Treating Selective Mutism in Children

In children with selective mutism, we can welcome any form of communication.

“It took me quite a long time to develop a voice, and now that I have it, I am not going to be silent.”

– Madeleine K. Albright

Some children chatter endlessly at home, their thoughts spilling out in bright, effortless streams. Yet place the same child in a classroom, among unfamiliar adults, or even beside certain relatives, and the words disappear completely.

Juliet was like that. Nine years old, clever, creative, but unable – or, as her dad said, “unwilling” – to speak to anyone except her nearest and dearest.

Eventually they brought her to see me.

Allowing, not forcing

We don’t force, cajole, or threaten someone to speak, but we can be kind and offer them the space in which to find their voice. Actually, ‘finding your voice’ is, I think, a better reframed metaphor than the literal ‘having to speak’.

We find something when we’re ready to find it, and when it is ready to be found.

Pressure can, of course, be worse than useless. Juliet’s father felt she was “wilfully” refusing to speak, and yet what I saw in the child wasn’t obstructive self-assertion but real fear.

It’s not what it seems (to some)

To an outside observer, the silence of selective mutism can look oppositional, avoidant, even wilful. But selective mutism is often none of those things.

It is, at heart, an anxiety response and, like all anxiety, it softens not through pressure, but through understanding. The child who is selectively mute may come to depend on someone ‘speaking for them’. Or they may have been brought up in a noisy household in which their own voice always felt ‘drowned out’.

When we dig deeper, we can see what’s really going on.

What selective mutism really is

Selective mutism (SM) is strongly linked with social anxiety. Most children who experience it are not choosing silence; they are experiencing genuine fear in specific social situations, which forces silence upon them.

Yes, some clients are reluctant to speak and naturally laconic, but SM goes well beyond this.

Often there is an inborn sensitivity to anxiety. Some children’s internal alarm systems simply trigger more quickly, as though the brain’s threat detector has been set a little too high. Situations that seem ordinary to others can feel overwhelming to them.

Juliet looked genuinely scared when her parents brought her to me. Her mother was keen to assure me of one thing though: Juliet had not been diagnosed with autism.

Autism and selective mutism are different conditions, but can overlap. One study found up to 63% of children diagnosed with SM also meet the diagnostic criteria for autism.¹

Regardless of whether autism is a feature or not (and it certainly isn’t always), SM is driven by anxiety, and anxiety can be treated. Even if Juliet had been autistic, I think my treatment of her would have followed a similar course.

So what fears might be behind the freeze response when it comes to verbalization?

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Fear of verbalization

Fears that drive SM might include but are not limited to:

• Fear of making mistakes or saying ‘something stupid’
• Fear of meeting new people
• Fear of presenting their voice, which they may believe to be ‘ugly’ or ‘sound weird’.

Additional factors may also play a part:

• Sensory sensitivities to sound, light, or touch
• Speech or language delays
• Learning differences
• Navigating a second language
• A naturally cautious or shy temperament

Seen this way, the silence begins to make sense. And when something makes sense, we can work with it rather than against it.

Of course, communication happens whether a person speaks or not. So we can welcome any form of communication: nodding, pointing, whispering to a trusted person, drawing, even writing.

I asked Juliet not to speak yet, a form of paradoxical intervention. Freed from pressure, she seemed to relax – while the “yet” left the door open.

I learned from her mother that Juliet liked to draw. I gently wondered aloud whether she could draw herself at school and made paper and pens available to her.

As her mum chatted to me, Juliet drew herself in the middle of lots of faces. It seemed clear she felt ‘on display’ at school and she had communicated that to me, all without words.

I wondered whether she could draw another picture of herself at school being “really happy”. This time she drew herself smiling and seemingly interacting with a few other children while the rest of her class were doing other things.

Paradoxically, when speaking is no longer demanded, it often becomes possible.

But we also, as with any problem, need to know, as far as possible, its possible genesis.

Two: Find out when and how it started

I asked the mother privately when the mutism had started and she said it had been sporadic at first but had led to an almost complete shutdown of speech with “outsiders”. Juliet’s older sister had been bullied at school and also by some girls (from her school) in the street. Although the issue had been resolved, her sister’s unhappy experiences had clearly affected Juliet.

Any intervention would need to deal with a fear of being bullied or ridiculed as well as the fear of speaking itself.

I explored with Juliet (okay, I talked on my own with her present) all the potential ways a child and the adults in her life might deal with bullying if it ever happened.

I wanted her to feel that bullying can be survived, countered, and even perhaps conquered.

Next, going by the principle that stories are therapy, I started to interweave stories and metaphors.

Three: Use stories to rehearse bravery

Young children live close to imagination. Stories are not just entertainment; they are emotional rehearsals for real life.

You might tell gentle stories with themes such as:

• Words being like small animals that sometimes need quiet before they feel ready to come out and play
• A child who can speak freely in one place but forgets she can also speak in another, until one day she remembers
• A shy creature who begins at the edge of a group and slowly discovers it’s become safe to join

Psychology has long known the power of modelling. In one classic line of research, which I just can’t find I’m afraid, very shy children simply watched a film of another shy child gradually joining in with peers. Nothing else was done.

Yet their behaviour became noticeably more confident, and the change was still evident even months later when the researchers went back into the school. There have also been more recent iterations of this research with the same findings.²

Storytelling as modelling therapy

A well-told story can work in much the same way, quietly widening what feels possible.

I told Juliet’s mother, in front of Juliet – who, despite drawing freely now, was clearly listening – a story about a little girl who had to say some very important things but had forgotten she could speak. In the story, frustration builds to the point where it’s clear our heroine needs to speak in order to protect herself and others but believes it’s not possible.

At last, a kind old woman gives her a magic stone to keep in her pocket. The girl miraculously finds her voice under a big mountain and then can speak. She loses the stone but realizes the voice came from her anyway and the stone was “just to help her believe”.

To our amazement, at the end of the story Juliet echoed the word believe very quietly. Her mum later told me that was the first word her daughter had said to a non-family member in a year.

Calm and physical relaxation signals to ourselves that we are safe. Therefore we can also seek to help the child physically relax.

Four: Calm the body to free the voice

Because selective mutism is rooted in anxiety, helping the body feel safe is essential.

Breathing techniques are simple, portable, and surprisingly powerful, especially when wrapped in play:

• Smelling a flower, then blowing out a candle
• Filling a balloon in the tummy
• Slow, steady breaths that fill the child with magic.

We can suggest the child can do this whenever they want to “feel brave”. The language matters. I don’t tend to talk about “relaxing” to a child but rather feeling “nice and brave” or “sleepy and happy”.

We are helping the child feel calm and brave at the same time.

Practised regularly, not only in stressful moments, these small rituals teach the nervous system a new way of being.

And when the body settles, speech often follows.

Five: Shift identity through gentle responsibility

Confidence rarely grows through being told to be confident. It grows through experience. Confidence is a byproduct of certain experiences.

Sometimes a subtle change in role can help. For example, being given small responsibilities can enlarge self-perception:

• Looking after a younger child
• Handing out classroom materials
• Caring for a pet or plant.

Responsibility, when safe and manageable, sends the message: You are capable. You are needed. You belong here.

The focus goes from being directed inward to being directed outward. I discussed with Juliet’s mum the possibility of her talking with Juliet’s teacher about giving Juliet some kind of responsible role. Nothing too daunting. Perhaps just being asked to look out for a new pupil.

And as identity shifts, anxiety often loosens its grip.

The child is no longer simply “the quiet one”. They become the helper, the guide. The one who knows what to do.

Because speech then becomes not just self-expression but more to do with day-to-day expedience, it’s more likely natural speech will have room to develop.

But if you’re skilled in inner client work, the next idea can really elevate treatment for SM.

Six: Use mental rehearsal

I used hypnosis directly alongside storytelling to help Juliet mentally rehearse calmly talking.

I encouraged her to close her eyes, feel “sleepy and brave”, breathe in the calming way I’d taught her, and imagine watching herself on a screen in her mind talking to the whole class. Then just talking to one or two people at a time. I didn’t ask her to do these things in reality but simply had her strongly envisage communicating verbally over and over while she felt relaxed.

Above all, the child needs to feel:

• They are safe.
• They are understood.
• Their voice is welcome.

Children’s development is fluid, not fixed. What seems immovable today can shift surprisingly fast once fear begins to fade.

Juliet began to say the odd word to me during the sessions. I found I could make her laugh, and after three or four sessions she started to talk in sentences. I simply created the right environment for that to happen and taught her how to relax with the feeling of being able to express herself.

Eventually a new girl joined her class at school and the teacher sat her next to Juliet. The new girl was very shy and Juliet was given a little responsibility.

Her teacher asked her to just make sure the new girl was okay. Juliet spoke to the girl and also to the teacher and other children. She began to integrate. But the change had not been forced – simply given space to happen.

A gentler way to think about speaking

Perhaps we don’t need to frame the treatment of SM as ‘getting a child to talk’. I think this sort of work is closer to helping the child discover that speaking can feel good.

You might even playfully suggest that when people can hear clearly not whispers but real words, their ears feel happier. I talked quite a lot about “happy ears” to Juliet. I didn’t put pressure on her to make other people’s lobes happier but rather talked in general about other people and speaking.

Because children are inherently curious and imaginative, I built up a sense in Juliet of adventure and discovery.

• “What might it be like when…?”
• “What will the best things be, do you imagine…?”

I framed speaking as “sharing” and “good words” as “gifts”. But I want to stress I interspersed these ideas into a wider framework of just focusing on helping Juliet feel calmer in herself. No pressure, just curiosity.

Juliet began to say the odd word. Her mum would ask her something or even I would and she’d say “yes” or “no.” She began to use fuller sentences bit by bit. I gave her room to express herself and apparently she’d started talking more to other non family members. It wasn’t sudden but it was steady.

She had found her voice, and it was a real pleasure to start listening to her. In a world that likes to speak but not always listen, perhaps we could all learn to listen more.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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