Selective mutism is a childhood social communication disorder in which children consistently fail to speak in select situations

Selective mutism is a childhood social communication disorder in which children consistently fail to speak in select situations, despite the ability to understand and to use language. Children with SM usually speak to family members at home, but do not speak at kindergarten or school. The speech patterns of each SM child vary along a continuum of severity from children who speak to everyone outside school, and select peers in school, through children who fail to speak to everyone in school, peers and staff. Some will not speak to anyone outside their home, or to only certain family members inside their home, and a rare few do not speak to family members inside the home. Onset usually occurs between the ages of 4 to 8, and in rare cases it may continue until the teen years.

When left untreated - as is frequently the case with anxiety based disorders, where the patient causes little disruption to his surroundings, but great suffering to himself - SM can develop into a generalized anxiety disorder, or a social anxiety disorder. Therefore, early intervention is vital. In addition, with young children, early symptom removal enables the child to return to the normative developmental track, where he will see himself, and be seen by others as a regular child. This has a great impact on the child's self image, confidence, social experience and development.

Ruth Perednik is a psychologist who heads a municipal psychological services department for the treatment of children with SM and their families. She has researched and published on SM and bilingualism.

She has developed an innovative treatment approach, over two decades and hundreds of cases of treating children with SM. She has written a clear, concise treatment manual which can be applied by mental health professionals and lay people alike. The treatment manual is divided into three sections: For therapists, parents and teachers. The focus is on symptom removal, with a combination of home and school based sessions. This usually results in an excellent response to intervention within several months. The emphasis on the enjoyable nature of the therapy means that not only is it not a traumatic experience for the child and his family, it is an empowering and enjoyable one.

The therapy is based on a deep respect for the child's nature, accepting his character and utilizing his strengths. It also calls for respect of all the parties involved in the process, particularly the parents, who are, after all, the ones who best know and most care for the child. Both the therapist and the school staff should try to learn elements of the home setting that enable the child to lower his anxiety level and speak naturally, and the parents may implement certain skills used by the teacher which facilitate the child's independence.

It is a cognitive - behavioral therapy, aimed to be short term, effective and pleasant, and treats as equal and active partners in the process the school staff, parents and child. It has an ecosystems orientation which encompasses all of the contexts in which the child lives: school, home and others, and aims to generalize the child's optimum behavior from each setting so that it is applied to the other settings. Treatment sessions take place in the home and in the school, and in other settings if necessary. The child with SM usually speaks freely and behaves uninhibitedly at home; the therapist will harness this behavior and facilitate similar functioning in school or kindergarten. This blurring of delineations between school and home facilitates a more homogeneous level of functioning across settings, which in turn enables the child to develop a more unified sense of self across the environments in which he lives.

The behavioral underpinnings of the treatment reflect the program's primary aim of symptom removal. With children, symptom removal is vital to enable them to function in a regular, age appropriate manner. Symptom removal allows normal social behavior to develop, deeply effecting the child's ongoing psycho-social development and wellbeing.