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Selective Mutism: Diagnosis And Treatment

by — Last updated: 2017-02-20 in Children's & Teens Health

Table of Contents

Michael was always a shy kid, but he stopped speaking altogether when he started daycare. Why?

How Is Selective Mutism Diagnosed?

Diagnosing selective mutism is a complex process in which many other problems have to be ruled out first. Most children who are diagnosed with selective mutism receive the diagnosis between the ages of three and eight, after already displaying symptoms of extreme shyness and being uncomfortable with people before. 

A combination of different professionals will be involved in the diagnostic process, and they will usually include a speech-language pathologist (SLP), the child's pediatrician, and a psychologist or psychiatrist, who can determine the safest SSRI antidepressants for anxiety in children, where necessary, and offer cognitive behavioral therapy. 

These professionals will look into many different aspects of the child's physical, emotional and social development, including:

  • Observations offered by parents, teachers, and standardized testing in school.
  • Hearing: hearing tests and ruling out ear infections are both part of the diagnostic process.
  • Physical ability to speak, looking at the strength of facial muscles.
  • The family's history of anxiety and other mental disorders.
  • The child's history of social development and verbal expression.
  • The child's ability to express themselves verbally within the family.
Parents who suspect their child may have selective mutism should always seek an initial consultation with their pediatrician or a speech-language pathologist. Since pressuring the child to speak can make them feel more anxious, this pressure should be removed (if it existed before, as it often will) as soon as selective mutism is expected. Tell the child you understand speaking can be scary and you will try to do your best to understand them without speech.

Treating Selective Mutism

The treatment approach will be multifaceted and tailored to meet the needs of the individual child. It will typically involve both a psychologist (or sometimes a psychiatrist, as antidepressants have also been shown to hold promise), and a speech-language pathologist. The child's pediatrician, teacher and parents all have roles to play in the treatment plan as well.
 
The goals of treatment are to reduce the child's anxiety and to gradually make them more comfortable with speaking in stressful environments. 
 
Techniques such as gradually introducing new people into situations where the child is comfortable speaking, and positive reinforcement for any communication (gestures, whispering) are used. A small and less intimidating classroom environment may benefit children with selective mutism as well.
Michael eventually paired up with a girl — the loudest and most outgoing in his first grade class. This friendship played a large role in his path towards communicating with others. He'd feel comfortable whispering things in his friend's ear, and she'd speak for him. As treatment progressed, he gradually became comfortable with speaking to more and more people again. He's still shy, but no longer mute in most situations.

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