Selective Mutism (SM) is an anxiety disorder in which an individual consistently fails to speak in social situations where there is an expectation for speaking. Symptoms of selective mutism often present in early childhood. However, diagnosis may be delayed until elementary school where the absence of speech is more noticeable. SM may persist for months, or even years, and may result in social and academic impairment due to difficulty communicating needs and preferences.
CBT addressing selective mutism occurs in two parts. First, the therapist teaches coping and relaxation skills to the child. Second, the therapist engages the individual in gradual, supported, and safe exposure therapy which helps them practice speaking in different situations and with different people. “Fear ladders” provide the individual with a visual hierarchy of goals to which they can refer as they progress. For instance, a “first rung” goal for a child with severe selective mutism might be to communicate non-verbally, with pictures or gestures. The next rung up might be nodding “yes” or “no” to questions. The next rung up might be mouthing words, followed by whispering them. From there, the next rung may involve vocalizing a word or two, followed by full sentences and back-and-forth conversations. Exposures continue until the individual is able to speak with a regular voice in all desired settings and to all desired people.
For treatment of SM you may contact our expert, Dr. Bianca Levy , directly at drlevy@gordontherapygroup.com