Though some may fear that allowing nonverbal communication will enable the mutism to continue, many therapists believe it is a necessary step for most children with mutism to overcome their communication anxiety in a step-by-step manner.
Anxiety is still the root cause of the mutism, and it is theorized that these language difficulties may make the child more self-conscious about his or her speaking skills and thus may increase the fear of being judged by others.
The stress of dealing with the child's mutism may have created various imbalances in family dynamics, and parents may need help in coming to terms with their own emotions and becoming more consistent in their parenting styles.
It is important for family members to be educated and informed about selective mutism and to be included in the child's treatment plan in order to provide a supportive environment for the child's recovery.
A significant number of children with mutism also have expressive language disorders, and a fairly large number come from a bilingual environment, which may add to a child's vulnerability to mutism.
Since selective mutism is an anxiety disorder, successful treatment focuses on methods to lower anxiety, increase self-esteem, and increase confidence and communication in social settings.
In mutism, the child has the ability to converse normally and does so, for example, in the home, but consistently fails to speak in specific situations such as at school or with strangers.
What is clear is that children and adolescents with mutism have an actual fear of speaking and of social interactions where there is an expectation to talk.
Over time, a child with selective mutism becomes mute because of an inability to cope with fearful feelings that occur when he or she is expected to speak.
Often a parent suspects during the preschool years that there is a problem, but lack of knowledge about selective mutism makes it difficult to find help.