Find a Treating Professional in Your Area
SM Specialists by State/Country
(Link will take you to the Selective Mutism Association's list of resources)
(Link will take you to the Selective Mutism Association's list of resources)
SM State Coordinators by State/Country
(Link will take you to the Selective Mutism Association's list of resources)
(Link will take you to the Selective Mutism Association's list of resources)
Selective Mutism on Facebook
Parents of Children with Selective Mutism
Parents and Caretakers of Teens and Younger Adults with Selective Mutism
SMIRA - Selective Mutism Information and Research Association (UK)
Confident Children - Selective Mutism Therapy
SM Space Cafe - a space for adults/young adults with SM to find support
Selective Mutism Awareness for Adults/Teenagers
Support Groups by State
Arizona
Arkansas
California
Illinois (Chicago & Surrounding Area)
MD, DC, VA & PA Selective Mutism Support
Minnesota
New Jersey
North Jersey
New York (Staten Island)
North Carolina
Washington
Support Groups by Country
Australia
Canada
Ireland
New Zealand
Philippines
Philippines
Scotland
Scotland
Singapore
Sweden
Taiwan
Parents of Children with Selective Mutism
Parents and Caretakers of Teens and Younger Adults with Selective Mutism
SMIRA - Selective Mutism Information and Research Association (UK)
Confident Children - Selective Mutism Therapy
SM Space Cafe - a space for adults/young adults with SM to find support
Selective Mutism Awareness for Adults/Teenagers
Support Groups by State
Arizona
Arkansas
California
Illinois (Chicago & Surrounding Area)
MD, DC, VA & PA Selective Mutism Support
Minnesota
New Jersey
North Jersey
New York (Staten Island)
North Carolina
Washington
Support Groups by Country
Australia
Canada
Ireland
New Zealand
Philippines
Philippines
Scotland
Scotland
Singapore
Sweden
Taiwan
Common Concepts for Treating SM
Selective Mutism Stages of Social Communication Comfort Scale® This is a great starting point to help determine the severity of your child's Selective Mutism. It will give you a way to determine which type of goals you should be working on so your child progresses through the stages to hopefully overcome their Selective Mutism. Another great visual to use is the Social Communication Bridge® to help determine how to move your child from one stage to the next in order to keep them progressing towards the end goal of overcoming their SM.
P.R.I.D.E. skills Pride skills are a great way to build rapport and is used with CDI (Child Directed Interaction) skills. It is a time when all pressure for the child to speak is taken away which will decrease their anxiety and increase the likelihood of them speaking. You are commenting on what they are doing in a positive manner without asking them any questions. Here is an example of what you may say when you are playing blocks with a child and using these skills:
Praise - "Wow, I can't believe how tall you are able to stack those blocks, it looks so cool!"
Reflect - "I wonder what you are going to do next. Oh, I see you are putting a green block on top of the red block." If a child does speak, repeat what they say "Oh, you are going to put a green block on top of the red block, thanks for telling me!"
Imitate: "I'm going to put a green block on top of a red block, too!"
Describe: "I like how you are putting a strong base of blocks down first so they don't fall over as easily."
Enthusiasm: "Wow, this is so fun. I'm so glad we are able to play blocks together!"
Verbal Directed Interaction (VDI): This skill set should be used only after CDI has been done successfully (see above) to ensure the child's anxiety has decreased. If you start when the child is still anxious, it may not be as effective. When using this skill, you want to get a verbal response with every question that is asked. This may take a lot of patience and silence, but the end result should be a verbal response. Here is an example of picking out a cookie:
Open-Ended Question: What kind of cookie would you like? Wait 5 seconds for the child to respond; if no verbal response try a Forced-Choice Question.
Forced-Choice Question: Would you like a chocolate chip cookie or an oatmeal raisin cookie? Wait 5 seconds for the child to respond; if no verbal response try a Yes/No Forced-Choice question
Yes/No Forced-Choice Question: Would you like a chocolate chip cookie? Yes or no? Wait 5 seconds for child to respond verbally; if they respond by nodding their head, ask another Yes/No Forced-Choice Question
Yes/No Forced-Choice Question again: I see you nodding, does that mean yes or no?
At any point they give a verbal response, give immediate praise "Thanks for telling me! Lets get you that cookie!" If the child is unable to give a verbal response let them know that it is ok. You can restart the CDI skills to get them more comfortable, or practice in a more familiar/less anxiety inducing location.
Exposure Therapy: This approach can be used to help an SM child confront their fear of speaking. It can be beneficial to develop a hierarchy of difficult situations with the child to help assist in overcoming their fear. Click here for general information about Exposure Therapy. Here is an example of steps you could take to have your child overcome their fear of speaking in their classroom.
Step 1: be able to talk to their parent in the car in the school parking lot
Step 2: be able to talk to their parent while walking up to the school
Step 3: be able to talk to their parent in the hallway of their school
Step 4: be able to talk to their parent at their locker
Step 5: be able to talk to their parent outside the door of their classroom
Step 6: be able to talk to their parent inside their empty classroom
Step 7: be able to talk to their parent inside their classroom with the teacher in the room
Step 8: be able to talk to their parent inside their classroom with the teacher and 2-3 other students in the room
Step 9: be able to talk to their teacher inside the classroom without their parent present
Step 10: be able to talk to other students inside the classroom without their parent present
Cognitive Behavior Therapy (CBT): This approach is to help the SM child understand where their anxiety comes from and what anxiety feels like. An example could be if a child says they are unable to talk to men, the cognitive approach would be to understand why they are unable to. The child's response could be they don't like the sound of men's low voices. The therapist would then talk with them that the sound of a low voice does not put them in any sort of danger and that they are in a state of worry. The child would then be taught how to self-talk and tell themselves that it is ok to talk to men and the sound of men's voice doesn't affect their own speech. Click here for more information on CBT.
Fade-In/Slide-In Process: fading-in/sliding in is a way to slowing introduce another person for your child to speak to. The goal is to keep the child's anxiety level low so that they can continue verbal communication with someone they are familiar with while an unfamiliar person (i.e. a teacher, student, relative, family friend, etc) slowly comes closer. Here is an example of how you could fade-in a teacher.
Step 1: the child and parent are playing a game of Guess Who in the child's classroom. The child is able to speak comfortably and at a normal speaking volume when it is just the two of them in the classroom.
Step 2: the teacher stands outside the classroom door while the child and parent continue playing the game.
Step 3: if the child maintains normal speaking volume, the teacher can enter the classroom, but near the door.
Step 4: the teacher can continue decreasing the amount of space between them and the child if the child maintains a normal speaking volume while playing the game.
Step 5: the teacher can sit at the same table as the child and parent, but may busy themselves with their own work.
Step 6: if the child is still talking at a normal speaking volume, the teacher may start repeating what the child says "Ooh, wearing a hat, good one!"
Step 7: if the child is continuing to speak at a normal volume, the parent may excuse themselves to the restroom and allow the teacher to play the game with the child.
This process needs to be taken slowly and if at any point the child stops talking or begins whispering, the person fading in must back away. The whole process may not get completed in the first attempt and may need to be repeated on several different occasions in order for the child's anxiety level to decrease enough to continue speaking. Click here to watch a video from Thriving Minds to see how a fade-in can be done.
Rewards: Using rewards (extrinsic motivation) is a great way to help reinforce your chid's speaking when first starting out. Rewards should be something your child loves - candy, ice cream, coins, new small toy, new book, etc - in order for them to be motivated to communicate. Decide with your child "how hard" it would be to do something in order to choose a challenge they could earn rewards for completing. The challenge should be considered medium hard - not too easy and not too hard. Then, decide with your child how they will be rewarded. For example, you and your child decide they are going to practice answering the question "What is your favorite color?" from people at the grocery store. If they are able to answer the question fives times loud enough for the person asking can hear their response, they will get to pick out a pint of ice cream. As challenges get easier, you can increase the number of times they have to complete the challenge in order to get their prize, or you can start working towards harder challenges (i.e. asking someone at the grocery store what their favorite color is). Eventually you want to be able to have the child use intrinsic motivation (being motivated by the way it makes them feel) to use their voice. You can help guide this by talking about what it felt like when they completed their challenge, how it became easier to answer the question the more times they answered it, and how proud you are of them.
For those children who are unable to speak, you can still use rewards. You can give them a "brave ticket" whenever they make eye contact with Grandma, or wave at a passing car, or nod their head to a stranger's question. They can cash in their "brave tickets" for candy or a small toy. These little challenges will help decrease their anxiety and will give you an opportunity to increase the difficulty of the challenges when their anxiety levels are lowered. You want them to be successful and feel good about their brave work so they want to continue.
P.R.I.D.E. skills Pride skills are a great way to build rapport and is used with CDI (Child Directed Interaction) skills. It is a time when all pressure for the child to speak is taken away which will decrease their anxiety and increase the likelihood of them speaking. You are commenting on what they are doing in a positive manner without asking them any questions. Here is an example of what you may say when you are playing blocks with a child and using these skills:
Praise - "Wow, I can't believe how tall you are able to stack those blocks, it looks so cool!"
Reflect - "I wonder what you are going to do next. Oh, I see you are putting a green block on top of the red block." If a child does speak, repeat what they say "Oh, you are going to put a green block on top of the red block, thanks for telling me!"
Imitate: "I'm going to put a green block on top of a red block, too!"
Describe: "I like how you are putting a strong base of blocks down first so they don't fall over as easily."
Enthusiasm: "Wow, this is so fun. I'm so glad we are able to play blocks together!"
Verbal Directed Interaction (VDI): This skill set should be used only after CDI has been done successfully (see above) to ensure the child's anxiety has decreased. If you start when the child is still anxious, it may not be as effective. When using this skill, you want to get a verbal response with every question that is asked. This may take a lot of patience and silence, but the end result should be a verbal response. Here is an example of picking out a cookie:
Open-Ended Question: What kind of cookie would you like? Wait 5 seconds for the child to respond; if no verbal response try a Forced-Choice Question.
Forced-Choice Question: Would you like a chocolate chip cookie or an oatmeal raisin cookie? Wait 5 seconds for the child to respond; if no verbal response try a Yes/No Forced-Choice question
Yes/No Forced-Choice Question: Would you like a chocolate chip cookie? Yes or no? Wait 5 seconds for child to respond verbally; if they respond by nodding their head, ask another Yes/No Forced-Choice Question
Yes/No Forced-Choice Question again: I see you nodding, does that mean yes or no?
At any point they give a verbal response, give immediate praise "Thanks for telling me! Lets get you that cookie!" If the child is unable to give a verbal response let them know that it is ok. You can restart the CDI skills to get them more comfortable, or practice in a more familiar/less anxiety inducing location.
Exposure Therapy: This approach can be used to help an SM child confront their fear of speaking. It can be beneficial to develop a hierarchy of difficult situations with the child to help assist in overcoming their fear. Click here for general information about Exposure Therapy. Here is an example of steps you could take to have your child overcome their fear of speaking in their classroom.
Step 1: be able to talk to their parent in the car in the school parking lot
Step 2: be able to talk to their parent while walking up to the school
Step 3: be able to talk to their parent in the hallway of their school
Step 4: be able to talk to their parent at their locker
Step 5: be able to talk to their parent outside the door of their classroom
Step 6: be able to talk to their parent inside their empty classroom
Step 7: be able to talk to their parent inside their classroom with the teacher in the room
Step 8: be able to talk to their parent inside their classroom with the teacher and 2-3 other students in the room
Step 9: be able to talk to their teacher inside the classroom without their parent present
Step 10: be able to talk to other students inside the classroom without their parent present
Cognitive Behavior Therapy (CBT): This approach is to help the SM child understand where their anxiety comes from and what anxiety feels like. An example could be if a child says they are unable to talk to men, the cognitive approach would be to understand why they are unable to. The child's response could be they don't like the sound of men's low voices. The therapist would then talk with them that the sound of a low voice does not put them in any sort of danger and that they are in a state of worry. The child would then be taught how to self-talk and tell themselves that it is ok to talk to men and the sound of men's voice doesn't affect their own speech. Click here for more information on CBT.
Fade-In/Slide-In Process: fading-in/sliding in is a way to slowing introduce another person for your child to speak to. The goal is to keep the child's anxiety level low so that they can continue verbal communication with someone they are familiar with while an unfamiliar person (i.e. a teacher, student, relative, family friend, etc) slowly comes closer. Here is an example of how you could fade-in a teacher.
Step 1: the child and parent are playing a game of Guess Who in the child's classroom. The child is able to speak comfortably and at a normal speaking volume when it is just the two of them in the classroom.
Step 2: the teacher stands outside the classroom door while the child and parent continue playing the game.
Step 3: if the child maintains normal speaking volume, the teacher can enter the classroom, but near the door.
Step 4: the teacher can continue decreasing the amount of space between them and the child if the child maintains a normal speaking volume while playing the game.
Step 5: the teacher can sit at the same table as the child and parent, but may busy themselves with their own work.
Step 6: if the child is still talking at a normal speaking volume, the teacher may start repeating what the child says "Ooh, wearing a hat, good one!"
Step 7: if the child is continuing to speak at a normal volume, the parent may excuse themselves to the restroom and allow the teacher to play the game with the child.
This process needs to be taken slowly and if at any point the child stops talking or begins whispering, the person fading in must back away. The whole process may not get completed in the first attempt and may need to be repeated on several different occasions in order for the child's anxiety level to decrease enough to continue speaking. Click here to watch a video from Thriving Minds to see how a fade-in can be done.
Rewards: Using rewards (extrinsic motivation) is a great way to help reinforce your chid's speaking when first starting out. Rewards should be something your child loves - candy, ice cream, coins, new small toy, new book, etc - in order for them to be motivated to communicate. Decide with your child "how hard" it would be to do something in order to choose a challenge they could earn rewards for completing. The challenge should be considered medium hard - not too easy and not too hard. Then, decide with your child how they will be rewarded. For example, you and your child decide they are going to practice answering the question "What is your favorite color?" from people at the grocery store. If they are able to answer the question fives times loud enough for the person asking can hear their response, they will get to pick out a pint of ice cream. As challenges get easier, you can increase the number of times they have to complete the challenge in order to get their prize, or you can start working towards harder challenges (i.e. asking someone at the grocery store what their favorite color is). Eventually you want to be able to have the child use intrinsic motivation (being motivated by the way it makes them feel) to use their voice. You can help guide this by talking about what it felt like when they completed their challenge, how it became easier to answer the question the more times they answered it, and how proud you are of them.
For those children who are unable to speak, you can still use rewards. You can give them a "brave ticket" whenever they make eye contact with Grandma, or wave at a passing car, or nod their head to a stranger's question. They can cash in their "brave tickets" for candy or a small toy. These little challenges will help decrease their anxiety and will give you an opportunity to increase the difficulty of the challenges when their anxiety levels are lowered. You want them to be successful and feel good about their brave work so they want to continue.
Additional Resources
Parent Essentials: Helping Your Child With Selective Mutism: Coursework from Confident Children to help parents learn what they need to do if they suspect their child has SM or if they have been recently diagnosed with SM. It takes the feeling of being overwhelmed away by giving you the information you need to get started down the right path.
Interoception: a sense that allows your body to know what it is feeling on the inside in any situation. When we can understand what the body signals mean, we can have a better opportunity to manage those signals or respond to those signals. For example, if you are thirsty, you may feel your mouth getting dry, so you get something to drink. If the interoception system isn't fully developed, internal signals may be misinterpreted, not interpreted at all, or become too intense to interpret . This can be common for those with anxiety, sensory processing disorder, autism, and other conditions. For more information, click here.
Reflex Integration: reflexes are an automatic response to help us grow, develop, and survive. Some reflexes become integrated as we age which means the reflexes have developed into different, more complex movements. However, in some individuals, certain reflexes they have when they are in infancy don't become integrated. This can contribute to issues with anxiety, learning disorders, behavioral issues, sensory issues, and others. Various Neurodevelopment Movements can integrate reflexes which allows the nervous system to rebuild. For more information on common unintegrated reflexes and what conditions may arise, click here.
About Me: One way for a teacher to get to know an SM child is to create an "About Me" handout prior to the start of a new school year. This can be a one page synapsis on what your child likes and a quick "How to" when it comes to interacting with your child. Any teacher that may come in contact with your child should get a handout and any substitute teacher should have an opportunity to read through it as well. To create your own About Me handout, click HERE for a downloadable template for Microsoft Word or for a template on Canva, click HERE. **If using the Canva template, please undo all the changes after you have downloaded it so it is in its original form for the next person.
Interoception: a sense that allows your body to know what it is feeling on the inside in any situation. When we can understand what the body signals mean, we can have a better opportunity to manage those signals or respond to those signals. For example, if you are thirsty, you may feel your mouth getting dry, so you get something to drink. If the interoception system isn't fully developed, internal signals may be misinterpreted, not interpreted at all, or become too intense to interpret . This can be common for those with anxiety, sensory processing disorder, autism, and other conditions. For more information, click here.
Reflex Integration: reflexes are an automatic response to help us grow, develop, and survive. Some reflexes become integrated as we age which means the reflexes have developed into different, more complex movements. However, in some individuals, certain reflexes they have when they are in infancy don't become integrated. This can contribute to issues with anxiety, learning disorders, behavioral issues, sensory issues, and others. Various Neurodevelopment Movements can integrate reflexes which allows the nervous system to rebuild. For more information on common unintegrated reflexes and what conditions may arise, click here.
About Me: One way for a teacher to get to know an SM child is to create an "About Me" handout prior to the start of a new school year. This can be a one page synapsis on what your child likes and a quick "How to" when it comes to interacting with your child. Any teacher that may come in contact with your child should get a handout and any substitute teacher should have an opportunity to read through it as well. To create your own About Me handout, click HERE for a downloadable template for Microsoft Word or for a template on Canva, click HERE. **If using the Canva template, please undo all the changes after you have downloaded it so it is in its original form for the next person.
Click HERE to get even more information about Selective Mutism from Professionals around the world!
