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The Source® for Selective Mutism
Ages: 2-18   Grades: Toddler-Adult

Empower the child with selective mutism to speak with confidence.  Speech-language pathology expert and author, Dr. Gail Richard, combines current knowledge with years of experience to give an authoritative, practical guide for the diagnosis and successful treatment of selective mutism.


  • Confidently assess and treat children with selective mutism
  • Improve social and academic development
  • Resolve selective mutism in the early years
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** This is a Cloud E-Book that is accessible from any device with Internet access. .

End the confusion you may have about selective mutism with this easy-to-read Source.  Learn crucial information you need including:

  • differentiating selective mutism from shyness
  • differentiating the types of selective mutism
  • the behavioral parameters of selective mutism
  • the most beneficial treatment methodologies
  • Dr. Richard's desensitization treatment program to alleviate speaking anxiety includes 44 pages of detailed instructions
  • setting treatment goals 
  • how to address comorbid speech and language disorders
  • why SLPs are uniquely qualified to assess and treat selective mutism
  • roles of the multidisciplinary team members
  • why the "wait and see" approach is harmful
  • how to meet the need for services within regular education and special education

The eye-opening information gives you the facts you need to confidently work with children with selective mutism.  Copy the student activity pages or print them from the FREE CD.  The chapters include:

Chapter 1: diagnostic criteria, types of selective mutism, leading evidence-based etiological factors

Chapter 2: prevalence, behavioral symptoms, comorbidity, misdiagnoses

Chapter 3: informal and formal assessment procedures, developmental speech-language issues, differential diagnosis, prognosis, Selective Mutism Questionnaire

Chapter 4: treatment considerations, common treatments

Chapter 5: four-stage desensitization treatment program (44-page, detailed program), speech-language goals, working with adolescents

Chapter 6: roles and responsibilities of professionals, qualifying a child for services

Chapter 7: resources for parents, teachers, and other professionals


Copyright © 2011                            

158-page book plus a CD of the reproducible pages, Selective Mutism Questionnaire, parent and teacher handouts
  • Early intervention on selective mutism is critical to prevent long-term secondary consequences of poor performance in social skills (Kolvin & Goodyer, 1982), educational progress (O'Reilly et al., 2008) and emotional health (Steinhausen & Juzi, 1996).
  • Therapy for selective mutism is more successful when initiated with younger children (Porjes, 1992).
  • The aspects of treatment that contribute to success with selective mutism are based in operant conditioning with positive reinforcement, contingency management, and stimulus fading (Krohn, Weckstein, & Wright, 1992; Cohan, Chavira, & Stein, 2006; Kee, Fung, & Ang, 2001).
  • The majority of intervention studies utilize a behavioral aspect to treatment for selective mutism that includes establishing verbal behavior and then shaping and generalizing verbalization across people and settings (Stone, Kratochwll, Sladezcek, & Serlin, 2002).

The following supports the speech-language pathologist as a primary service provider to address the disorder of selective mutism:

  • Research suggests that as many of 68% of children with selective mutism may have comorbid speech-language deficits (Manassis et al., 2007; Kristensen, 2000).
  • A trend in the research supports considering selective mutism as a communication anxiety disorder instead of a specific social phobia (Remschmidt, Poller, Herpertz-Dahlmann, Hennighausen, & Gutenbrunner, 2001; Omdal & Galloway, 2008; Yeganeh, Beidel, & Turner, 2006; Nowakowski et al., 2009).
  • There appears to be a close relationship between selective mutism and expressive language delays (Steinhausen & Juzi, 1996; Kristensen, 2000).

The Source for Selective Mutism incorporates these principles and is also based on expert professional practice.


Cohan, S.L., Chavira, D.A., & Stein, M.B. (2006). Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990–2005. Journal of Child Psychology & Psychiatry, 47(11), 1085-1097. doi:10.1111/j.1469-7610.2006.01662.x

Kee, C.Y., Fung, D.S., & Ang, L. (2001). An electronic communication device for selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 389. doi:10.1097/00004583-200104000-00004

Kolvin, I., & Goodyer, I.M. (1982). Child psychiatry. In K. Granville Grossman (Ed.), Recent advances in clinical psychiatry (1-24). London: Churchill-Livingstone.

Kristensen, H. (2000). Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 39(2), 249-256. Retrieved from EBSCOhost.

Krohn, D.D., Weckstein, S.M., & Wright, H.L. (1992). A study of the effectiveness of a specific treatment for elective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 31(4), 711-718. doi:10.1097/00004583-199207000-00020

Manassis, K., Tannock, R., Garland, E., Minde, K., McInnes, A., & Clark, S. (2007). The sounds of silence: Language, cognition, and anxiety in selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 46(9), 1187-1195. Retrieved from ERIC database.

Nowakowski, M., Cunningham, C., McHolm, A., Evans, M., Edison, S., St. Pierre, J., . . . Schmidt, L.A. (2009). Language and academic abilities in children with selective mutism. Infant and Child Development, 18(3), 271-290. Retrieved from ERIC database.

Omdal, H., & Galloway, D. (2008). Could selective mutism be re-conceptualised as a specific phobia of expressive speech?: An exploratory post-hoc study. Child & Adolescent Mental Health, 13(2), 74-81. doi:10.1111/j.1475-3588.2007.00454.x

O'Reilly, M., McNally, D., Sigafoos, J., Lancioni, G.E., Green, V., Edrisinha, C., . . . Didden, R. (2008). Examination of a social problem-solving intervention to treat selective mutism. Behavior Modification, 32(2), 182-195. Retrieved from EBSCOhost.

Porjes, M. (1992). Intervention with the selectively mute child. Psychology in the Schools, 32, 114–123.

Remschmidt, H., Poller, M., Herpertz-Dahlmann, B., Hennighausen, K., & Gutenbrunner, C. (2001). A follow-up study of 45 patients with elective mutism. European Archives of Psychiatry & Clinical Neuroscience, 251(6), 284-296. Retrieved from Academic Search Premier database.

Steinhausen, H., & Juzi, C. (1996). Elective mutism: An analysis of 100 cases. Journal of the American Academy of Child & Adolescent Psychiatry, 35(5), 606-614. Retrieved from EBSCOhost.

Stone, B., Kratochwill, T.R., Sladezcek, I., & Serlin, R.C. (2002). Treatment of selective mutism: A best-evidence synthesis. School Psychology Quarterly, 17(2), 168-190. Retrieved from EBSCOhost.

Yeganeh, R., Beidel, D., & Turner, S. (2006). Selective mutism: More than social anxiety? Depression & Anxiety, 23(3), 117-123. doi:10.1002/da.20139


Gail J. Richard


Gail J. Richard, Ph.D., CCC-SLP, is professor and chair in the department of communication disorders & sciences at Eastern Illinois University in Charleston, IL.  She teaches undergraduate and graduate courses and serves as a clinical supervisor for diagnostic practicum experiences.  Gail enjoys the challenges presented in childhood developmental language disorders, such as autism spectrum disorder, language processing, language-learning disabilities, and selective mutism.  Prior to her 30 years at Eastern, Gail's professional experience included working as a public school speech clinician and at a diagnostic/therapeutic preschool.  She consults extensively with other professionals and parents, and she shares her practical knowledge through workshop presentations around the country.

Professional honors and awards include fellow of the American Speech-Language-Hearing Association, Honors of the Association and fellow of the Illinois Speech-Language-Hearing Association, recipient of the Illinois Clinical Achievement Award, ASHA Legislative Council from 1991-2008, Outstanding Alumnus Award at Southern Illinois University Carbondale and Eastern Illinois University, five Faculty Excellence Awards at Eastern Illinois University, and the 2000 Distinguished Faculty Award and College of Science Scholar of the Year.  Additional interests include collegiate athletics, in which Gail has served as the NCAA Faculty Athletics Representative at Eastern Illinois University for 16 years, and directing shows for the community theater.

The Source for Selective Mutism is Gail's eighth book in LinguiSystems' Source series.  She is also author of The Source for Processing Disorders, The Source for Autism, and The Source for Treatment Methodologies in Autism; she is coauthor of The Source for Syndromes and The Source for Syndromes 2 with Debra Reichert Hoge; The Source for Development of Executive Functions with Jill Fahy; and The Source for ADD/ADHD (out of print) with Joy Russell.  Additional assessment and clinical materials published with LinguiSystems include Language Processing Test 3 (LPT 3) Elementary and Language Processing Treatment Activities coauthored with Mary Anne Hanner, Differential Screening Test for Processing (DSTP) coauthored with Jeanane Ferre, Differential Assessment of Autism & Other Developmental Disorders (DAADD) coauthored with Lynn Calvert, The Autism Spectrum Disorders IEP Companion coauthored with Tina Veale, and That's LIFE! Language Cards.  Gail also has several book chapter and article publications in the areas of autism and processing disorders.


"What do you mean my child doesn't talk at school?"

"Oh, I think she's just shy."

"He's just being manipulative."

"Just give her time to get comfortable; she'll be fine."

"Is this an emotional problem?"

"What am I supposed to doWho works with this?"

Do any of these comments or questions sound familiar?  Selective mutism tends to confuse parents, teachers, and other professionals.  Most of the wh- questions apply: who, what, when, how, and why.  Confusion exists regarding what selective mutism is, who diagnoses it, who treats it, how to treat it, when treatment should begin, and why it occurred.  Let's revisit the statements above and the issues the various comments raise.

  • "What do you mean my child doesn't talk at school?"
    Parents are often incredulous when someone contacts them and tells them that their child isn't talking in the school setting.  It is extremely difficult for parents to understand that their verbal child presents a very different personality when she is outside of the home setting.  In order for parents to comprehend this "Jekyll and Hyde" transformation in their child, professionals must discuss and explain the situation to parents.
  • "Oh, I think she's just shy."  "He's just being manipulative."
    Both of these comments relate to the unique characteristics children within the selective mutism profile display.  One child within the disorder may be shy, reserved, and extremely reticent to engage in interaction while another child might be controlling, confident, and stubborn in his resistance to express himself in a public situation.  It is important for professionals to understand the behavioral parameters consistent with selective mutism.
  • "Just give her time to get comfortable; she'll be fine."
    Professionals and parents often hesitate to label a child with selective mutism, preferring to allow additional time for the issue to go away.  They often initially react with a "wait and see" attitude, hoping that the child's reluctance to verbally communicate in a public situation will resolve on its own over time.  Research statistics suggest a significant gap between the initial onset of selective mutism and initiation of intervention, which contributes to a poorer prognosis for resolution of the problem.  This research supports treatment starting as soon as possible.
  • "Is this an emotional problem?"
    It might be, but it could also be a communication problem.  There are a variety of possible factors that contribute to the onset of the disorder.  Selective mutism can be comorbid with a variety of other problems, which professionals must consider as part of the intervention approach. Successful treatment will be dependent on carefully evaluating contributing factors.
  • "What am I supposed to doWho works with this?"
    Good questions!  A variety of professionals can effectively address selective mutism.  The challenge is to find someone willing to tackle the disorder who has knowledge, experience, and confidence in treatment techniques.  The intervention approach needs to be comfortable for both the child and the professional implementing the treatment.  It needs to be consistent, structured, and multi-faceted to achieve generalization.

The Source for Selective Mutism is intended to address the confusion and issues surrounding selective mutism.  Empirical research is extremely limited in this disorder area, partially due to conflicting opinions as to who is responsible for treating it.  However, there are clinical experiences reported among psychologists, psychiatrists, speech-language pathologists, and teachers who have successfully worked with children presenting the disorder.  There have also been some published studies regarding various treatment techniques that I review in this book.

  • Chapter 1 provides the evolution of the disorder, diagnostic criteria, and types of selective mutism.  I discuss several of the leading evidence-based etiological factors of selective mutism.
  • Chapter 2 addresses the prevalence of selective mutism and describes a variety of behavioral symptoms that are associated with the disorder.  Comorbidity and misdiagnoses are discussed.
  • Chapter 3 provides information on assessment for selective mutism, including informal and formal procedures, developmental speech-language issues, differential diagnosis, and prognosis.  A form for observation notes and a Selective Mutism Questionnaire are included.
  • Chapter 4 discusses considerations for treatment of selective mutism and provides a review of some common treatment types advocated to address the disorder.
  • Chapter 5 outlines desensitization principles.  It describes in detail the four stages of a desensitization treatment program and offers a variety of activities to gradually desensitize the child to verbal interaction.  I provide information on incorporating speech-language goals into treatment and working with adolescents/older students with selective mutism.
  • Chapter 6 highlights the importance of collaboration among professionals in treating the disorder.  I discuss roles and responsibilities of several multidisciplinary team members as well as important information about qualifying a child with selective mutism for services.
  • Chapter 7 presents guidelines for providing resources to parents, teachers, and other professionals working with a child who has selective mutism.  I include specific suggestions for parents and teachers as well as several credible online and print resources you may recommend to parents and teachers to help them understand the disorder.

Despite the controversy and lack of agreement among professionals, most clinical experience has provided support for early diagnosis and intervention.  In fact, my own clinical experience has yielded very positive outcomes and complete resolution of the problem when diagnosis occurred in preschool to early elementary years.  The earlier we addressed the issue, the better the outcome data.  The important aspect to remember about selective mutism is that it is not an organic etiology; if the selective mutism is addressed, the prognosis is excellent.  So let's get started!