Treating selective mutism

With appropriate handling and treatment, most children are able to overcome selective mutism.But the older they are when the condition is diagnosed, the longer it will take.

The effectiveness of treatment will depend on:

• how long the person has had selective mutism
• whether or not they have additional communication or learning difficulties or anxieties
• the co-operation of everyone involved with their education and family life

Treatmentdoesn't focus on the speaking itself, but reducing the anxiety associated with speaking.

This starts by removing pressure on the person to speak. They should then gradually progress from relaxing in their school, nursery or social setting, to saying single words and sentences to one person, before eventually being able to speak freely to all people in all settings.

The need for individual treatment can be avoided if family and staff in early years settings work together to reduce the child's anxiety by creating a positive environment for them.

This means:

• not letting the child know you're anxious
• reassuring them that they'll be able to speak when they're ready
• concentrating on having fun
• praising all efforts the child makes to join in and interact with others, such as passing and taking toys, nodding and pointing
• not showing surprise when the child speaks, but responding warmly as you would to any other child

As well as these environmental changes, older children may need individual support to overcome their anxiety.

The most effective types of treatment are behavioural therapy and cognitive behavioural therapy (CBT) .These are described below, along with some commonly used techniques to overcome anxiety.

Behavioural therapy

Behavioural therapy is designed to work towards and reinforce desired behaviours while replacing bad habits with good ones.

Rather thanexamining a person's past or their thoughts, it concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears.

Several of the techniques below can be usedat the same time by individuals, family members and school or college staff, possibly under the guidance of a speech and language therapist or psychologist.

Stimulus fading

In stimulus fading, the person with selective mutism communicates at ease with someone, such as their parent, when nobody else is present.

Another person is introduced into the situation and, once they're included in talking, the parent withdraws. The new person can introduce more people in the same way.

Positive and negative reinforcement

Positive and negative reinforcement involves responding favourably to all forms of communication and not inadvertently encouraging avoidance and silence.

If the child isunder pressure to talk, they'll experience great relief when the moment passes, which will strengthen their belief that talking is a negative experience.

Desensitisation

Desensitisation is a technique that involves reducing the person's sensitivity to other people hearing their voice by sharing voice or video recordings.

For example, email or instant messaging could precede an exchange of voice recordings or voicemail messages, leading to more direct communication, such as telephone or Skype conversations.

Shaping

Shaping involves using any technique that enables the person to gradually produce a response that's closer to the desired behaviour.

For example, starting with reading aloud, then taking it in turns to read, followed by interactive reading games, structured talking activities and, finally, two-way conversation.

Graded exposure

In graded exposure, situations causing the least anxiety are tackled first. With realistic targets and repeated exposure, the anxiety associated with these situations decreases to a manageable level.

Older children and adults are encouraged to work out how much anxiety different situations cause, such as answering the phone or asking a stranger the time.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) works by helping a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings.CBT also challenges fears and preconceptions through graded exposure.

CBT is carried out by mental health professionals and is more appropriate for older children, adolescentsparticularly those experiencing social anxiety disorderand adults who've grown up with selective mutism.

Younger children can also benefit from CBT-based approaches designed to support their general wellbeing.

For example, this may include talking about anxiety and understanding how it affects their body and behaviour, and learning a range of anxiety management techniques or coping strategies.

Medication

Medication is only really appropriate for older children, teenagers and adults whose anxiety has led to depression and other problems.

Medication should never be prescribed as an alternative to the environmental changes and behavioural approaches described above.

However, antidepressants may be used alongside a treatment programme to decrease anxiety levels and speed up the therapy process, particularly if previous attempts to engage the individual in treatment have failed.