Treatment ideas for Selective Mutism

Understanding Selective Mutism encourages recovery.

The fear reaction is the guiding force behind Selective Mutism. Although, those struggling with SM may not think of this feeling as traditional fear, their bodies react in a similar way. When a person with SM is in a perceived fearful situation (around unfamiliar people and/or in unfamiliar environments), their brain interprets this as fear and begins the physical symptoms:

  • the heart pumps faster
  • breathing becomes shallow and quicker
  • palms perspire
  • hands shake
  • mouth is dry
  • the chest feels tight
  • dizziness or feeling faint may occur
  • the ears may ring
  • they become foggy headed

Imagine one or more of these symptoms occurring without understanding why. That is what a child with SM feels. Not afraid of the people they are around but of the symptoms they are experiencing. These symptoms don’t feel good. Deep calming breaths can help prevent a panic attack and help them regain control.


  1. One treatment technique is called Stimulus Fading. Practice by having the child with Selective Mutism talking to a person they are comfortable with conversing (usually a parent or sibling). Bring one unfamiliar person into the room (unfamiliar person just means someone they aren’t comfortable talking to), but don’t have them engage with the SM child. Instead, they may only listen at a distance. The SM child should still engage in conversation with their comfort person. After a couple of short sessions, bring the unfamiliar person closer to the two. As long as the SM child continues to talk to their comfort person, continue bringing the unfamiliar person closer.
  2. In the next phase, you can have the unfamiliar person ask a question to the other comfort person (not the person with SM). After a short dialogue, the comfort person and SM person can reengage with their conversation.
  3. Then begin to have the unfamiliar person say something to the SM child (they do not have to face the person). They should only comment on a subject, not ask a question. Then the comfort person and SM child may resume with their conversation.
  4. Work up to the unfamiliar person asking the SM child a question. If the SM child manages to answer consistently for a couple of sessions, then advance to adding a second unfamiliar person and repeating the process.
  5. *Before beginning this treatment (or any), inform the child with Selective Mutism what to expect. Explain the procedure, be clear and ensure they understand the steps. They may be able to handle their fear if they know that the unfamiliar person will not be talking to them in the first few sessions.

While this technique is often successful over time at easing a child into speaking, it doesn’t work for every person. And the older a child is, you may need a different approach. Older children/teenagers need to be informed of what you plan to do (because they’ll see right through your attempt anyway, so you might as well be transparent about the goal). Don’t worry about doing it wrong. Any attempt to help someone struggling with SM is better than no attempt.

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