For an explanation of CBT, look here.  Currently, no specific cognitive behaviour therapies have been developed for selectively mute children and our team at HSC is working to develop such a programme.  The aim of CBT in SM is to help these children develop coping skills as part of a multimodal treatment programme.  Contact me if you want to know more.

This is by far the most often used method in helping selectively mute children.  It is a popular way to help these children because we know so little about the etiology of selective mutism.  As we are not sure what causes lead to the behaviour of selective mutism, the behaviourist assumes that it is a learned process which can be "unlearned".  Behavioural approaches are based on learning theory.  Behaviour therapy aims at helping the child change by modifying the environment.  Behaviour that is unwanted (like the child's mutism) is gradually extinguished and replaced with more acceptable behaviours. A number of behavioural methods have been described successfully in various case studies: 1. Contingency measures.  The child is rewarded for speaking.  The use of points, stars as a positive reinforcement of the child's speech in the mute situations result in the child being motivated to change.  This is useful and works in a number of situations in which the child is already beginning to speak (or whisper) in school.  It is also preferred to punishing the child, which some parents and teachers resort to in order to "force" the child to speak.  Read a personal example from a mother of a selectively mute child here. 2. Stimulus fading.  This, put simply, is looking for a "stimulus" for the child's speech in the mute situation.  The most common and problematic mute situation is in school.  Common "stimulus" for the child would include family members but I know of some pets which really can help the child speak.  By having these "stimulus" for speaking in the mute situation, it is hoped that the child will gradually start to speak and that the speech will generalise to other people.  The behaviour therapist will help design a gradual process for the child to start speaking to the parent (or other stimulus) and introducing new people, like classmates and teachers. 3. Video or audio self modelling.  This technique has been described in various forms.  Basically, the idea is to let the child see for himself or herself that he/she is capable of speaking in the mute situations.  In video self modelling, a video of the child speaking is edited to show that he/she is speaking in the class.  Audio self modelling is essentially the same but uses an audiotape.  Both methods are time consuming and for video editing, special equipment is required.  A simpler way of doing this which is practical would be to make audiotapes of the child making a presentation and playing this back in school.  I have seen a child responding positively to this.  In a sense, the child gets to hear his/her own voice which takes away the "mystique" of the child's mutism in class and also serve to desensitise the child to the fear of his/her own voice.  It must be said some children would merely refuse to record anything when an attempt to do an audio recording is made.  It is probably useful if the child is motivated by promise of reward or better school marks. Read a case study published in the American Academy of Child and Adolescent Psychiatry Journal. 4. Reinforcements of approximate behaviours.  Some parents have remarked that children would not respond to rewards for speaking.  This is likely due to the fact that the task being asked of the child is too difficult to acheive and so the child will not make the attempt.  By gradually introducing tasks that are in the form of steps, it will hel and this forms the basis of approximation.  Approximating speech can start with smiling or using gestures.  If the child accomplishes this, the next step could be trying to mouth simple words like "Hi".  By using a series of steps, the child is eventually led to achieve actual speech in the mute situation.

Behavioural Approaches for Selective Mutism

This is by far the most often used method in helping selectively mute children.  It is a popular way to help these children because we know so little about the etiology of selective mutism.  As we are not sure what causes lead to the behaviour of selective mutism, the behaviourist assumes that it is a learned process which can be "unlearned".  Behavioural approaches are based on learning theory.  Behaviour therapy aims at helping the child change by modifying the environment.  Behaviour that is unwanted (like the child's mutism) is gradually extinguished and replaced with more acceptable behaviours. A number of behavioural methods have been described successfully in various case studies: 1. Contingency measures.  The child is rewarded for speaking.  The use of points, stars as a positive reinforcement of the child's speech in the mute situations result in the child being motivated to change.  This is useful and works in a number of situations in which the child is already beginning to speak (or whisper) in school.  It is also preferred to punishing the child, which some parents and teachers resort to in order to "force" the child to speak.  Read a personal example from a mother of a selectively mute child here. 2. Stimulus fading.  This, put simply, is looking for a "stimulus" for the child's speech in the mute situation.  The most common and problematic mute situation is in school.  Common "stimulus" for the child would include family members but I know of some pets which really can help the child speak.  By having these "stimulus" for speaking in the mute situation, it is hoped that the child will gradually start to speak and that the speech will generalise to other people.  The behaviour therapist will help design a gradual process for the child to start speaking to the parent (or other stimulus) and introducing new people, like classmates and teachers. 3. Video or audio self modelling.  This technique has been described in various forms.  Basically, the idea is to let the child see for himself or herself that he/she is capable of speaking in the mute situations.  In video self modelling, a video of the child speaking is edited to show that he/she is speaking in the class.  Audio self modelling is essentially the same but uses an audiotape.  Both methods are time consuming and for video editing, special equipment is required.  A simpler way of doing this which is practical would be to make audiotapes of the child making a presentation and playing this back in school.  I have seen a child responding positively to this.  In a sense, the child gets to hear his/her own voice which takes away the "mystique" of the child's mutism in class and also serve to desensitise the child to the fear of his/her own voice.  It must be said some children would merely refuse to record anything when an attempt to do an audio recording is made.  It is probably useful if the child is motivated by promise of reward or better school marks. Read a case study published in the American Academy of Child and Adolescent Psychiatry Journal. 4. Reinforcements of approximate behaviours.  Some parents have remarked that children would not respond to rewards for speaking.  This is likely due to the fact that the task being asked of the child is too difficult to acheive and so the child will not make the attempt.  By gradually introducing tasks that are in the form of steps, it will hel and this forms the basis of approximation.  Approximating speech can start with smiling or using gestures.  If the child accomplishes this, the next step could be trying to mouth simple words like "Hi".  By using a series of steps, the child is eventually led to achieve actual speech in the mute situation.

Updated on: August 24, 2001

For an explanation of CBT, look here.  Currently, no specific cognitive behaviour therapies have been developed for selectively mute children and our team at HSC is working to develop such a programme.  The aim of CBT in SM is to help these children develop coping skills as part of a multimodal treatment programme.  Contact me if you want to know more.

Cognitive Behaviour Therapy