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Frequently Asked Questions

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Pricing
FAQS

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Parent
Faqs

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Teacher
FAQS

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Professional FAQS

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Treatment
Program FAQS

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Selective
Mutism FAQS

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Pricing
FAQS

We can’t afford the full treatment right now.

The Selective Mutism clinic also holds a series of webinars every year about Selective Mutism. These webinars are run by the director of the Selective Mutism Clinic, Dr Elizabeth Woodcock, and explain key information such as what Selective Mutism is, why it occurs and treatment strategies.

For more details about our seminars and to register, please click here. You can also purchase an online recording or a USB package of our webinars.

If your child is 6 years and under, contact NDIS on 1800 800 110 to apply for funding under their ‘Early intervention route’. Ensure you apply to be 'self-managed' rather than plan-managed. NDIS will pay for almost all of the session costs.

A standard 50-minute therapy appointment is $260 and the initial 60-minute assessment is $290. It is recommended that rural and interstate families who are travelling to Sydney for an assessment have a three-hour assessment and session ($780). Fees can be paid by EFTPOS, cash, or credit card at the end of the appointment.

Rebates for therapy services are available from several sources including:

Under the Medicare ‘Better access to mental health‘ scheme you can obtain a Mental Health Care Plan (MHCP) that allows you to claim a rebate with eligible psychologists at the clinic for part of the session cost for up to 10 therapy sessions in each calendar year. To be eligible to receive the rebate you must visit your GP, Psychiatrist, or Paediatrician and obtain a referral for Psychology services as part of your overall treatment plan. If you have reached your Medicare family ‘safety net’ threshold for the calendar year, the rebate will be almost all of the session cost. Click here to read more about the Medicare safety net. Medicare rebates are currently also available for Telehealth sessions for children with an eligible mental health care plan from their GP.

Two of the 10 rebates can be for consultations with carers that do not involve the child such as the initial assessment with the parent(s) alone, parent sessions, or school consultations.

GPs can also provide rebates for Speech Pathology services via a Chronic Disease Management Plan (also known as a GP Management Plan). This type of plan allows you to claim a small rebate for up to 5 sessions each calendar year.

Most private health funds provide rebates for psychological and speech pathology services depending upon your level of cover. Please contact your health fund to find out more.

Parent
FAQS

As a parent, how can I help my child with Selective

Our “How to Help Your Child with Selective Mutism” webinar is a 3-hour session specifically designed for parents. Gain insights into understanding Selective Mutism and implementing strategies to support your child.

Yes, there are! Our 3-hour “Advanced Strategies for Parents of Children with Selective Mutism” webinar delves deeper into advanced strategies for various social situations. Explore further to enhance your child’s communication skills.

Children with Selective Mutism typically have the most difficulty communicating in the school environment. Most parents will need to be involved in the school treatment program, however you can also help your child with other skills such as understanding and managing their anxiety and other emotions, change their anxious patterns of thinking, and improving their communication outside of school. Children with Selective Mutism will often struggle with their social skills as well as friendship difficulties, which is another important area that you can help your child with.
We consider children who whisper in social situations instead of talking to be a form of Selective Mutism. The child often fears that their voice sounds strange or different in some way to other children, and so whispering is used as a strategy to mask their true voice. We would generally use similar strategies with these children as those who are mute.
Yes, the program at the clinic is tailored to your individual situation. We may find that the teacher and school do not need any input from us, so our strategies will be focused on those other social situations where your child finds it difficult to communicate. In those situations where children with Selective Mutism don’t seem to have a problem at school, there are sometimes still subtle difficulties with communicating – such as asking for help, contributing to class discussions, telling the teacher when there is conflict with a peer, and so on. These children may answer teachers when spoken to, but say very little spontaneously. They may also answer with limited words instead of full sentences. Our assessment will look at all of these aspects of communication and assist the teacher where necessary to help build your child’s communication to the level of their peers.
Children with Selective Mutism are born with an anxious temperament. It is therefore common for them to be vulnerable to developing additional anxieties, such as phobias, general worries, fears of trying new things, separation anxiety, performance anxiety, fears of the dark and sleeping on their own, and perfectionism and fears of getting things wrong. In some cases, particularly as the child gets older, they may also experience low mood as a result of reduced self-esteem, their frustration about not talking, and the social implications of this. Some children with Selective Mutism may also have other behavioural problems such as aggression, tantrums, and noncompliance. The therapists at the Selective Mutism Clinic can assist your child and family with any other kinds of difficulties that may arise and our treatment is tailored to the individual needs of your child.
Some (but not all) cases of Selective Mutism can resolve spontaneously and these children will eventually start talking in those situations where they had been mute. If this does happen, it is usually in preschool or in the first year of school. It is difficult to distinguish those cases that may resolve spontaneously from those that won’t, although an important factor appears to be how well the child’s parents and teachers intuitively help the child to gradually face their fear of communicating, without placing too much pressure on them to do so. If the child’s condition is not talked about and there are little opportunities for them to socialise and communicate with peers and adults, then there is a greater chance that the mutism will persist. Even when Selective Mutism does resolve without intervention, these children tend to remain socially anxious and may also develop other anxieties or emotion regulation difficulties. They will generally find it difficult to talk in front of groups, ask for help, contribute to discussions, and be assertive. Treatment is therefore beneficial for all cases of Selective Mutism as it can help your child learn about their anxiety and be comfortable communicating in all situations. Once children with Selective Mutism enter their second year of school the mutism becomes more entrenched. Therefore, the older the child, the less likely the mutism will resolve without treatment.
Some (but not all) cases of Selective Mutism can resolve spontaneously and these children will eventually start talking in those situations where they had been mute. If this does happen, it is usually in preschool or in the first year of school. Once children with Selective Mutism enter their second year of school, the mutism becomes more entrenched. In fact, many of the older children we see with Selective Mutism have had a period in the past of ‘wait and see’ where people have waited to see if the child has ‘grown out of the condition’. It is difficult to distinguish those cases that may resolve spontaneously from those that won’t, although an important factor appears to be how well the child’s parents and teachers intuitively help the child to gradually face their fear of communicating, without placing too much pressure on them to do so. If the child’s condition is not talked about and there are little opportunities for them to socialise and communicate with peers and adults, then there is a greater chance that the mutism will persist. Even when Selective Mutism does resolve without intervention, these children tend to remain socially anxious and may also develop other anxieties or emotion regulation difficulties. They will generally find it difficult to talk in front of groups, ask for help, contribute to discussions, and be assertive. This could affect their academic performance at school and the development of important social skills. Treatment is therefore beneficial for all cases of Selective Mutism or extreme shyness as it can help your child learn about their anxiety and be comfortable communicating in all situations.
Many children with Selective Mutism do also have a diagnosis of Autism. One study showed that 7% of children with Selective Mutism also had Asperger’s disorder (now called Autism), however another study using a sample of children treated at a hospital outpatient clinic showed a massive 63% of children with Selective Mutism had Autism (these were obviously a more severe sample, but a very high comorbidity). However we also see cases where Selective Mutism has been misdiagnosed as Autism. One telling indicator of whether a child has Selective Mutism or Autism is the difference between communication at home and at school and other social situations. A child with Autism would show impairments in social/emotional communication (amongst other factors) across all settings, whereas in Selective Mutism, the impairments in communication are only seen in situations where the child is anxious, such as school or even home when there are visitors. At the start of treatment we conduct a comprehensive assessment of the child’s current and past communication and developmental and family history to help determine whether there is a diagnosis of Selective Mutism alone, or a possible additional diagnosis of Autism. When we do suspect the child might have both diagnoses we generally treat the Selective Mutism first before we recommend testing for Autism.
Children with Selective Mutism can often appear stubborn, particularly when you know that they can talk without any difficulty in some situations. They may not become anxious unless they are asked to talk, so they often look very relaxed and can smile, laugh, sometimes make other noises, and join in activities just like other children. Despite this appearance, and the fact that many children with Selective Mutism are strong-willed, these children do want to talk, but don’t because they are too afraid to do so. When adults interpret a child’s Selective Mutism as defiance, they are more likely to place consequences on the child for not talking, show frustration, or pressure the child to talk. However, such approaches will worsen the mutism. By understanding that the child is extremely anxious about talking, adults are more likely to help the child face this fear in a gradual way and the child is more likely to be better able to attempt tasks.
Anxious children will typically avoid anything that makes them feel anxious – including acknowledging or discussing their anxiety or difficulties talking. This is not a reason to avoid talking about it, as their anxiety is likely to worsen over time. Children need support to learn to understand and talk about their anxiety and other feelings in order to manage them. Although this may be difficult for them and you, wIth time and support from the therapist, your child’s distress will gradually lessen and they will find it helpful to talk about their worries. During the first session which only the parents attend, the therapist can talk with you about how to best explain treatment to your child, and why they will be attending.
Selective Mutism generally starts to emerge around three years of age, sometimes slightly earlier, and this is a wonderful age to start intervention. We find that children respond so much more quickly to the intervention the younger they are, for the reasons outlined in the question above. Many of the children attending the clinic are three years of age and we have even seen children just under three.
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.
Comments such as these are often a child’s way of expressing that they really want to talk, but find it too hard to talk currently. They sometimes feel pressured by others asking them when they are going to talk, and if they talked at school that day. They often say that they will start talking at some point in the future to stop people asking them. Children often have a strong desire to talk, but don’t necessarily know how to move from their current level of communication toward free and spontaneous speech. In very rare circumstances children have started talking at the point that they predicted, however most cases in our experience children’s communication remains the same and they still require treatment.
This doesn’t sound like a typical presentation of Selective Mutism. Selective Mutism typically presents when a child is in preschool and it would be very rare for it to suddenly occur at a later age. A diagnosis also depends on whether you see a difference in communication between situations where he is relaxed, such as with family at home, and social situations – such as school or with strangers at the shops or other activities. If there is less communication in social situations, then this could possibly be social anxiety disorder or Selective Mutism. In any case, we would recommend that you have your son assessed by a psychologist or neurologist to start to investigate the nature of the difficulties communicating and from there treatment can be planned.

We have a dedicated webinar for high school teachers, learning support teams, psychologists, parents, and administration teams. Check out our “Treatment for Selective Mutism in High School” a 3-hour webinar focusing on strategies for teens.

The Clinic has successfully treated adolescents with a long history of Selective Mutism using our intensive home- and school-based program. When Selective Mutism persists into adolescence, it is understandable that the young person and their parents can feel stuck, discouraged or helpless about whether the condition will improve. They have often tried various strategies and treatments that have largely been unsuccessful, and many families have also had a period of years without treatment where they have hoped that the condition would have resolved by itself. While treatment will take longer for older children, it is never too late to get help. Not only is it possible for the child to start communicating more freely with peers and adults but treatment can have enormous benefits in terms of enhancing the adolescent’s current and future quality of life, including vocational study and employment, living independently, and building friendships and intimate relationships.
It is more helpful to start intervention in term 4 than to wait until the new school year as there are many procedures that can be put in place to ensure that the child’s transition to the new year goes as smoothly as possible. This includes advising the school in selecting an appropriate teacher, placement with with appropriate classmates, building rapport with the new teacher, and preparing the teacher for how to manage a child with Selective Mutism. If these things are not addressed prior to your child starting the new school year their anxiety may be unnecessarily high and it will be harder for them to communicate. Also, the school holidays provide many more opportunities to practise communicating with others, and therefore can be a fruitful time to facilitate a child’s progress with their communication.
Selective Mutism varies in severity. When a child’s Selective Mutism starts to resolve, there will often be some (often subtle) aspects of the child’s communication that need to be improved. These include their voice volume, moving from using a whisper to using their vocal chords, initiating speech rather than only speaking when prompted, increasing the length of their responses, being assertive, asking for help, joining in discussions, talking in front of larger groups, and generalising talking to other teachers and staff. Furthermore, children with a history of Selective Mutism have potential to regress in the future unless they are encouraged to communicate in all of the above situations to a level that produces minimal anxiety.

Professional
FAQS

Do you provide professional development for

Absolutely!

Our "Professional Development for Psychologists and Other Clinicians" webinar focuses on the assessment and treatment of Selective Mutism. Choose from a 6.75-hour webinar recording or a shorter 3-hour version. We also provide individual supervision for professionals to discuss their Selective Mutism cases. Read more about supervision

Yes! Our "Selective Mutism Treatment for Speech Pathologists"webinar is a comprehensive 5-hour session tailored for Speech Pathologists.

There are! Our "Preschoolers with Selective Mutism: Transitioning to School" webinar is a 1.5-hour session focusing exclusively on strategies to aid with the transition to school. Learn more about what preschoolers with SM need, and prepare for a smooth transition.

We have a dedicated webinar for high school teachers, learning support teams, psychologists, parents, and administration teams. Check out our "Treatment for Selective Mutism in High School" webinar, a 3-hour session focusing on strategies for teens.

Engaging a child of this age can be very difficult and will take a lot of time. Two basic things that would help are to find an interest or hobby to do together that will help them to relax. Find out what they are interested in, learn about that topic and chat to them about it. The second strategy would be not to ask the teen any questions at all, to chat a lot, be very friendly, and use humour and silliness to engage them. Don’t expect a response right away; you will need to be patient and persistent. We would also be encouraging the family to seek treatment from a Psychologist or Speech pathologist with experience in Selective Mutism to work on their anxiety and communication.

Teacher
FAQS

Can I provide basic information about Selective Mutism to all staff at my
school or preschool?

Certainly! Our “What All Staff Need to Know About Selective Mutism” is a 1-hour seminar designed as an in-service for school and preschool staff. Get the details about the basic do’s and don’ts of managing children with Selective Mutism. However, this webinar will not discuss specific treatment strategies, so if your teachers are showing an interest in helping your child, we would recommend the 3-hour webinar “Treatment for Selective Mutism in Schools and Preschools”.

We recommend you reach out to the parents to find out if they are working with a Psychologist or Speech Pathologist who can provide some specific tailored strategies for you. If the child is a client at our clinic then as part of our treatment program we will be providing two video consultations each school term for you to provide in-depth help with applying accommodations in the classroom that will help the child to build their talking with yourself, as well as all peers and staff. If the child is not a client of our clinic and are not linked in with a different therapist, then we can provide individual video sessions for teachers to discuss specific strategies for children in their class. Please contact us or call 029 438 2511 to express your interest.

There are a number of options for support and help for teachers:

1) For families who are receiving treatment at the clinic, we provide ongoing consultations to the classroom teacher (usually one every 4 weeks) to help them to implement an intensive program to address the child’s Selective Mutism. These consultations are generally paid for by the family.

2) We run evening webinars for teachers and parents. Details about our upcoming live webinars and online webinars are here or by calling our office on 029 438 2511. The most relevant webinar for teachers is a 3-hour webinar called "Treatment of Selective Mutism in Schools and Preschools". There is an equivalent webinar about "Treatment for Selective Mutism in High Schools".

3) Where families are not linked in with treatment yet, teachers/schools are able to access video consultations with one of our experienced therapists to discuss the child and our recommendations for school strategies. The cost of these are the same as our usual session cost plus GST. For details of our fees click here

Because children with Selective Mutism talk freely and normally at home, sometimes parents are not aware of the extent of their child’s difficulties with talking. Begin by giving the parents detailed information about how the child is communicating in your classroom. Express your concerns openly to the parents, provide reading material about Selective Mutism, and invite them to observe their child at school. Give information about the effects of the condition on the child’s social skills (e.g., difficulties building friendships, asserting themselves, safety issues such as telling teachers when there is a problem) and academic skills (e.g., not able to elaborate ideas, explain how they reached a particular answer, ask for help, contribute to class discussions, or complete oral tasks in the classroom). If over time the child’s condition does not improve naturally (or worsens), you can provide this feedback to the parents. You can also encourage the parents to speak to a clinician about Selective Mutism and what is involved in treatment.

Yes! Our "Preschoolers with Selective Mutism: Transitioning to School" webinar is a 1.5-hour session focusing exclusively on strategies to aid with the transition to school. Learn more and prepare for a smooth transition.

There are a few options for you:

1) A good resource is the ‘Selective Mutism Resource Manual’ by Wintgens and Johnson

2) Our clinic runs regular 3-hour evening webinars for teachers about how to support students with Selective Mutism at school

3) If you cannot make a live webinar, you can access an online recording or purchase the webinar as a USB package here.

4) We would also encourage the student/family to engage with a therapist so that they can receive treatment for the Selective Mutism. Selective Mutism is a complex condition that requires therapy with the child and family in order for it to fully resolve. As part of that treatment the therapist should support you with strategies for the classroom.

Certainly! We recommend our "Treatment for Selective Mutism in Schools and Preschools" webinar, a 3-hour intensive session designed for early childhood and primary school teachers, learning support staff, aides, and school Psychologists and Speech Pathologists.

We have a dedicated webinar for high school teachers, learning support teams, psychologists, parents, and administration teams. Check out our "Treatment for Selective Mutism in High School" webinar, a 3-hour session focusing on strategies for teens.

Engaging a child of this age can be very difficult and will take a lot of time. Two basic things that would help are to find an interest or hobby to do together that will help them to relax. Find out what they are interested in, learn about that topic and chat to them about it.

The second strategy would be not to ask the teen any questions at all, to chat a lot, be very friendly, and use humour and silliness to engage them. Don’t expect a response right away; you will need to be patient and persistent.

We would also be encouraging the family to seek treatment from a therapist to work on their anxiety and communication and who can support you with additional strategies. Our webinar "Treatment for Selective Mutism in High Schools" can also provide you with lots of additional strategies.

Our program for Selective Mutism is fairly intensive, as this is what is needed for Selective Mutism to resolve. If we work with a child alone in the clinic, the improvements in the child's communication with the therapist do not generalise to the school environment, unfortunately. Therefore many accommodations and strategies are needed in the school environment to help children start to build their communication in that setting. We often invite principals/deputy principals and other support staff to sit in on the video consultations that you have with us so that they can understand the rationale for any recommended strategies. We can also assist with writing letters to support applications for funding.

If the Learning Support Teacher and/or School Psychologist are also involved in consultations with the Clinic, this can provide you with additional support in terms of the day to day implementation of accommodations for the child.

However, it is important to note that the classroom teacher needs to play a primary role in our school program or else it will be difficult to generalise any gains in the child’s communication to the classroom setting.

Children with Selective Mutism are usually less anxious when talking with their peers than with adults. If the child is already speaking to some of their peers, this is a good sign. It is important that you make the classroom environment as relaxed as possible and build good rapport with the child. Ensure that no consequences are placed on the child for not talking (by you or any specialist teachers) as this will worsen the mutism.

Also ensure that no-one is placing pressure on the child to talk, making comments about their lack of talking, or asking open-ended questions if she is unable to answer. Those strategies will give you a good start. However, in order for the Selective Mutism to resolve, the child, their family, and the school will need support from a therapist.

The Selective Mutism Clinic provides ongoing training and support for classroom teachers to implement strategies that gradually build the child’s communication until they can eventually talk directly to the classroom teacher, to all peers and staff, in small groups, and in front of the whole class. Read more about this program here.

The clinic also has online webinars available to purchase, which provide details about strategies that teachers can use in the classroom.

Treatment
Program FAQS

The Selective Mutism Clinic uses Cognitive Behavioural Therapy (CBT) because
research and our experience has shown this is the most effective treatment for Selective Mutism. CBT addresses children’s avoidance of talking by helping them to gradually confront and practise increasingly more difficult forms of non-verbal and verbal communication. This is done at a pace that the child can cope with. Children with Selective Mutism also have particular anxious beliefs about how other people might respond or think about them if they heard them speak (e.g., ‘they might tell everyone that I talked’, ‘they might think my voice sounds funny’). CBT helps them to start to think in a more helpful and rational way about talking.

The program requires parents and teachers to be committed to implementing strategies both within and outside of school, both of which are extremely important. Parents will be given skills to help their child gradually increase their communication with extended family, friends, in public places and in other settings. The Clinic implements an intensive school or preschool program and provides the classroom teacher and other relevant school personnel with regular video consultations to support them to implement this program (i.e., a video consultation every 4 weeks). Your family will be seen by one of our therapists who are all registered Psychologists or Speech Pathologists and have specialised training and experience in treating Selective Mutism. All therapists at the clinic receive ongoing supervision from the Director and Clinical Psychologist, Elizabeth Woodcock. Find out more about our treatment program here.

Appointments are offered during business hours from Monday to Friday.
The clinic is located at Suite 306, Level 3, 480 Pacific Hwy in St Leonards, Sydney. The building is a short 5-minute walk from St Leonards train station on the lower North Shore. Enter the building from glass doors on Pacific Highway. ​ If you are travelling from the City you can take either a train or bus, both of which typically take 20-25 minutes. There is a direct train from many of the City train stations to St Leonards train station, which is just a 5-minute walk from the clinic. The nearest bus stop is also a short 5-minute walk from the practice on the Pacific Highway just before St Leonards train station. ​ If you are coming from Sydney Airport, St Leonards is a 25-minute drive or approximately 40 minutes by train. ​ The Wilson Parking underneath the building provides 1.5 hours of free parking and the extra half hour after that costs $8.00. The entrance to the carpark is at the back of the building on Nicholson Street. Enter under the large blue sign "St Leonards Sq Customer Parking". The building is the very tall grey/orange building). If you park underneath the building you can take the lift up to our office on Level 3. There are a number of lifts, however the best one is the one towards the back of the carpark. The one near the carpark entrance will take you to the middle of the plaza, in which case you will need to walk out of the plaza and around to the front of the building on the Pacific Highway. ​ Alternative options are the Hume Street Council Carpark (approximately a 4-minute walk on the other side of the Pacific Hwy) which provides 2-hours free parking before 6pm. There is metered parking available in the streets around the practice, however ensure you leave enough money in the meter as one hour is generally not sufficient time.
A face-to-face assessment can be beneficial because it allows the clinician to meet you and observe your child’s level of anxiety. The clinician can also demonstrate how to conduct one of the main treatment strategies, ‘Sliding In’, to you in that session. However, we recognise that the cost of airfares and accommodation for a family can be expensive, and our program is just as successful for those families who do not have a face-to-face assessment. For families in our Outreach program, we have many handouts and a video to show how to do one of the main strategies called ‘Sliding In’ and we find that this is sufficient to train the parent and the classroom teacher in how to use this strategy. For remote families, during the video sessions with the parent (the child is not included), we teach the parent strategies to teach their child about anxiety and how to help the child work on building their communication at home and at school. The ‘school program’ is almost the same as for clients in Sydney, as we provide all of our support to schools via regular video consultations with the classroom teacher and other relevant school personnel. We provide two video consultations with the classroom teacher each school term and teach the classroom teacher (through discussion, handouts, and videos) how to do ‘Sliding In’ (the 'gold standard' treatment for Selective Mutism) with the child and parent at school, and also how to build the child’s communication in the classroom.
Selective Mutism is one of the more severe anxiety disorders in children. It therefore takes some time for a child to learn to talk freely and spontaneously to everyone in all situations. Our experience shows that it takes approximately 12-24 months for Selective Mutism to resolve with an intensive treatment program. However, there are various factors that will impact on the rate of progress. These factors include the age of the child when they first present to treatment, the severity of the condition, the commitment of families and schools to implement the treatment program, and the existence of co-occurring anxieties or other behavioural problems. A child in preschool will often take less time than the above estimate (e.g., 6-12 months), and a child in high school will generally require longer treatment. If a child also has Autism or other severe anxiety disorders, then treatment tends to take longer.
This will vary from family to family and will be arranged with the therapist throughout the course of treatment. Treatment for Selective Mutism is generally lengthy (i.e., 12-24 months) so we attempt to space the sessions out to keep treatment affordable for most families. We would normally see children and their families more frequently at the start of treatment (e.g., every 2-3 weeks). This is to provide more intensive support initially while developing and getting the treatment program underway. We then gradually lengthen the time between sessions (e.g., every 3-6 weeks depending upon the child’s progress, the family’s budget, and how confident you feel in being able to continue the strategies between sessions). Because we are not seeing families on a weekly basis (like many treatments), it is crucial that parents and teachers continue to work on the strategies every day with the child in order to help improve their anxiety. We recommend that the school has two consultations with the therapist each school term.

Yes, the clinic provides treatment for adults with Selective Mutism. Whilst Selective Mutism is more common in children, there are many adults who also suffer from Selective Mutism.

Selective Mutism in adults is treated using similar principles as other anxiety disorders such as phobias and Social Anxiety Disorder. A large part of treatment involves learning to understand feelings and sit with feelings, with strategies such as ‘mindfulness’. Another major component of treatment is called ‘Graded exposure’. This may involve entering social situations rather than avoiding them, then practising nonverbal communication such as nodding or writing notes, and finally working your way up to making voice recordings or using someone you trust and talk to as a “talking buddy”, and finally talking directly to a person.

We understand that as an adult with Selective Mutism it can be very scary to reach out to get treatment, and we will work out ways initially that you can communicate with us. This could be via writing, or talking to a friend or parent when we are not in the room, or responding nonverbally to our questions. We will find a way for you to communicate that is not too difficult, and we never ask or expect you to communicate in a way that is too uncomfortable for you. We will show you a way that you can communicate to us how difficult certain forms of communication are, and will use that tool to help guide how we progress i treatment.

Treatment for adults generally takes longer than it does for young children (more than 2 years, compared to 6-24 months for children), but it is possible to get to a stage where you can eventually talk to people in social situations and feel less distress around this! Please see our page about Treatment for Adults with Selective Mutism here.

The clinic will typically implement a Cognitive Behavioural Therapy (CBT) program before considering medication as an option, as CBT is an effective treatment for Selective Mutism. Most of the children we have worked with at the Selective Mutism Clinic respond well to CBT by itself. However, there are some cases where medication has been indicated; for example, if there is concern that a child is also suffering from clinical Depression and their low mood is a barrier to them implementing the strategies that we have recommended. Children in the latter primary school years and high school often benefit from a combination of CBT and medication.

​

We are Psychologists and Speech Pathlogists and do not prescribe medication. In those cases where we feel that a child might benefit from medication, a referral will be made to a child/adolescent psychiatrist or paediatrician, who will assess the child independently and liaise with the therapist at the clinic.The medication prescribed in these instances is typically an antidepressant medication as these are effective at reducing anxiety, have the least side-effects, and are the safest type of medication to provide to children. Antidepressant medication typically acts by helping to reduce the child’s anxiety sufficiently to help motivate them to work on the behavioural strategies in the program. The emphasis remains on the child, the parents, and the school learning and practicing CBT strategies that they can continue using once medication has been ceased.

Engaging a child of this age can be very difficult and will take a lot of time. Two basic things that would help are to find an interest or hobby to do together that will help them to relax. Find out what they are interested in, learn about that topic and chat to them about it.

The second strategy would be not to ask the teen any questions at all, to chat a lot, be very friendly, and use humour and silliness to engage them. Don’t expect a response right away; you will need to be patient and persistent.

We would also be encouraging the family to seek treatment from a Psychologist or Speech pathologist with experience in Selective Mutism to work on their anxiety and communication.

Our program for Selective Mutism is fairly intensive, as this is what is needed for Selective Mutism to resolve. If we work with a child alone in the clinic, the improvements in the child's communication with the therapist do not generalise to the school environment, unfortunately. Therefore many accommodations and strategies are needed in the school environment to help children start to build their communication in that setting. We often invite principals/deputy principals and other support staff to sit in on the video consultations that you have with us so that they can understand the rationale for any recommended strategies. We can also assist with writing letters to support applications for funding.

If the Learning Support Teacher and/or School Psychologist are also involved in consultations with the Clinic, this can provide you with additional support in terms of the day to day implementation of accommodations for the child.

However, it is important to note that the classroom teacher needs to play a primary role in our school program or else it will be difficult to generalise any gains in the child’s communication to the classroom setting.

Children with Selective Mutism are usually less anxious when talking with their peers than with adults. If the child is already speaking to some of their peers, this is a good sign. It is important that you make the classroom environment as relaxed as possible and build good rapport with the child. Ensure that no consequences are placed on the child for not talking (by you or any specialist teachers) as this will worsen the mutism.

Also ensure that no-one is placing pressure on the child to talk, making comments about their lack of talking, or asking open-ended questions if she is unable to answer. Those strategies will give you a good start. However, in order for the Selective Mutism to resolve, the child, their family, and the school will need support from a therapist.

The Selective Mutism Clinic provides ongoing training and support for classroom teachers to implement strategies that gradually build the child’s communication until they can eventually talk directly to the classroom teacher, to all peers and staff, in small groups, and in front of the whole class. Read more about this program here.

The clinic also has online webinars available to purchase, which provide details about strategies that teachers can use in the classroom.

It is much more helpful to start intervention in term 4 than to wait until the new school year as there are many procedures that can be put in place to ensure that the child’s transition to the new year goes as smoothly as possible. This includes advising the school in selecting an appropriate teacher, placement with with appropriate classmates, building rapport with the new teacher, and preparing the teacher for how to manage a child with Selective Mutism. If these things are not addressed prior to your child starting the new school year their anxiety may be unnecessarily high when starting a new school year with an unfamiliar teacher and classroom and it will be harder for them to communicate. Also, the school holidays provide many more opportunities to practise communicating with others, and therefore can be a fruitful time to facilitate a child’s progress with their communication. For children transitioning to high school, this can be a particularly stressful time and we recommend a transition program starts in early Term 3 in the year prior to high school.

Children with Selective Mutism are born with an anxious temperament. It is therefore common for them to be vulnerable to developing additional anxieties, such as phobias, general worries, fears of trying new things, separation anxiety, performance anxiety, fears of the dark and sleeping on their own, and perfectionism and fears of getting things wrong. In some cases, particularly as the child gets older, they may also experience low mood as a result of reduced self-esteem, their frustration about not talking, and the social implications of this. Some children with Selective Mutism may also have other behavioural problems such as aggression, tantrums, and noncompliance. The therapists at the Selective Mutism Clinic can assist your child and family with any other kinds of difficulties that may arise and our treatment is tailored to the individual needs of your child. Most of our therapists also work as part of our general psychology clinic, MindBox Psychology, and see children with many other conditions as part of that work.

You don’t need a referral to see a Psychologist or Speech Pathologist. Many people simply decide to make an appointment themselves, without visiting their GP or obtaining a referral from a health professional. However, if you wish to obtain a Medicare Rebate you will need to visit your GP, psychiatrist, or paediatrician to obtain a suitable referral, which may involve a Mental Health Care Plan (MHCP) or a Chronic Disease Management Plan.

Selective
Mutism FAQS

Selective Mutism (SM) is a condition where children are able to talk comfortably in some situations such as at home or around familiar relatives, but are not able to use their voice in other social situations where there is an expectation for speaking such as at school or with less familiar people.

SM is a form of social anxiety where the child fears that when people hear their voice they will react in a way that might be embarrassing for them or that they may be judged for how they sound or what they say. This fear prevents the child from being able to speak freely. Sometimes children with SM are unable to speak to adults or peers at school. Sometimes they can speak to select people (e.g., 1 or 2 peers, or adults but not peers), and sometimes children are able to whisper to a large number of people but unable to use their normal voice.

Although Selective mutism usually becomes apparent around three years of age, the condition is often not diagnosed until much later (e.g., early to mid primary school). The delayed referrals of children to appropriate services is often due to the perception that the child will ‘grow out of it’ and eventually start talking. However, this is often not the case, as improvements tend to occur very slowly (if at all) if it is left untreated. Preschool workers, early childhood carers, and speech therapists play a key role in early detection of the condition and in ensuring that steps are taken before the mutism becomes firmly established.

In the past ten years or so, the recognition that Selective Mutism is a form of social anxiety has led to the development of effective treatment programs, such as cognitive-behaviour therapy (CBT). CBT programs aim to gradually expose the child to anxiety-provoking social situations and assist them to build up nonverbal, and later verbal communication.

Extreme shyness and Selective Mutism can be thought of as being on a continuum with Selective Mutism being a more severe condition. Shy children are generally able to respond when they are asked questions, even though it may be quietly and with very few words. Children with Selective Mutism have specific situations or people (particularly at school) where they are not able to respond verbally at all.
Selective Mutism is one of the more severe anxiety disorders in children. It therefore takes some time for a child to learn to talk freely and spontaneously to everyone in all situations. Our experience shows that it takes approximately 12-24 months for Selective Mutism to resolve with an intensive treatment program. However, there are various factors that will impact on the rate of progress. These factors include the age of the child when they first present to treatment, the severity of the condition, the commitment of families and schools to implement the treatment program, and the existence of co-occurring anxieties or other behavioural problems. A child in preschool will often take less time than the above estimate (e.g., 6-12 months), and a child in high school will generally require longer treatment. If a child also has Autism or other severe anxiety disorders, then treatment tends to take longer.
Selective Mutism varies in severity. When a child’s Selective Mutism starts to resolve, there will often be some (often subtle) aspects of the child’s communication that need to be improved. These include their voice volume, moving from using a whisper to using their vocal chords, initiating speech rather than only speaking when prompted, increasing the length of their responses, being assertive, asking for help, joining in discussions, talking in front of larger groups, and generalising talking to other teachers and staff. Furthermore, children with a history of Selective Mutism have potential to regress in the future unless they are encouraged to communicate in all of the above situations to a level that produces minimal anxiety.

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