Selective Mutism (SM)

Selective mutism (SM) is an anxiety disorder affecting as many as 1 in 140 children. Individuals with selective mutism experience significant anxiety speaking in certain social situations, usually at school and in the community. In these settings, they typically do not speak at all and instead rely on gestures (e.g., nodding, pointing), other forms of nonverbal communication (e.g., writing, typing), or others to speak for them. While these individuals may appear as if they are refusing to speak, they are actually experiencing heightened anxiety that prevents them from talking.

In contrast, these individuals are able to speak freely and easily in situations in which they are comfortable (e.g., at home or with immediate family members). Some caregivers describe their children with SM as seeming like entirely different kids at home versus school or in their community. SM is different from shyness: many individuals experience some hesitation when meeting new people or being in new places but those with SM do not warm up to these situations even after a significant period of time. Their anxiety is pervasive and negatively impacts their ability to build age-appropriate friendships, fully participate in school and extracurricular activities, and independently get their basic needs met. SM typically emerges during the preschool years but at times can persist into adolescence and beyond, especially if left untreated. SM is more prevalent in females than males, and it is not uncommon for SM to present with other forms of anxiety, such as separation anxiety or social anxiety.

The SM program at BCSC is directed by Dr. Kaitlyn Wilbur-Smith. Dr. Wilbur-Smith provides program oversight and training to BCSC’s team of SM clinicians. SM treatment services begin with an initial clinical assessment, which consists of a caregiver interview and either a behavioral observation of the child/adolescent alongside a caregiver and/or a clinical interview with the individual. We utilize an inclusive approach, considering family history, cultural context, and multilingualism when relevant. Following the assessment, treatment recommendations are made and shared with the family. When the recommendations include treatment services, the family is then connected to the assigned clinician(s). Our team has been trained in providing evidence-based SM services and includes a few multilingual clinicians (French-, Haitian-Creole-, Serbo-Croatian/Bosnian-, and Spanish-speaking). Given the challenges typically faced by youth with SM in the school environment, we offer school consultation services and encourage close collaboration and coordination with an individual’s educational team. In an effort to expand access to treatment, we are pleased to offer services via telehealth and on a sliding scale. Please note that clinical services via telehealth can only be provided in the state in which the clinician holds an active license.

SM treatment services offered at BCSC: