Selective mutism (SM) is a childhood anxiety disorder where a person is unable to speak in certain social situations, such as schools or in public, despite being able to speak comfortably in other settings like at home. It is not a behavioral choice, but a consistent failure to speak that interferes with daily life, often first appearing before age five. Treatment typically involves therapy, like controlled exposure (fade in/fade out technique, bug-in-the-ear coaching), and sometimes medication for severe cases. 

Key Characteristics

• Context: Dependent: Speech occurs freely in "safe" environments but is impossible in "uncomfortable" settings.

• Non-Verbal Indicators: When anxious, individuals may appear frozen, stiff, or expressionless. They may avoid eye contact and rely on nodding, pointing, or whispering.

• Onset: Symptoms typically begin between ages 3 and 5, though the disorder is often not diagnosed until a child starts school.

• Duration: For a diagnosis, the behavior must persist for at least one month (excluding the first month of a new school year).

Treatment Strategies

Treatment focuses on reducing anxiety rather than forcing speech. Key evidence-based techniques include: 

• Stimulus Fading: Gradually introducing a new person into a situation where the child is already speaking comfortably with a trusted adult.

• Shaping: Using positive reinforcement for any effort to communicate, moving from non-verbal gestures to whispering and eventually full speech.

• Behavioral/Cognitive Behavioral Therapy (CBT): Helping children manage their physical symptoms of anxiety and challenge negative thoughts.

• Medication: Selective Serotonin Reuptake Inhibitors (SSRIs) may be used for older children or severe cases to lower overall distress levels and make therapy more effective.

• School Support: Accommodations such as a Section 504 Plan or Individualized Education Plan (IEP) can provide "warm-up" time and allow non-verbal communication in the classroom. 

Resources

• Selective Mutism Association (SMA): Provides a directory of specialists and educational toolkits.

• Child Mind Institute: Offers comprehensive parent guides and treatment webinars.

• ASHA (American Speech-Language-Hearing Association): Detailed information on the role of speech therapy in SM treatment.