Teens With SM – How to Treat SM

Teens With SM – How to Treat SM

Teens and adults tms clinic can also suffer from SM, which is an anxiety disorder associated with young children. Teens with SM have been struggling with anxiety for years. It could be that the SM was not treated or that it was not responsive to the level of treatment given in childhood. Environmental factors may have kept the anxiety in check. A well-intentioned parent or teacher can help an anxious child avoid distressing situations. A child with SM who has been practicing this avoidance for many years may become a teen who is very good at not talking. SM specialists have identified important factors to consider in supporting teens with SM, despite the limited research on the subject.

Entrenched Avoidance Requires Treatment

SM teens have a tendency to have avoidance and ineffective skills for managing anxiety. A teen’s identity as the “One Who Does Not Talk” has likely been reinforced by this point. Teens have increased self-consciousness about what others think. Teens with SM often have anxiety or depression. Social anxiety is a disorder that can make it difficult to engage with peers. Teens with social anxiety may be hard to get along with in school or gym class. Adolescents with SM are more at risk for these disorders because of the long-term struggles that result in impairment in school, social, and family functioning. In the school setting, there are other manifestations of anxiety such as perfectionism, procrastination, test anxiety, and even school refusal behaviors. A teen might not go to high school due to the fear of being in class. If speech is expected in the transaction, a student with SM and social anxiety may struggle to turn in materials to the teachers. Treatment is required in order to reduce the risk of poor outcomes.

Social Isolation May Increase

Children are in a more social world as they get older. High school students often establish social groups and friends will engage in hobbies with each other. Teens with SM who struggle to share personal information, advocate for themselves, and initiate interactions can be quite challenging to socialize. Teens with SM will be more likely to stand out and be at increased risk for teasing or being bullied from peers. Teens with SM benefit from warm relationships with teachers and thoughtful assignments in school. Increased social pressures in high school and college years can increase the risk of using substances such as alcohol or drugs to self-medicate for anxiety. There is a thin line between appropriate use and self-medicating that must be monitored.

A Robust Treatment Plan

SM children are likely to be struggling with anxiety about speaking for years before they reach adolescence. SM symptoms will be more difficult to treat. The treatment approach for a teen with SM needs to be comprehensive and well-staged to give them the extra boost needed to see progress. A teen with SM may need more intensive treatment, for example, scheduling 20–30 hours of treatment in one week versus 1 hour weekly sessions over the course of many months. More intensive treatment can allow for more gains in a short period of time. Exposures for teens may focus on real-life skills such as asking a question at the grocery store or practicing presentations. A psychiatric evaluation is recommended for teens with a history of selective mutism. Getting on a stable dose of an anxiety medication is important for some children. Who is a good fit for medication? Kids who have been anxious for years and have more pervasive SM symptoms will benefit from medication. Children who have difficulty with treatment may benefit from medication. If a teen has a comorbid disorder such as depression, the symptom presentation will be more complex to treat and could benefit from medication.

What Are Medications for SM?

The most popular drugs for SM are the SSRI’s. These are the first-line treatments for anxiety disorders. The specific medication chosen may be influenced by family history of the drug. If a parent is positive about Medication X and the child is not, the child’s biochemistry could be an appropriate fit. Some children will respond to a low dose of medication, while others will need a larger dose to see a therapeutic effect. There are risks of under-treating, even though parents may worry about potential side effects. Every day that a child is impaired is demoralizing. SM can be a long term risk of under-treating anxiety disorders, which can include increased school absences, underachievement, and continued anxiety disorders in adulthood.

Getting Accommodations in School and at Work

SM can make it difficult to engage in successfully or fully. It can be hard for a teen to raise their hand when they are giving a presentation. An Individualized Education Plan or a 504 Plan from the teen’s school will help in obtaining a formal assessment and identifying the best supports for the child in the school setting. School accommodations can be useful if your teen is struggling to engage in schoolwork or attend school due to SM challenges. For teens with SM, assignments can be adjusted. A student could videotape their assignments. School and work accommodations can be provided at the college level. Assessment is often conducted through a private psychologist.

It can be difficult to see your teen struggle with SM symptoms, but it is never too late to engage in behavioral treatment for SM! A thorough intake evaluation can help you and your family find the best course of treatment, including the intensity and frequency of sessions. It is possible to normalize your teen’s SM experience. The stories of children with SM are told in young adult books. Teens with SM can be helped by such readings.


Boorady, Roy, and others. When should medication be used to treat certain types of mental illness? Child Mind Institute published an article on when to use medication to treatselective-mutism.

Clarissa J. Gosney. There is deviant behavior in teens and adults. The Anxiety.org has a story aboutselective-mutism in teens and adults.

How can you help a 16-year-old who still has some tendencies? Child Mind Institute asked an expert how to help a 16-year-old who still hasselective-mutism.

The information is about older children and teens. SMIRA, 11 Sept. 2017: www.selectivemutism.org.uk/ info-older-children-teens

“Selective Mutism.” Anxiety Canada, www.anxietycanada.com/disorders/selective-mutism/.

What success rate is given to treating teens with SM? The SelectiveMutism.org has a question about what success rate is given to treating teens with sm.

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