Case Study
Case Study, Selective Mutism Nov 26, 2023


Sarah is a 7-year-old girl. Her school teacher referred her to a child psychologist due to concerns about her persistent silence in the classroom. Despite displaying age-appropriate language skills and sociability in familiar environments, Sarah refrained from speaking in school, particularly during group activities and peer interactions.

Initial Assessment:

Upon the initial assessment, it became evident that Sarah’s silence was not due to a lack of language skills but instead rooted in intense anxiety. Sarah’s parents reported that she had always been reserved, but her reluctance to speak in specific social situations had become more pronounced since starting school.

Presenting Issues:

1. Silence in School Settings:

Sarah refrained from speaking in the classroom, even when addressed by teachers or peers. Her teachers noted that while she excelled. Her social interactions were limited to non-verbal communication.

2. Social Avoidance:

Sarah displayed avoidance behaviors in social situations. She often positions herself at the periphery of group activities. She was hesitant to engage in classroom discussions or participate in activities requiring verbal communication.

3. Physical Symptoms of Anxiety:

Sarah exhibited physical symptoms of anxiety, including fidgeting and avoiding eye contact. She displays signs of distress (e.g., rapid breathing) when expected to speak.

Contributing Factors:

1. Genetic Predisposition:

Both of Sarah’s parents acknowledged a family history of anxiety disorders, suggesting a possible genetic predisposition to anxiety-related conditions.

2. Inhibited Temperament:

Sarah’s preschool records indicated a shy and reserved temperament from an early age, contributing to her cautious approach to social situations.

3. Transition to School:

The onset of Sarah’s Selective Mutism coincided with her transition to formal schooling. Exposure to the unfamiliar social dynamics of a larger group setting triggered heightened anxiety. It is leading to her consistent silence.

Diagnostic Findings:

After a comprehensive assessment, Sarah was diagnosed with Selective Mutism. The diagnosis considered her consistent inability to speak in specific social settings, her average verbal communication skills in familiar environments, and the presence of anxiety symptoms associated with speaking. Understanding Selective Mutism: Unveiling the Silence Within

Treatment Plan:

1. Cognitive Behavioral Therapy (CBT):

CBT was chosen as the primary therapeutic approach to address the underlying anxiety associated with speaking.

Sessions focused on identifying and challenging negative thought patterns, exposing Sarah to anxiety-provoking situations, and building coping strategies.

2. Parental Involvement:

Parents were involved in the treatment process, receiving guidance on creating a supportive home environment.

They were educated about reinforcement techniques and strategies to encourage Sarah’s verbal communication at home.

3. School Collaboration:

Collaboration with Sarah’s school was established to put in place strategies supporting her in the classroom.

Teachers received training on creating inclusive environments, providing opportunities for gradual exposure, and offering positive reinforcement.

4. Gradual Exposure and Reinforcement:

Therapeutic sessions involved gradual exposure to speaking in controlled settings, starting with one-on-one interactions and progressing to small group activities.

Positive reinforcement, such as praise and rewards, encouraged Sarah’s verbal communication.

Progress and Outcome:

Throughout treatment, Sarah demonstrated gradual improvement in her speaking ability in school settings. With consistent therapeutic interventions, positive reinforcement, and a supportive environment at home and school, Sarah’s anxiety diminished. While challenges persisted, the foundation for effective communication was established, empowering Sarah to navigate social interactions more.


Sarah’s case illustrates the complexity of Selective Mutism and the importance of a multidisciplinary approach involving cognitive-behavioral interventions, parental involvement, and collaboration with educational professionals. Understanding the interplay of genetic, temperamental, and environmental factors informed a tailored treatment plan, fostering Sarah’s journey toward overcoming the silence imposed by Selective Mutism.

About author

Karuna Kaul is psycho socio clinical psychologist, who works with all age group people. Her profession motivates her to serve people who are facing behavioral issues. She has over 8 years of experience and has successfully established credibility in the areas of counselling and wellness. Assessment and behavioral analysis and training and coaching. She has been an active advocate of mental health awareness. And all her endeavors in the field are primarily focused on educating more and more people about Mental Health concerns and promoting Holistic Wellbeing. She has done master in clinical psychology PG Diploma in counselling and guidance and certified in drug addiction counselling Also she has done neuro medicine psychology from London University, Kent College of United Kingdom. With an experience of six years, she had worked with various organization which provides mental health services.