When your child has Selective Mutism, you’ll hear about many different kinds of help – speech therapy, play therapy, counselling, medication, CBT. It can be hard to know which will make a difference. Here’s how the main options compare.
CBT and behavioural therapy
Behavioural and cognitive behavioural therapy (CBT) have the strongest research support for Selective Mutism. They build speaking in small, planned steps, using techniques such as stimulus fading (“Sliding In”), shaping and gradual exposure, with parents and teachers closely involved. Read more in CBT for Selective Mutism: What Treatment Involves.
Speech therapy
Selective Mutism is an anxiety problem, not a problem with the ability to speak. Traditional speech therapy that works on sounds or language while the child stays silent won’t, on its own, help a child start talking at school.
That said, speech pathologists can play a very important role:
- some children with Selective Mutism also have speech or language difficulties, which need their own help
- speech pathologists trained in Selective Mutism use the same gradual, step-by-step strategies to build speaking.
At our clinic, both Clinical Psychologists and Speech Pathologists are trained in our Selective Mutism program.
Play therapy
Play is a natural part of working with young children – games and activities make sessions fun and help children relax. But play therapy on its own, where the child leads and there are no steps towards talking, has little research support for Selective Mutism. A child can become very comfortable with a therapist and still not speak. What helps is play that’s built around gradual speaking goals.
Parent-Child Interaction Therapy (PCIT)
PCIT is a coaching program for parents and young children. An adapted version for Selective Mutism shows promise in early research. Like CBT, it focuses on gradual steps and on how adults respond.
Medication
Some children, teenagers and adults with Selective Mutism are prescribed medication for anxiety (such as an SSRI) by a paediatrician, psychiatrist or GP – usually when anxiety is severe or progress with therapy is slow. Research on medication for Selective Mutism is limited, and it’s generally used alongside behavioural treatment rather than instead of it. Psychologists and speech pathologists don’t prescribe medication, but we’re happy to work with your doctor.
Art, music and other therapies
Art, music, occupational therapy and counselling can support a child’s wellbeing in other ways, but there’s little research showing they help children with Selective Mutism start speaking. If your child sees other professionals, it helps when everyone uses the same approach to talking.
Choosing a Selective Mutism therapist
Questions worth asking:
- Do you use a gradual, step-by-step approach to speaking?
- Will you work with us as parents, and with my child’s teacher or educator?
- How will practice happen at school and in everyday life, not just in sessions?
- Can sessions be online if travel is difficult?
How the Selective Mutism Clinic can help
Our therapy is primarily cognitive-behavioural, using a gradual, child-led approach. We usually start with parent-only sessions, then sessions with your child, and video meetings with your child’s teacher or educator. Sessions are at our clinic in St Leonards, Sydney, or online anywhere in Australia. We also run Social Confidence Groups and Selective Mutism webinars for parents, teachers and professionals.
You don’t need a referral to book. Medicare rebates may be available with a referral and Mental Health Treatment Plan from your GP or paediatrician. Private health funds and self-managed NDIS may also cover some costs. Get in touch or call 02 9438 2511.
More articles: What Is Selective Mutism? A Guide for Parents | CBT for Selective Mutism | Is Selective Mutism an Anxiety Disorder? | Selective Mutism or Shyness?
Written by Dr Elizabeth Woodcock, Clinical Psychologist and Director of the Selective Mutism Clinic in St Leonards, Sydney. Elizabeth has over 20 years’ experience as a clinical psychologist and has seen or supervised more than 1,800 children, teenagers and adults with Selective Mutism. She runs the clinic’s webinars for parents, teachers and health professionals. Read more about Elizabeth
