Expert Evaluation and Treatment for Selective Mutism

The therapists at Thriving Minds are highly trained and experienced in the treatment of Selective Mutism, a childhood anxiety disorder. Children with Selective Mutism have great difficulty speaking or communicating in public or social settings (school, extracurricular activities, extended family), but can speak in comfortable situations (e.g., in the home or with immediate family). Thriving Minds offers weekly treatment, school consultation, parent training, and intensive interventions at both of their locations. Request an appointment today.

INTENSIVE IN-CLINIC OR IN-SCHOOL INTERVENTION:

Many children need more intensive intervention or intervention directly in the location where muteness is occurring – the school setting. Weekly treatment session in the school can take months or even years, and this can be critical time lost both academically and socially for a child with Selective Mutism. New research is finding that intensive interventions are a wonderful option for children with Selective Mutism. Intensive intervention can be 3, 4, or 5 days in length, and typically entail 4-6 hours of intervention each day (including evaluation, direct intervention with the child, parent training, consultation with the school/current psychotherapist, etc.). Carried out in the clinic or the child’s school, these behavioral interventions:

  • reduce warm-up time

  • allow for faster progression toward speech (4 days as opposed to months or years!)

  • may reduce the need for a long-term pull-out program (and the potential disruptions to the child’s schedule that individual intervention involves)

  • returns the child to adaptive, appropriate functioning more quickly

  • reduces frustration of lengthy treatment

INDIVIDUAL TREATMENT

Typically, treatment begins with a clinical interview with parents and continues primarily in the office but also includes collaboration with personnel within the school setting. Throughout the course of therapy, therapists at Thriving Minds consult with personnel in the school to ensure your child is meeting his or her goals outside of the office.

Initial Clinical Interview (60-90 minutes): Parents meet with an expert therapist to obtain background history and current issues, determine a diagnosis, provide education and clarification, and jointly develop a treatment plan. Furthermore, this appointment will be used to discuss the process of treatment.

Therapy sessions (45-60 minutes): Sessions will focus on moving toward goals set in the initial clinical interview. The focus will be both on increasing communication/decreasing anxiety in the clinic, as well as "practices" in public environments and generalization to the school setting.

Common components of SM Treatment may include:

Exposures/Stimulus Fading: The primary component of Selective Mutism treatment is the use of what is called exposure, or gradually facing the fear of speaking and communicating. One form of exposure that is commonly used in Selective Mutism treatment is stimulus fading. Stimulus fading is a form of exposure therapy that slowly introduces the client to anxiety-provoking stimulus. In the context of Selective Mutism, this technique is used to gradually introduce the client to new people, new settings, or larger settings that cause anxiety. If introduced at a gradual pace, anxiety will decrease over time. This procedure can be easily tailored to the needs of the client.

Positive Reinforcement for Speech: While the client is being faded into situations that cause anxiety, setting up rewards for speaking to these new people or speaking in new settings will allow the client to recognize that speaking in these settings is beneficial. The therapist will work with the parent's to establish systems that track progress and provide rewards for brave behaviors.

"Brave Practices": As treatment progresses, the therapist will set up situations that allow the client to speak, and receive rewards for speaking immediately. These are what we call "brave practices." Brave practices can occur not only in the clinic, but also in the community and in school. A common brave practice is to go to an ice cream parlor to practice ordering ice cream. This allows for the client to practice ordering from a novel person, and receive ice cream as a direct result. Once again, these practices can be tailored to the client's needs.

Parent Training: Weekly psychotherapy sessions are incredibly beneficial for reversing the effects of Selective Mutism, but brave practices that occur outside of weekly sessions contribute exponentially to the child's progress. Therapists will train parents to conduct fade ins and set up brave practices so these interventions can be implemented in everyday life.

School Consultations: For child with Selective Mutism, school can be an incredibly difficult setting. If Selective Mutism symptoms aren't addressed in this setting, the child's learning can be severely impacted. Unfortunately, not may clinics are equipped to help bring Selective Mutism treatment strategies into the school setting. Our therapists, however, regularly offer training and consultation with schools to help create consistent expectations and interventions in all environments.

Developing Special Education Plans: For many schools, an Individualized Education Plan (IEP) is needed in order to make accommodations in the classroom. Our clinicians are able to write letters and attend meetings to help advocate for the development of a plan for the client.