Selective mutism is generally more difficult and slower to treat once a child reaches school. There are a few reasons for this: 1) In general the older the child, the more resistant the selective mutism is to treatment because their avoidant behaviours and anxious thinking styles are more entrenched and habitual; 2) School teachers generally find it more difficult than preschool teachers to find the time to devote to the program; and 3) Preschool is a less structured environment than school and children with selective mutism generally become more anxious and less communicative once placed in the more structured environment of school. Our experience is that children who receive treatment in preschool can make solid gains which place them in the best possible position to start school.