Behavioral: The most evidence-based recommended treatment for selective mutism is behavioral therapy using controlled exposure. The therapist works with the child and her parents to gradually and systematically approach the settings where she cannot speak, building her confidence one situation at a time. The child is never pressured to speak, and is always encouraged with positive reinforcement. Specialized techniques are used to guide the child’s increasing exposure to difficult settings, and the therapist will teach parents and child how to use these techniques in real-life settings. Newer approaches offer evidence that intensive treatment from the time of diagnosis may prove more effective than traditional weekly sessions.
Pharmacological: Not every child with selective mutism requires medication. Some children may be prescribed anti-anxiety medications from the start, typically if their initial presentation is quite severe, if they’ve had SM for a long time, if they have not done well with a prior behavioral or other psychotherapy, if they have a very strong family history of similar disorders, or if they suffer from other impairing anxiety disorders as well as selective mutism. Some children will be prescribed medication if the results of an initial behavioral intervention fall short of the desired gains, or the process is too onerous. Many children who take medication as part of their treatment find that exposure tasks become easier to tolerate, making the difference between success and avoidance. The preferred medication for SM is one of the selective serotonin reuptake inhibitors, or SSRIs, better known as antidepressants. SSRIs are effective for anxiety and are tolerated well by children, who should always monitored for the presence of side effects.