What is Selective Mutism?

Selective Mutism – often just called SM – is a severe anxiety disorder characterized by a child’s inability to speak in social situations despite being completely able to talk. These children are typically chatterboxes at home and typically silent in public. They do not speak in social situations such as school classrooms or the playground, or with certain people, such as their teacher, sports coach or peers. It’s not that they won’t but rather they can’t. That’s what severe anxiety can do to a young child. SM interferes with social interactions and often interferes with educational achievement as well.

Their difficulty speaking is not from a lack of knowledge of the language, and is not due to being oppositional or traumatized. It’s due to anxiety getting in the way. Children with SM can literally go an entire school year not speaking in a school setting. Kids with SM typically also have some important relatives in their lives they do not talk to. They will dutifully nod or gesture to their doctors and dentists well-intentioned questions – but not verbally respond to them. When parents see their child awkwardly avoiding or in apparent emotional pain, they feel like they have no choice early on but to answer for them or to tell people they are “just shy.” We know these reactions are well-intentioned and we wish it were that simple! Shy kids warm up but kids with SM get deeper and deeper into the habit of not talking and can’t find their way out on their own.

Kids don’t just grow out of SM and families should definitely seek professional help early for best outcomes. Untreated, or even under-treated, early childhood anxiety disorders put kids at known risk for the development of other anxiety disorders and possible depression later on.

Our approach to treating Selective Mutism

Dr. Kurtz has been a cutting-edge pioneer in assessing and treating SM since 2002 when he developed the first comprehensive Selective Mutism Program at the NYU Child Study Center serving as a child psychiatry professor on the NYU School of Medicine faculty. His clinical and research team worked for several years developing what has now become a widely accepted state-of-the-art behavioral approach to treating SM called Parent-Child Interaction Therapy for SM or PCIT-SM for short. In 2009, Dr. Kurtz then created the Brave Buddiesprogram – the world’s first intensive group treatment for SM, which is based on PCIT-SM. The name of the program changed to Mighty Mouth Kids in 2014.  In 2016, his team introduced WeSpeak the first ever intensive group treatment for older children (10-14) with SM.

Treatment options for SM

We treat children with SM in a few different ways. Treatment is always customized to your family’s unique situation and we work with you to decide on the best option:

  • Individualized family treatment We work with you as a family unit to teach you and your child the necessary skills to start bravely talking. Treatment can take place in our NYC offices or in your home community. Treatment is usually weekly but can be done equally well as an intensive approach, which is especially helpful to out-of-town families.
  • Mighty Mouth Kids Dr. Kurtz was the pioneering developer in 2009 of the Brave Buddies model – a one-week group intensive treatment for kids with SM 3-9 years old.  Mighty Mouth simulates a real classroom for the entire week. Dr. Kurtz renamed the model to Mighty Mouth Kids in 2014 and is very proud that the original model now exists under several creative names in 9 sites in 3 countries on 2 continents, bringing the same empirically-supported treatment to children with SM around the world. During this week, the children get repeated practice successfully talking in the very situations that have become “contaminated” in their minds, making talking so difficult – morning meetings, recess, academics, Show ‘n’ Tell, etc. We use lots of positive reinforcement to help them face these challenges. Live coaching of parents and parent classes are integral to the program as well. Mighty Mouth runs in the summer and winter. Click here to check the calendar for upcoming dates.
  • WeSpeak WeSpeak is our signature program created in 2016 to meet the needs of older children with SM who are 10-14 years old. WeSpeak is developmentally matched to the unique challenges of tweens and teens in their school and social environments. Using mentors, we help students target daily individualized goals. Summer and winter sessions are available. Follow-up consultation and parent training are key to the program’s success.

What is PCIT-SM?

PCIT-SM is an adaptation of Parent-Child Interaction Therapy (PCIT). PCIT is a gold-standard treatment recognized by numerous professional organizations for the effective treatment of young children who struggle with self-control. PCIT-SM was based on Dr. Kurtz’s idea that psychologists and mental health experts really do understand the science of relationship building.

Once we build a positive, trusting, and fun relationship with an anxious child, they are much more likely to do the hard work of “Brave Talking” exposures with us. Brave Talking exposures are the carefully guided, step-by-step opportunities to practice talking to others in a graduated, carefully controlled and monitored hierarchy from less challenging to more challenging goals.

PCIT-SM always starts where kids with SM feel most safe and are able to talk – with one of their parents, playing games they enjoy and find easy. The therapists then systematically fade themselves into that situation with the child and parent, making it easy for kids to trust us and include us in their talking circle. From there we venture out with the kids to practice brave talking in their real world environments – their homes, their schools, and their communities.

PCIT-SM is the underlying basis of all of our individual and group SM treatments. We work with you to build a positive, trusting relationship with your child, and then use that relationship to help them develop and practice their brave talking.

Where do the parents fit into the treatment?

The heart and soul of this treatment is teaching the parents how to be their child’s behavior therapist. We systematically teach parents a well-defined set of behavioral Do’s and Don’ts, so they become the experts helping their child learn to talk with others.

The treatment occurs in two phases: Child-Directed Interactions (CDI) to help them warm up to people, followed by Verbal-Directed Interactions (VDI) to help the process of starting to talk with other children and adults. We coach parents live, in actual interactions with their child, using state-of-the-art bug-in-ear technology so they become the experts guiding their child.

Where does the school fit into the treatment?

We partner with our parents to provide the necessary information and training to the schools so they can work effectively with their students. At a minimum, we are available to do inservice training with all school staff that will interact with the student. This can be done live, at the school, and for families who live far away, we can do a live streaming training.  Some parents and schools choose to engage us for live coaching of the skills in the actual school setting as well.  Most children with SM will have their needs met in the general education program. For those students who require either an Accommodation Plan (also called a 504 Plan) or an Individualized Education Plan (also called an IEP), we are available to consult with you and your District to develop those plans.

How long should treatment take?

Together we should be able to see quite quickly that your child is responding to the treatment approach. A good treatment outcome requires these key ingredients:

 

  • A good treatment approach such as PCIT-SM, Mighty Mouth or WeSpeak
  • The parents doing their part by doing assigned home and community practices – without practice in real life situations kids simply can not get better
  • A cooperative school willing to learn new ways of interacting with students with SM

 

Our experience tells us that most children will meet these benchmarks in their progress with these behavioral treatments:

 

# Sessions Behavioral Milestone
1-3 Fading in talking to a new person
3-5 Talking to us with parents out of the room
4-6 Fading in a 2nd person to talk to
6-8 Fading in peers to talk to
8-10* Talking in other settings, such as school
10+ Higher order goals, such as initiating, not just responding

How often do sessions happen?

Most families are local and work with us on a weekly basis.  In the beginning, sessions happen in our office. When ready, we move with you to your child’s school and other situations where they struggle to talk.

For families who live outside the Metro NY area, we provide intensive treatments. Dr. Kurtz was the first professional to deliver intensive treatments for SM and these have become an important option for many families. Intensive treatments are anywhere from 10-20 hours of treatment sessions condensed into one week. Intensive treatments can happen either by the family coming to our flagship NY offices or by us coming to spend the week with you where you live. Both models have been successful. Feel free to discuss personally with us if one of these options is right for you and your family.

How can you know which treatment option is best for your family?

We are happy to provide a free phone consultation to help you think through which of our available options is best suited to your child’s needs and your family’s circumstances. Simply call 212.658.0110, ext. 122 to schedule a phone consultation.

Payment

While we do not participate in any insurance plans, our licensed providers’ fees are reimbursable to some extent under most insurance plans using your out-of-network, outpatient mental health benefits. Our itemized statements of your payments to us can then be submitted by you to your carrier for reimbursement directly to you. We also have Post-Doctoral Psychologists and advanced practicum therapists providing services under our direct supervision at significantly reduced costs. Some financial aid is available.

Coordination of care

We look forward to coordinating care with any of your other providers. You will have the option to sign a Release of Information for us to discuss details with other providers if you so choose and your privacy and confidentiality are always of great importance to us.

What is Selective Mutism? | Kurtz Psychology