What Types Of Support Help Children With Selective Mutism?
TL;DR: The Quick Download
Selective Mutism (SM) can keep kids stuck in a cycle where avoidance feels safe and adults unknowingly reinforce it through well-intentioned accommodation.
Effective support for SM begins with a single warm and positive relationship, with the trusted adult then gently coaching a child through gradual “brave” exposures — small, supported steps that build bravery and confidence.
Expert-delivered behavioral therapy, parent coaching, and school collaboration form the foundation of progress for most children.
Speech or occupational therapy can be helpful when language, sensory, or regulation challenges are also part of the picture — as long as treatment remains anxiety-informed.
Early, coordinated support gives children the safety and tools they need to practice approaching their fears, build confidence, and let their true personality shine in any setting.
It often starts quietly. A teacher mentions that your child didn’t speak to any adults at school last year. A friend realizes they’ve never heard them talk. You start noticing patterns — school drop-offs are hard, birthday parties are harder, and your once-chatty child seems to disappear in certain settings.
You try to help: you reassure, you speak for them, you give them time. And yet, the problem deepens. That’s because anxiety has a way of turning adult’s good intentions into a loop that keeps everyone stuck.
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When Anxious Avoidance Feels Safer Than “Brave”.
Anxiety has a function: to keep us safe.
When something feels threatening — like being called on to give an answer in front of the class, walking up to a group of friends, or having eyes on you during a performance — the body’s instinct is to retreat. That retreat brings incremental, short-term relief. And the body quickly files this away as a “solution”, even though it doesn’t stop anxiety from spiking the next time the child is in a similar situation. Often, a child’s anxious avoidance is met with some form of environmental accommodation . Parents and teachers, trying to protect, often step in to shield the child from distress. They speak for them, skip over triggering situations, or lower expectations to make things easier.
This cycle of negative reinforcement — defined as the removal of an aversive leading to the increased likelihood of a behavior occurring again — is incredibly powerful. The increment of relief that children feel from some form of anxious avoidance and their environment feels from some form of accommodation is enough to keep this cycle going. Practice something enough times and you’ll get really good at it! In that way, children often miss numerous opportunities to practice acting opposite to their anxiety, and it’s one of the main reasons anxiety grows stronger over time.
Breaking this cycle means retraining the system. Children need carefully crafted experiences to teach them they can tolerate small doses of anxiety and still be okay. Over time, they work towards higher-level goals and more firmly establish a cycle of approach that helps counter their history of anxiety.
The Heart of Effective Treatment.
The most powerful treatments for SM begin with connection. Kids can only practice brave when they feel safe with the person coaching them to try. That’s why, at Square One Psychology, we focus first on warmth, playfulness, and trust before layering in challenges.
From there, progress is built by gently coaching a child to practice approach when their nervous system is otherwise calling for avoidance. We call these small, structured steps that help a child build tolerance for uncertainty and social risk as “increments of brave”. And brave certainly comes in a package.
Increments of brave approach might include: walking towards a peer, joining a group game, or moving more freely in a once-intimidating space
Increments of brave looking up might include: facing someone directly, smiling towards a new person, or making brief eye contact.
Increments of brave talking might include: whispering a short response to a trusted adult, answering a peer’s question, reciting a pre-rehearsed show-and-tell presentation in front of the class.
The goal is for children to learn through experience that anxiety can dissipate and/or that they can tolerate the discomfort when they stay engaged. Each successful step in treatment is measured by a child’s ability to tolerate an increment more of anxious distress, to demonstrate an increment of brave approach. This type of courage grows from intentional exposures, repetition, and relentlessly supportive coaching. It is not about speed.
Parents (and Teachers) as Key Agents of Change.
Anxiety thrives on rescue, so our work often starts by changing how adults respond to their own anxious distress when a child with SM is prompted to speak. Instead of filling the silence, practice waiting a few more seconds. Instead of coaxing a child to speak, model calm curiosity and olive-branch space for the child to respond. Instead of rewarding only ‘perfect’ speech, celebrate a child’s effort to practice flexibility, approach, and brave talking - tolerating adults’ brave coaching, a step forward, a whisper.
Parents are essential to this process. In our parent coaching sessions, we guide caregivers to notice when, and to what degree, their child’s anxiety kicks in and how to respond in ways that encourage brave behaviors rather than reinforce avoidance. By helping parents learn how to effectively be their child’s “brave talking coach”, children receive consistent support outside of the office and learn to generalize their brave successes to birthday parties, visits with extended family members, and on playdates. At Square One Psychology, we also offer teacher training and support to help relevant school staff also learn key skills and strategies to help a child practice “brave” at school. Over time, these micro-adjustments create big shifts in confidence.
Additional Supports, Beyond Behavioral Therapy.
Behavioral therapy — specifically, Parent-Child Interaction Therapy Adapted for Selective Mutism (PCIT-SM) — has been shown to be a gold-standard intervention for children with SM and is often recommended as the first-line approach. However, other supports can sometimes also play an important role in a child’s treatment plan:
Speech Therapy: Selective Mutism is not a speech disorder, but some children may also experience articulation or expressive-language delays. In those cases, speech therapy can support progress — if the provider understands SM and doesn’t push for speech prematurely.
Occupational Therapy: If a child struggles with sensory processing or regulation (e.g., sound sensitivity, movement challenges, or difficulty self-soothing), occupational therapy can help. A good occupational therapist can design strategies to support a child in sensory-heavy environments like classrooms, and, in turn, help set the stage for brave talking exposures led by trained adults (e.g., teacher, PCIT-SM certified therapist).
School Collaboration: Even one informed teacher at school can make a difference. We often collaborate directly with schools to ensure consistency between therapy and classroom-based supports. This may involve a one-off teacher training, a series of consultation sessions, or even collaboration on a child’s Individualized Education Plan (IEP) or 504 Plan, if needed.
Medication: In more severe cases, selective serotonin reuptake inhibitors (SSRIs; such as Fluoxetine or Sertraline) can help lower a child’s baseline anxiety enough to make progress possible. It is important to note that medication supports behavioral therapy — it doesn’t replace it. The medication evaluation and ongoing medication management should be completed by a board certified psychiatrist experience in treating SM.
Square One Psychology works directly with families, schools, and adjunctive providers to build treatment plans that hold steady — even outside the therapy room.
An Effective Treatment Plan Looks Different for Every Child.
There is no single formula for helping a child overcome SM. Some benefit from just behavioral therapy and school collaboration; others benefit from more layered support, including speech or occupational therapy. What matters most is that the intervention is personalized, evidence-based, compassionate, and consistent.
At Square One Psychology, we offer expert-led exposure practice for children in our office and across school and community settings, parent coaching, school consultation, and intensive group behavioral therapy programs, all in service of providing a child with a sufficiently therapeutic “dose” of behavioral treatment in a coordinated way. When the right people, tools, and structure come together, kids with SM learn that brave is possible — and that their voice has power.
Ready For The Next Steps?
Selective mutism can feel isolating. But it doesn’t have to stay that way. With the right support, kids can find their voice — one brave step at a time. Square One Psychology offers targeted programs built specifically for children with SM.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Dow, S., Sonies, B., Scheib, D., Moss, S. E., & Leonard, H. L. (1995). Practical guidelines for the assessment and treatment of selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 836–846.
Kurtz Psychology. (2019). Medications for SM: Facts & Fears. Retrieved from https://www.kurtzpsychology.com/wp-content/uploads/2019/07/Medications-for-SM-Facts-Fears.pdf
Kurtz Psychology. (n.d.). What is Selective Mutism? Retrieved from https://www.kurtzpsychology.com/selective-mutism/what-is-selective-mutism-2/
NHS. (n.d.). Selective Mutism. Retrieved from https://www.nhs.uk/mental-health/conditions/selective-mutism/
Schneider, S. C., & Goldstein, M. E. (2019). Selective mutism: Current perspectives. PubMed Central. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31351241/
Viana, A. G., Beidel, D. C., & Rabian, B. A. (2009). Selective mutism: A review and integration of the last 15 years. Clinical Psychology Review, 29(1), 57–67.