Adjunctive Treatments for Selective Mutism: When to Consider Medication, Social Skills Groups, and Speech Therapy
When working with children with Selective Mutism (SM), behavioral and exposure-based approaches remain the most effective and empirically supported treatments. These strategies help children gradually face feared speaking situations, build confidence, and generalize communication skills across settings. However, some children benefit from additional supports alongside traditional SM treatment. Medication, social skills groups, and speech therapy are all adjunctive options that may enhance progress when used thoughtfully and at the right time.
Adjunctive supports are not “first-line” interventions for most children with SM, but they can be helpful when progress stalls or when complex factors contribute to a child’s speaking difficulties. For example, some children experience high levels of generalized anxiety, perfectionism, or physical symptoms that make engagement in exposures more difficult. Others may need structured opportunities to practice social communication with peers, or they may present with speech or language differences that overlap with or complicate their SM. Understanding when—and when not—to consider these options is key.
Medication can be beneficial when anxiety significantly interferes with daily functioning or when a child’s fear response is so strong that it limits participation in exposures. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications and may help reduce the intensity of anxiety, making therapeutic practice more manageable. Medication is generally considered when a child shows minimal progress despite consistent behavioral treatment, when anxiety is pervasive across settings, or when SM co-occurs with other anxiety disorders. Importantly, medication does not replace therapy; rather, it can create a window of opportunity for learning and bravery.
Social skills groups can be helpful for children who struggle with peer interactions beyond speaking difficulties, but timing is critical. While SM is not caused by a lack of social skills, some children benefit from guided practice with turn-taking, initiating conversation, and navigating group interactions. However, social skills groups are generally not recommended before a child is able to engage verbally with at least some members of a small group. Placing a child in a group setting before they are ready to speak can increase anxiety and reinforce avoidance. Once a child can use their voice in low-pressure peer settings, a well-structured, small group led by professionals familiar with SM can support generalization of speech and confidence across peers.
Speech therapy may be appropriate when SM overlaps with speech-sound disorders, language delays, or pragmatic language difficulties. Although SM itself is an anxiety disorder, some children have co-occurring speech or language challenges that contribute to their reluctance to speak. A speech-language pathologist (SLP) can help determine whether articulation, expressive language, or social communication difficulties are present and how they interact with anxiety. Speech therapy may be especially helpful when a child expresses embarrassment about how they sound or struggles with communication once speech begins to emerge.
Decisions about adjunctive treatments are best made through ongoing collaboration among parents, therapists, educators, and medical providers. If a child shows steady progress with behavioral treatment alone, additional services may not be necessary. When barriers persist—such as high distress, limited engagement, or co-occurring communication challenges—adjunctive supports can help remove obstacles and support continued growth.
Adjunctive treatments are not one-size-fits-all solutions, but when used intentionally, they can meaningfully enhance SM treatment. By carefully considering timing, readiness, and the child’s unique profile, families and professionals can build a comprehensive plan that supports communication, confidence, and long-term success.