Q My daughter is nine years old and has selective mutism. We had her in therapy from when she was four years old to five years old when they told us they could not help her anymore. She would not talk to them at all. She started school after that, and we put her in speech therapy. They only kept her for six months and said they had no idea how to help her, and we have been on our own trying to get her to talk in school for three years now with no luck. She has started sometimes talking in restaurants to answer what she wants to eat directly to us, but other than that, she will not talk outside of the house or at school. What else should we try?
Generally, our first recommended step is to connect with a professional with experience assessing and treating selective mutism (SM), to ensure you have an accurate diagnosis. They will help you make a treatment plan that best fits your daughter and family.
SM is an anxiety disorder, and the good news is that childhood anxiety disorders are highly treatable. We recommend an evidence-based treatment, Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM), which teaches families how to interact positively with their child and improve their child’s ability to speak in new situations.
Kids with SM benefit from the adults in their lives acquiring the tools to help encourage and increase their “brave talking.” This happens through specialized behavior therapy techniques that prompt and reinforce speech.
Treatment also often focuses on generalizing skills in settings outside of the therapy office, like school and other public places. An important component of treatment is also collaboration with a child’s school.
There are techniques we can employ to help your child reach a goal, like ordering food in a restaurant. Often kids with SM need a warm-up to help them feel comfortable before being encouraged to speak. This is known as Child Directed Interaction (CDI) skills in the PCIT-SM approach. From there, we use specific techniques to help facilitate speech. This is the Verbal Directed Interaction (VDI) phase of the PCIT-SM approach. In the VDI phase, we ask questions in specific ways that increase the likelihood of a child verbally responding.
It’s important to identify small steps from where your daughter is to where you want her to go. When ordering at a restaurant, the first step might be for a child to say their order to their parent while the waiter is present. For other kids, the first step might be to say their order to their parents while the waiter is not present. If you’re working with a professional with expertise in SM, they can help set these goals with you for your child.