There are many research-based SM treatment options, which need to be tailored to the individual under the care of an experienced professional. These include behavioral and cognitive-behavioral therapies (CBT), medication and speech-language therapy.
Necessary components of SM treatment should address:
Reducing underlying anxiety disorder through various treatment strategies, including CBT, family therapy, play therapy and school-based or community-based behavioral interventions
Teaching coping skills that assist the child or teen to use when confronted with anxious situations
Desensitizing and decreasing anxiety in social settings where mutism occurs by gradually progressing from nonverbal to verbal communication
Treatment should not focus solely on getting the child or teen to speak or setting speaking goals:
- Children progress from using nonverbal communication (nodding, pointing, writing) toward speaking (whispering, initiating nonverbal communications).
- Placing too much emphasis on speaking can increase pressure and anxiety, leading to a lack of progress or regression.
- Focusing on speaking alone neglects to address other symptoms of anxiety that can remain problematic after becoming verbal.
Treatment should also address individual characteristics and co-occurring (co-morbid) problems:
These may include social phobia, separation anxiety, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), learning difficulties, speech/language disorders and developmental delay.
A child’s success requires a team approach, including therapist, doctors, the child, family, teacher and other significant persons.
Education of parents, school staff members and significant others enables treatment strategies to be appropriately implemented across various settings, either via direct involvement in treatment or regular consultation with all involved.
Treatment can involve increasing the child’s or teen’s awareness of their anxiety, in a developmentally appropriate way. For example:
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- Preschoolers may be taught to recognize basic feelings (happy, sad, mad, scared) and communicate how much or little of each they feel. They can be taught to use progressive muscle relaxation and deep breathing techniques
- Older children and teens may be able to rate their feelings, creating a hierarchy of feared situations from easiest to most difficult, and apply anxiety-reduction techniques through gradual exposure to the feared situations.
- Goals for desensitization and exposure should be in small increments to emphasize experiences of success over failure, and children need to be willing to participate. The therapist can apply developmentally appropriate strategies to use with an anxious child and ways to work with a resistant child or adolescent.
- Medication may be useful for children who have longer-lasting effects of SM, co-morbid issues or slower response to behavioral treatment. It can be used with CBT to help lower anxiety enough to allow the child or teen to participate in the treatment process. It can also treat co-morbid depression, common in older children and adolescents.
- Nutritional therapy supplements and herbal remedies should be used with caution, and only then under the supervision of a health professional due to potential harmful side effects.
