Ask An Expert / Selective Mutism

How can you help a 16-year-old who still has selective mutism?

Intensive treatment can overcome well-practiced avoidance

Steven Kurtz, PhD, ABPP

I have a 16 year old with SM who has never spoken to his peers at school. He will do oral reports only in front of teachers when kids are not around. Would cognitive behavioral therapy work at his age? Would the teachers have to be involved?

Thanks for your inquiry. First of all, older kids with SM are always more complicated to treat than younger kids. They have “practiced” their SM avoidance many thousand times more than the younger patients. Also, parents, teachers, and others close to them have all gotten very used to working around their avoidance, further strengthening everyone’s expectations that things will continue as they are. This is not to blame anyone at all — it just is what it is.

Putting in place a robust treatment plan that really changes everyone’s expectations — the teen included — is a daunting but achievable challenge. Older children with SM are more likely to have co-occuring disorders such as social phobia, and they are often demoralized if not actually depressed. Entrenched and long-standing or over-learned habits need to be treated aggressively.

We have been having the best success with intensive treatments using upwards of 30 hours of cognitive behavioral treatment (also known as CBT) in one week to treat these children. We also do treatment onsite where the teen lives — literally going with him to the places where he is having difficulty. And we advocate combining CBT with medication to help children with significant impairments to improve. You might benefit from reading this article about the role of medications in the treatment of SM.

We always emphasize the importance of staying focused and positive, and never giving up. Your child needs you to keep seeking out the best evidence-based treatments available.