When my Niece was fifteen years old a school psychologist wrote in her Individualized Education Plan that she has “selective mutism”. Although she accepted help in school with special education classes, she has always refused any treatment. She is now nineteen years old, out of high school, and very unsure of how to proceed in the world. What treatment is available for someone nineteen years old who has great difficulty expressing her needs to anyone? I know she is struggling and I would like to make helpful suggestions to her. She lives in New York City. Thank you for your consideration of my question.


As you probably know, most cases of Selective Mutism are due to severe social phobia. It sounds as if your niece was never really engaged in any treatment for SM or social phobia. My recommendation would be to see a physician or therapist who specializes in anxiety disorders for a formal diagnosis. They can also initiate treatment. Cognitive behavior therapy, performed by a trained therapist, is an excellent form of treatment for severe anxiety.

In addition, medication is used often for social phobia. The best approach for your niece would probably be a combination of medication and behavioral modification. I would investigate this if I were you. Your niece is not a small child, so you cannot force her to go for therapy. You can only make recommendations and encourage her.

Good luck!

Dr. Elisa Shipon-Blum