfire for a child whose voice freezes when the alarm goes off. What helps is quieter and slower, and it works best when every adult in the child's life does the same thing.
The strategies below are the ones we coach parents and educators in most often. They don't replace treatment from a psychologist experienced with childhood anxiety, but they help it land.
Take the pressure off speaking
This change is probably the hardest, because it means undoing habits most of us have.
- Retire "say hello" and "say thank you." Greet people on your child's behalf ("Hi Jo, Maya's here with me") and model the thank-you yourself. Your child hears the script without having to perform it.
- No bribes or deals for talking. A sticker for saying hello to Grandma raises the stakes, and raised stakes are the problem. Rewards have a place later, inside a graded plan the psychologist sets, for tiny steps the child has agreed to.
- Skip the explanation in front of them. "She's shy" quickly becomes a label the child lives up to. "Maya's still warming up" and a change of subject does the job.
- Change how you sit and talk. The Norwegian treatment programme calls this defocused communication: sit beside rather than opposite, do something together that gives you both somewhere to look, think aloud ("I wonder where the blue piece went") rather than asking questions, and take any answer, spoken or not, as ordinary (Oerbeck et al., 2014).
Respond to all communication
A nod, a point, a drawing, a whisper to a sibling, a shrug: these are all your child communicating, and they deserve the same warm response you'd give a sentence. Answer the content ("You want the red one, here you go") without adding "now say it with your voice." Children whose non-verbal communication is accepted are more willing to take the next step; children who feel it's being withheld tend to retreat.
Two things catch parents out. The first is over-celebrating when speech appears. The first word to a new person is a huge deal to you, and the kindest thing you can do is treat it as nothing much. A big reaction spotlights exactly the moment that felt risky. The second is worrying that picture cards, a thumbs-up or writing things down will become a crutch. They won't. They keep your child in the conversation while confidence grows, and children drop them once speaking feels easier.
Small steps: stimulus fading and shaping in plain words
Your child already speaks to someone (usually you) somewhere (usually home). Stimulus fading means holding onto the person and place where talking is easy and changing one thing at a time. For example, a new person, say a grandparent or a speech pathologist, might start in the next room while you and your child play a noisy game, and over several visits come to the doorway, then into the room, then closer, then join the game, while you keep it going. Wherever the child keeps talking is where you stay for a while before moving on. It works in reverse too: keep the person and shift the place. You and your child chatting in the empty kindy room before the others arrive, then with an educator at the door, then pottering nearby.
Shaping is the other half: building up from the ways your child already makes themselves heard, which for one child might be sound effects in a game and for another a whisper or a single word, towards easy talking. The steps are small, and they're worked out for your child by the treating team rather than copied from a list. Your child won't need every step and the order isn't the same for everyone, so please don't read a sequence into this article. What stays the same is the feel of it: move on when the current step feels easy, not just possible, and if your child freezes, drop back without comment.
Some families and clinicians draw the agreed steps as a communication ladder on paper, with the child if they're old enough, so they can see where they are, tick things off and control the pace, which matters enormously to an anxious child. These stepped approaches have the strongest evidence for selective mutism (Cohan, Chavira & Stein, 2006), including a randomised pilot in which two-thirds of children no longer met criteria after a 24-week programme (Bergman et al., 2013) and a home-and-kindy programme whose gains held for most children five years on (Oerbeck et al., 2014; Oerbeck et al., 2018).
Video can be a rung too. Some children find it easier to speak to a new adult on a Zoom screen, camera off at first, with a parent beside them, and we fade from there towards face-to-face. The therapy itself is play-based, because play is where a child's voice is most likely to turn up on its own.
Working with educators
Kindy and school are where the silence bites hardest, so that's where the plan has to be tightest. Educators are usually relieved to be given something concrete, and they're key agents in a child's progress.
- One plan, on one page. What the child can do now, the next rung, who leads it, and how every adult responds. It travels with the child when staff change.
- A "no pressure" agreement across every adult. No unplanned requests to speak, no public fuss when the child does, and "cat got your tongue?" is off the table. Any planned speaking steps, and how the adults respond to them, come from the child's agreed plan.
- Warm-up time. Ten quiet minutes with one trusted educator before the room fills makes a real difference. That educator becomes the child's key person and runs any fading steps on site.
- Ways to take part without a voice. A card or hand signal for the toilet, a wave at roll call, choices as pictures.
We visit kindies and early learning centres to observe and coach educators in the plan. For school-aged children we work with the family at home, share the plan with the school and join by video where the school is open to it.
When professional support is needed
Settling in takes most children a few weeks. If your child has been silent at kindy or school for more than a month, act rather than hope. Act sooner if it's affecting eating, toileting, friendships or learning, if you have concerns about speech or language at home too, or if your child is visibly distressed. Children who start treatment younger do better (Oerbeck et al., 2018), and treatment takes months rather than weeks, so there's little to gain from waiting.
A GP can refer you to a psychologist who works with childhood anxiety. Alongside that, a speech pathologist's data collection tells the team whether speech or language is part of the picture and gives you the coaching sketched here. Most of it happens through you, because parents are such a big part of therapy, and in selective mutism that's doubly true: you're the person your child already talks to.
If you'd like to talk about where your child is at, get in touch. Speaking Speech Pathology offers mobile speech pathology across Brisbane's south side and Logan, at home, at kindy or by video. Any actual clinical work, including assessment and therapy, happens in a consultation about your child, not from an article.
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP), certified in Hanen's It Takes Two to Talk, with over 14 years' experience and a mum of two boys. She offers mobile speech pathology to families across Brisbane's south side and Logan.
This article is general information and not a substitute for individualised speech pathology assessment or therapy. If you have concerns about your child, please speak with a qualified speech pathologist.
References
- Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L. (2013). Integrated Behavior Therapy for Selective Mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51(10), 680–689.
- Cohan, S. L., Chavira, D. A., & Stein, M. B. (2006). Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990–2005. Journal of Child Psychology and Psychiatry, 47(11), 1085–1097.
- Oerbeck, B., Stein, M. B., Wentzel-Larsen, T., Langsrud, Ø., & Kristensen, H. (2014). A randomized controlled trial of a home and school-based intervention for selective mutism: Defocused communication and behavioural techniques. Child and Adolescent Mental Health, 19(3), 192–198.
- Oerbeck, B., Overgaard, K. R., Stein, M. B., Pripp, A. H., & Kristensen, H. (2018). Treatment of selective mutism: A 5-year follow-up study. European Child & Adolescent Psychiatry, 27(8), 997–1009.
