Cognitive Behavioral Therapy (CBT) for Selective Mutism in San Jose

What is Selective Mutism?

Selective mutism is a childhood anxiety disorder characterized by a child or adolescent's inability to speak in one or more social settings (e.g., at school, in public places, with adults) despite being able to speak comfortably in other settings (e.g., at home with family).  These children  understand language use and, although they have the physical and cognitive ability to speak, they demonstrate a persistent inability to speak in particular settings over a particular period of time due to anxiety. 

How do I know if my child has Selective Mutism?

Children suffering from selective mutism may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking. These children can be very talkative and display normal behaviors at home or in another place where they feel comfortable. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school. The average age of diagnosis is between 4 and 8 years old, or around the time a child enters school.

To meet diagnostic criteria, the child or adolescent with SM shows significant impairment in daily functioning, typically in educational or occupational settings, and by refraining from social participation at school and other settings due to a pronounced fear of speaking. Most affected children and adolescents function normally in other ways and learn age appropriate skills; however, some may have other comorbid anxiety disorders, developmental delays such as impaired social skills, and communication disorders in addition to selective mutism. Selective mutism differs from the developmentally appropriate behavior of a child with limited speaking and social interaction behaviors during the first month of school or daycare when he or she is adjusting to a new social environment with peers and teachers. Selective mutism differs from shyness, which is a socially adaptable personality trait.

What is the treatment for Selective Mutism?

The main goals of treatment are to lower anxiety, increase self-esteem and increase social confidence and communication. Emphasis should not be on getting a child to talk. With lowered anxiety, confidence, and the use of appropriate tactics/techniques, communication will increase as the child progresses from nonverbal to verbal communication.

While I tailor my treatment approach to the child and family I am working with, most children can benefit from a combination of:

Empathy and Trust: Treatment starts with developing a therapeutic relationship that establishes trust and safety with your child. 

Assessment and Treatment Planning: I will work with you and your child to thoroughly assess the possible triggers and maintaining factors for your child's selective mutism.

Behavioral Therapy: Positive reinforcement and desensitization techniques are among the primary behavior techniques for Selective Mutism, as well as removing pressure to speak.

Cognitive Behavioral Therapy: CBT can help your child learn to manage their fears and worries in a more realistic and helpful way. Many children with Selective Mutism worry about others hearing their voice, asking them questions about ‘why they do not talk’ and trying to force them to speak. The focus in CBT is on emphasizing the child’s positive attributes, building confidence in social settings, and lowering overall anxiety and worry.

School involvement: I'll work with you so you can educate teachers and school personnel about selective mutism, helping them to understand that your child is not being defiant or stubborn by not speaking, that they truly can't speak due to their anxiety. As the child progresses with treatment, the teacher should be involved in the treatment plan with verbalization being encouraged in subtle, non-threatening ways. An Individualized Educational Plan or 504 Plan may be necessary to help accommodate your child’s inability to communicate verbally and to help your child progress communicatively as well as build social comfort.  If needed, I may go to the school to observe your child at school and talk to teachers.

Family involvement: Family members must be involved in the entire treatment process. Changes in parenting styles and expectations might be needed to help your child.