Does selective mutism keep getting worse? My 3-year-old’s not talking seems to have spread from the classroom to the playground and family gatherings.

Changes in a child’s level of comfort and speech in various social settings occur as your child gets older and is more socially aware of her surroundings. It’s not unusual for anxiety to generalize from one environment (such as school) to others (such as the playground).

I think the first step for your daughter should be to start behavioral treatment, which research shows is very effective for childhood anxiety disorders, especially selective mutism. Children with SM respond very well to carefully structured positive reinforcement for what we call “brave talking.” They respond very poorly to pressure to talk, which tends to make them more anxious.

As for changing schools, we have found that sometimes a new environment can yield a different response since there is no history of not talking there. But it doesn’t always work for schools. Obtaining a SEIT is good idea, as long as the person is trained to work with children with SM and is willing to receive additional training. If the SEIT doesn’t have experience with SM you risk having someone negatively reinforce your daughter’s not talking.

School boards are sometimes hesitant to give speech services to children with selective mutism since the origin of the speech difficulty is related to anxiety; however, many of our patients can and do receive speech services. Again, the most important factor is that any adult who works with your daughter should be trained or willing to be trained in the specific techniques that are effective for children with SM.