The Selective Mutism Clinic provides assessment and treatment of Selective Mutism and extreme shyness in preschoolers, school-aged children, teenagers, and adults with selective mutism throughout Australia. Families in remote and rural areas can access our service through our ‘Outreach’ program. Services are also available at the clinic for other childhood emotional and behavioural problems. Adults with Selective Mutism or Social Anxiety Disorder (‘Social Phobia’) can receive treatment from the clinical psychologists at our clinic who provide treatment for adults.
Our Psychologists and Speech Pathologists are currently providing face-to-face, video or phone consultations for all clients.
SYDNEY-BASED TREATMENT PROGRAM
Assessment and program planning
Your family will be seen by one of our Clinical Psychologists or Speech Therapists who have extensive training and experience in treating selective mutism. Families who attend the clinic first undergo a comprehensive assessment.
The program involves the child and parent and uses specific evidence-based strategies to teach the child how to manage their anxiety in preschool/school and in public, thus enabling them to enjoy communicating and lead a less-anxious childhood. Many children who we work with also have other issues, such as behavioural issues at home, self-esteem issues, emotion regulation, phobias, toileting and eating issues, Autism Spectrum Disorder (ASD), learning difficulties, speech and language difficulties (separate from the selective mutism), and social skills difficulties. Each of these issues can be assessed and targeted as part of the overall treatment program.
The treatment strategies are mostly Cognitive Behavioural Therapy (CBT) because research and our experience has shown that these are the most effective treatment strategies for selective mutism. There are many strategies that are specific to selective mutism treatment such as a ‘Sliding In’ technique, and differ somewhat from standard strategies used for social anxiety. 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 (such as the shops and extracurricular activities), and in other settings. A successful program requires both parents and classroom teacher to be motivated and committed to working on strategies to help the child.
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. We often have children at the end of the treatment talk in front of the school assembly! So it is a condition, like other anxiety disorders, that can resolve completely. However, there are various factors that will impact the child’s rate of progress. These factors include the age of the child when they first present to treatment, the severity of the condition, the commitment and motivation of parents and teachers to implement the treatment program, and the existence of co-occurring conditions (e.g., other anxieties, behavioural problems, or ASD). A child in preschool will often take less time than the above estimate (e.g., 6-12 months), and a teenager in high school will generally require longer treatment. Because the commitment and motivation of the classroom teacher plays a large role in these children’s response to treatment, we usually spend considerable time helping the school to select the most appropriate classroom teacher. For this reason, we encourage parents to start the program before the new school year, rather than “waiting to see how the child goes”.
School treatment program
The Selective Mutism Clinic implements an intensive school or preschool program and provides the classroom teacher and other relevant school personnel (e.g., learning support, aide, vice principal, principal, counsellor/psychologist, speech pathologist) with regular video consultations to support them to implement this program (i.e., a 45-minute video consultation with summary email every 4-6 weeks). The classroom teacher (or a ‘key worker’ for teenagers in high school) must be present for these consultations as the main strategies discussed are intended for the classroom teacher to implement in the classroom during their daily teaching as well as in individual sessions with the child and parent.
Following the initial assessment with the family, a video consulation with the classroom teacher (or high school ‘key worker’) is organised, which involves gathering information about how the child is going at school, in terms of their communication, anxiety, social skills, academic skills, and emotion regulation. We also start to provide education about selective mutism and the treatment program that we are recommending for the child in the school. Following this consultation, the classroom teacher and supporting staff receive ongoing video consultations in which the classroom teacher is trained to implement the program in the school that will help to reduce the child’s anxiety and gradually move them towards confident communicating. Each video consultation is followed by a summary of the child’s progress with the program and our recommended strategies to implement at school. Generally the family pays for these school consultations unless other arrangements are made. We realise that the school program is intensive, however with the right support from the school, most teachers find the consultations to be invaluable professional development for learning about anxiety and other psychological issues in children. Most schools provide support for the teacher to allow them to carry out our program, and we are happy to speak with principals and support staff if they are any specific enquiries about the program.
Frequency of sessions, costs, and rebates
The frequency of sessions at the Selective Mutism Clinic after the initial two sessions will vary from family to family and will be arranged with the therapist throughout the course of treatment. We are aware that treatment for Selective Mutism is generally long-term (i.e., 9-24 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 1-2 weeks). This is to provide more intensive support initially while developing and getting the treatment program under way. We then gradually lengthen the time between sessions (e.g., every 3-6 weeks depending upon the child’s progress, 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 treatments for other childhood psychological conditions), 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 and communication.
Each session after the initial assessment lasts approximately 50 minutes and costs $260. Medicare rebates are available for children who have a Mental Health Care Plan (MHCP) via their GP, Paediatrician, or Psychiatrist and allow you to claim a rebate for each session (up to 10 sessions every year). School video consultations are generally paid for by the parents, unless other arrangements are made, and cost $260 for a 45-minute consultation, which is followed by an email to the school and parent(s) which summarises the child’s progress and recommended strategies. We can do school visits in the greater Sydney area, however we generally find that this is not necessary. Medicare can cover the cost of two school video consultations per calendar year (as part of the 10). NDIS and private health funds may also cover these sessions depending upon your health fund and level of cover.
ONLINE TREATMENT PROGRAM
The Selective Mutism Clinic’s ‘Online treatment program’ is available for families throughout Australia, including Sydney, Melbourne, Brisbane, Adelaide, Perth, Canberra, Darwin, as well as rural and remote areas and where there are no specialised services for Selective Mutism. This program is delivered via regular video consultations to the parents and child and also to the classroom teacher and relevant school personnel.
Online program – assessment options
- One option for assessment for families in the Online program is an initial face-to-face, combined assessment and session at the clinic in Sydney. This is a 3-hour session, where the parent(s) attend the first half alone, and the child attends the second half with their parents. For younger children it is recommended that someone is available to mind the child for the first half (which can be one of the parents). The cost of the 3-hour appointment is $780.
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 to you in that session and observe your child’s level of responsiveness. 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 opt for a video assessment rather than a face-to-face assessment.
- When attending the clinic in person is not an option or not convenient, an assessment can be held with the parent(s) over video. This assessment lasts for approximately 1 hour and costs $290. Following the assessment above, the child and their parent(s) receive ongoing video consultations to learn strategies to manage anxiety and other emotions, and work on building communication with the clinician. Strategies will also be taught that enable the child to build their communication in the school program and in other social situations outside school. The cost of these 50-minute consultations are $260.
Effectiveness of Online Therapy for Selective Mutism
Several studies have shown that online treatment for Selective Mutism in children is effective. One study published in the Journal of Child and Adolescent Psychopharmacology found that virtual reality exposure therapy improved Selective Mutism symptoms in children aged 5-12 years old. The study concluded that the virtual reality exposure therapy was a promising and effective treatment for Selective Mutism.
Another study published in the Journal of Telemedicine and Telecare found that internet-based CBT significantly improved Selective Mutism symptoms in children. The study concluded that internet-based CBT was a viable alternative to traditional face-to-face treatment for selective mutism.
During the Covid outbreak in 2019-2021 we refined our treatment online for children with Selective Mutism. We now have highly effective online strategies to help children start talking to their therapist and to generalise their talking to other adults and children. One online strategy is a modified version of our in-clinic strategy, which involves the parent playing a talking game with their child at home, and the therapist (who is on a laptop or other portable device) is placed in a different room in the house to the child, and then gradually moved closer to the child/parent until the therapist is able to comment on the game and eventually join in the game such that the child is talking to the therapist. We have found with many children, particularly those in preschool and primary school that this online strategy can even be faster than our traditional face-to-face strategies in helping a child start to communicate with others. This technique can work for children as young as 2 years of age, as well as adolescents and adults. Whilst many adolescents respond well to this online technique as well, we do find that some adolescents have a strong preference for face-to-face sessions over video sessions, in which case we encourage the adolescent to come into the clinic, if possible. If this is not possible then we can work with the parents alone initially, or we would recommend seeking face-to-face treatment elsewhere.
School Treatment Program for Outreach Families
The school treatment program in the Outreach program runs in the same manner as our local program that Sydney-based families receive – this involves 45-minute video consultations with the classroom teacher and other supporting staff at regular intervals (usually every 4-6 weeks) throughout the course of treatment. The frequency of the video consultations depends upon many factors including the child’s progress, and the ability of the parents to work independently on homework exercises in between the consultations. We understand that due to finances, parents may want to space out the sessions further than we would generally recommend, in which case we will let you know if we believe the sessions are not frequent enough to be effective. The Selective Mutism Clinic’s ‘Outreach service’ has been successfully provided to children and their families throughout Australia for over 15 years, including Melbourne, Canberra, Brisbane, Adelaide, Perth, Darwin, Hobart, as well as rural and remote areas.
Webinars about Selective Mutism Strategies
The clinic Director / Clinical Psychologist, Dr Elizabeth Woodcock, has conducted a series of webinars for parents, teachers, and other health professionals about Selective Mutism.
In our experience, families who start treatment having already watched one of our 3-hour webinars, make faster progress with the strategies that are taught as they have a thorough understanding of the techniques that we are discussing. See details of this webinar here. In addition, it is also highly beneficial for your child’s progress if you can help the classroom teacher to understand the benefits of watching the 3-hour webinar for schools. See details of the school webinar here. A high school version of the webinar is available here.