Journal of Speech Pathology & Therapy
Open Access

Selective mutism is an anxiety-related communication disorder that affects approximately 1% of children, typically emerging in early childhood. It is characterized by a consistent failure to speak in specific social situations—such as at school or in public—despite speaking comfortably in more familiar environments, like at home. This persistent silence can significantly interfere with academic performance, peer relationships, and overall social development [1-6].

Often associated with social anxiety, selective mutism is not the result of a language deficit or a lack of knowledge but rather a complex interplay of psychological, Behavioral, and sometimes familial factors. Early identification and intervention are critical, as the condition can become more entrenched over time if left unaddressed.

Effective treatment requires a comprehensive, multidisciplinary approach that includes detailed assessment of the child’s communication abilities, emotional state, and environmental influences. Interventions are most successful when they are individualized, gradual, and supported by collaboration between families, educators, and mental health professionals. Speech-language pathologists also play a vital role in supporting communication goals within the broader treatment framework.

 “Emily,” a 7-year-old girl, presented with a 2-year history of not speaking at school while communicating normally at home. Parents reported increased anxiety symptoms and avoidance behaviours. Standardized assessments ruled out speech or language impairments, confirming a diagnosis of selective mutism.

Intervention

A multimodal treatment plan was implemented:

• Cognitive-Behavioral Therapy (CBT): Focused on anxiety reduction, gradual exposure to speaking situations, and coping skills.

• Speech Therapy: Targeted communication skills, vocal exercises, and reinforcement of verbal attempts.

• Family Counseling: Educated parents on supportive strategies and encouraged collaboration with school personnel.

Outcomes

By the end of therapy:

• Emily began speaking in small group activities at school.

• Anxiety symptoms decreased as reported by parents and teachers.

• Increased social participation and willingness to communicate were observed.

• Follow-up at three months showed sustained improvements.

Discussion

This case highlights the efficacy of a multidisciplinary approach that integrates both psychological and speech-language interventions in the treatment of selective mutism. Addressing the emotional and Behavioral components of the disorder through anxiety-reduction techniques, while simultaneously supporting the development of functional communication skills, proved essential for progress. The collaboration between mental health professionals and speech-language pathologists allowed for a more holistic and responsive treatment plan tailored to the child’s specific needs [7, 8].

Family involvement played a pivotal role, providing consistent reinforcement, emotional support, and continuity of strategies across home and therapy environments. Likewise, cooperation from school staff was instrumental in creating a supportive setting that reduced performance pressure and encouraged gradual verbal participation. Training educators to recognize anxiety triggers and reinforce positive communication behaviours contributed significantly to the child’s comfort and progress in academic settings.

This case also underscores the importance of early diagnosis and intervention. When selective mutism is identified and treated promptly, outcomes tend to be more favourable, and the risk of long-term social and academic difficulties is reduced. Individualized treatment plans that adapt over time, depending on the child's progress and needs, remain central to successful management.

While the results in this case are encouraging, further research is needed to refine intervention protocols and explore long-term outcomes. Nonetheless, the case supports existing evidence that a collaborative, flexible, and individualized approach is key to treating selective mutism effectively [9, 10].

Conclusion

Multimodal therapy integrating CBT, speech therapy, and family counselling can lead to successful management of selective mutism. Collaboration among clinicians, families, and educators is essential for supporting children with SM in diverse environments.