Practical guidelines for the assessment and treatment of selective mutism

J Am Acad Child Adolesc Psychiatry. 1995 Jul;34(7):836-46. doi: 10.1097/00004583-199507000-00006.


Objective: To provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypothesis that selective mutism might be best conceptualized as a childhood anxiety disorder.

Method: An extensive literature review was completed on the phenomenology, evaluation, and treatment of children with selective mutism. Additional recommendations were based on clinical experience from the authors' selective mutism clinic.

Results: No systematic studies of the phenomenology of children with selective mutism were found. Reports described diverse and primarily noncontrolled treatment approaches with minimal follow-up information. Assessment and treatment options for selective mutism are presented, based on new hypotheses that focus on the anxiety component of this disorder. Ongoing research suggests a role for behavior modification and pharmacotherapy similar to the approaches used for adults with social phobia.

Conclusion: Selectively mute children deserve a comprehensive evaluation to identify primary and comorbid problems that might require treatment. A school-based multidisciplinary individualized treatment plan is recommended, involving the combined effort of teachers, clinicians, and parents with home- and clinic-based interventions (individual and family psychotherapy, pharmacotherapy) as required.

Publication types

  • Review

MeSH terms

  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology*
  • Anxiety Disorders / therapy
  • Child
  • Combined Modality Therapy
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Mutism / diagnosis
  • Mutism / psychology*
  • Mutism / therapy
  • Patient Care Team
  • Personality Assessment
  • Phobic Disorders / diagnosis
  • Phobic Disorders / psychology
  • Phobic Disorders / therapy
  • Social Environment