144 Chapter 16
the most appropriate ‘front line’ behaviour therapists, advised by clinicians
or educational psychologists. Speech therapy can be used to tackle artic-
ulation problems and thereby reduce the children’s embarrassment about
speaking in front of others. Social skills training and family therapy can
be included in the therapeutic package to tackle associated problems with
social relationships.
Selective serotonin reuptake inhibitors (SSRIs) have been advocated
when both social phobia and selective mutism are present. Several small
studies provide suggestive but not conclusive evidence for their utility.
It would seem prudent not to try medication until a thorough course of
behavioural treatment has been given and failed. When medication is used
and works, it should subsequently be withdrawn gradually.
Prognosis
Although mutism at school entry is usually transient, the likelihood of
resolution drops dramatically once the mutism has persisted for at least
6–12 months. One study of established cases found that half showed
little or no improvement five to ten years later. Improvement is most
likely to occur in the early school years, but may occur at a later stage.
Resolution of the mutism is usually, but not always, accompanied by
improved relationships too. As adults, those who have recovered from
earlier selective mutism have a higher rate of phobic disorders.
Subject review
Standard S, Le Couteur A. (2003) The quiet child: A literature review of
selective mutism.Child and Adolescent Mental Health, 8 , 154–160.
Further reading
Kearney, C (2010).Helping Children with Selective Mutism and Their Parents:
A Guide for School-Based Professionals. Oxford University Press, Oxford.
Kristensen H. (2000) Selective mutism and comorbidity with developmen-
tal disorder/delay, anxiety disorder, and elimination disorder.Journal of
the American Academy of Child and Adolescent Psychiatry 39 , 249–256.
MacGregor Ret al. (1994) Silent at school – elective mutism and abuse.
Archives of Disease in Childhood 70 , 540–541.
Steinhausen HC et al. (2006) A long-term outcome study of selec-
tive mutism in childhood.Journal of Child Psychology and Psychiatry 47 ,
751–756.