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Supporting Children with Medical
and Mental Health Needs at School


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Selective Mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as at school or to people they don't see very often.

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  • Consistent failure to speak in specific social situations despite speaking in other situations.
  • The condition interferes with educational achievement and with social communication.
  • The duration is at least one month (not limited to the first month of school).
  • The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The lack of speech is not better accounted for by a communication disorder (e.g., stuttering) and does not occur due to a pervasive developmental disorder, schizophrenia, or other psychotic disorder.

Causes of selective mutism

  • It is not known what causes some children to develop selective mutism although it is thought to occur as the result of anxiety.
  • Most children with selective mutism are believed to have an inherited predisposition to anxiety.
  • Given the very high overlap between social anxiety disorder and selective mutism it is quite possible that social anxiety disorder causes selective mutism. 
  • Children with selective mutism are not more likely than other children to have a history of early trauma or stressful life events.
  • Children who have suffered from trauma however are known to suddenly stop speaking.

Treatments for selective mutism

  • Treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing.
  • Treatment does not focus on the speaking itself, but focuses on reducing the anxiety the child has for speaking to and being overheard by people outside their immediate circle of family and friends.
  • The most effective forms of treatment are behavioural therapy and cognitive behavioural therapy

Supporting students with selective mutism

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Before joining school / nursery

  • Check how well the child speaks at home, including the extent to which they speak outside the home.
  • Prior to the child joining the school it is helpful to familiarise them with an adult from the school.
  • Provide an opportunity for the child to visit before they start, preferably when it is quiet. 
  • A buddy system may be helpful when they first start school.
  • In a nursery setting allow parents/carers initially to stay to help settle the child in. 


  • Do not put any pressure on the child to talk. Explain that you understand that it is difficult, and that they can talk when they are ready.
  • Accept a nonverbal response at register time. 
  • Adapt the curriculum so that tasks can be achieved non- verbally.
  • Don’t give extra attention for silence or over rely on alternative forms of communication.
  • Keep open communication between school and parents / carers.

Classroom support

  • Create an accepting and rewarding atmosphere for all children
  • Identifying one adult to help build rapport and develop confidence.
  • Encourage the child to interact with other children, especially with a quieter child.
  • Do not insist on eye contact.
  • Group activities like chanting or reciting a well-known rhyme can be helpful.

Monitoring and ongoing support

  • Be alert to signs of other developmental or educational difficulties.
  • Be mindful of possible teasing or bulling. Act quickly if this arises. 
  • When changing class, handover needs to be carefully planned.
  • Include individual targets for confidence building and independence.

More information

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HOPE (Hospital Organisation of Pedagogues in Europe)