HELPING A CHILD WITH
SELECTIVE MUTISM 11/04
Sandra Coiffman-Yohros, Psy.D, LMHC
North Miami Beach, Florida
Board Member, Selective Mutism Foundation, Inc.
children with Selective Mutism can be an arduous and difficult task
for teachers, parents and professionals alike. It is difficult to
understand the reasons why a child does not talk in the school or
social settings, and frustration and desperation often follow treatment
approaches. If we can fully understand what Selective Mutism is, the
etiology and most importantly the child, treatment progress
should follow in a slow but steady pace. As parents, teachers and
professionals setting realistic goals and pplying understanding,
we can help children overcome this condition.
Based on my research
and clinical experience, many children show a pattern of anxiety,
social phobia as well as predisposing factors such as excessive shyness
and slow to warm up temperaments. These children, for the most part,
are smart, inquisitive and highly observant of their environment and
the interactions around them.
The treatment of
Selective Mutism requires a “WHOLE APPROACH” incorporating
social, educational, psychological and at times psychiatric
interventions. The purpose of this paper is to give parents and
professionals a framework as well as tools for working with Selective
Mutism. It is important to be creative, have patience, understanding
and be flexible in all your interventions. What might work for one
child may not work for another. Therefore, an open mind and holistic
approach are of utmost importance.
play therapy approach is recommended.The therapist should have enough
materials such as games, pretend situations, and coloring materials to
allow the child to feel
comfortable without initial communication.
the child to take
the lead.Do not
force interaction or participation, and do
not focus exclusively on verbal
responses until the child feels secure and comfortable.
- Music and art
wonderful tools for promoting interaction and communication.
- As treatment
work towards successive
approximations such as a sign
system, verbal cues, one word responses leading to full sentences as
more language develops.
- Ask the
parents what are
favorite pastimes and activities and try to provide them in the office
the focus on the child and the present moment.
- When the child talks in
the office with ease, bring family members in to generalize verbal
- Remember, be
creative. Use telephones,
microphones, screens, puppets to allow the child a means of
communication through projective approaches.
- Keep in mind that
anxiety is a big underlying factor and promote safety, empowerment and
security for the child.
- Incorporate enhancing
self-esteem activities in the therapeutic setting.
- Teach the child
relaxation, breathing and positive imagery techniques to help with
- For some children a
behavioral program set with tangible rewards works. Make sure there are
a lot of small steps and frequent praise. Involve people, usually
parents and siblings, with
whom the child does speak.
- Keep open communication
with parents and teachers to follow up treatment progress.
It is important that the school considers the child’s needs
across the school day.
- Make sure all
are involved with the child are aware of the difficulty and most
importantly, provide them with accurate, up to date information
are many professional that do not understand what Selective
Mutism is or how to deal with
-Do not force
child in regular mainstream classes.
opportunities for activities that do not require spoken language
(such as silent reading, writing, board games etc)
the child to have a buddy system and participate in small group
- Allow the
communicate in another way
-For example by
gestures, cards, e mail.
reports, the child may tape themselves at home and then
bring the tape to the school.
-Use a peer
that the child talks to in the class as a bridge for
initial communication and for need situations, such as restroom
-As much as
possible, make sure the child is always included in teams
and group activities, regardless of verbal communication.-Keep
as consistent as possible, and advise the child in advance of any
changes in routine or classroom activities.
-Keep the child
in the same small groups for classroom work. Switching
partners frequently is not recommended.
and provide a “firm-loving” hand.
of praise for any sound or attempt at communication the
The home is a wonderful place to learn about social interactions and
rules of behavior.
- Provide a
loving environment for the child.
- Accept the
child for who
- Do not use
punishments to get the child to talk.
provide a secure environment for the child.
- Instill hope
child, reassuring them that there is help and they can overcome their
- Provide the
plenty of opportunities to explore extra-curricular activities, such as
swimming, gymnastics, art, theater or dance. This will allow them to
find pleasure in activities,
practice their strengths and foster self-esteem.
for after-school play-dates. Invite a peer that the child likes to the
home, allow them free time to play and interact. Once the child talks
to this peer freely, take them to
the park or outdoors to promote communication outside the home.
- Keep bringing
peers into the home (one or two at a time) and follow steps above to
generalize communication to other places and people. Once a peer group
has been established,
consider having the play-dates at the other child’s home.
- When taking
the child to
social activities, such as birthdays, school plays etc., arrive early,
allow the child time to “check out the environment”, feel
comfortable, and slowly warm up.
Do not force them to interact or play.
- The biggest
a parent is knowing when to “push the child” and
“when to let go”. You want to provide opportunities for
socialization and not reward isolation and
withdrawal. This is done in a slow and caring manner.
- Teach the
relaxation techniques, positive imagery and incorporate physical
activity into their daily routine. This will help reduce the anxiety.
that are anxiety provoking at home. This will help you understand their
difficulty as well as giving them social skills.
plenty of praise
and social rewards for communication.
- Seek advice
form professionals in your area.
- If family
trauma or dysfunction is present, consult a professional and attend
- Establish a
network for you as a parent. Children perceive their parents anxiety
and frustration. Take care of yourself so you can care for your
If the Selective Mutism is causing significant impairment and no
progress is seen in treatment, consult a child psychiatrist for
medication management. Medication is not the cure, but is one more
tool. Always as part of an integrative “Whole
Don’ts for Selective
Advisory Board Member
Mutism Foundation, Inc.
children to speak in social
can do this by saying “you can talk to me because you
will feel better after you do.”
give children the opportunity to participate in class even if they say
Try a reward
system, e.g. children who say a
word in class at least twice a week will be given an ice-cream party
(class mates want to have an ice-cream party so that will encourage a
child to speak in class).
- If children use gestures such as nodding
their head or pointing, tell them that they are doing a good job. Also, it encourages them to
children just so that they will
a reward system is used, be careful of what you do to help children.
Do not yell
at children for not speaking. This
just makes them feel more anxious and insecure about themselves.
Do not lie to
they need more improvement with speaking up, tell them.
need to know how you're feeling and, they are also aware of the fact
that they are not speaking
Do not have
other people talk for the child
does not help the child at all.
Do not ask a
child to bring in a cassette
tape that will play his/her voice on a tape recorder unless the child
says that it is ok.
Do not be
critical of these children. This
will only intimidate them more.
- Do not
assume that a child does not
understand you, because they do.