For children, teens, and adults
Selective mutism treatment in Escondido
A child who talks freely at home but cannot speak at school is not being difficult, and is not simply shy. Selective mutism is an anxiety disorder, and it responds to the right treatment.
Why won't my child talk at school?
Your child is not being rude, and is not refusing. This is what selective mutism looks like from the outside, and it is why it gets mistaken for shyness or defiance for years before anyone treats it.
Children with selective mutism often describe it as feeling like they have tape over their mouths. They try to speak, and the words will not come out.
Dr. Clarissa Gosney, PsyD
The basics
What is selective mutism?
Individuals with selective mutism (SM) have a strong understanding of their spoken language, but are so overcome with their anxiety that they are unable to speak in certain places such as school or restaurants, with certain people, or in certain situations.
SM differs from shyness in that it impairs one's ability to function normally at school, work, or other social situations. Left untreated, symptoms can worsen into a lifetime habit of mutism that lasts into adulthood and becomes much more difficult to treat.
It typically first appears in early school-aged children, from preschool through first grade.
Most parents of children with selective mutism report that they thought their child was just shy, but that they reached a point where they realized it was more than shyness.
Dr. Clarissa Gosney, PsyD
Getting the diagnosis right
Selective mutism, autism, or shyness?
SM differs from an autism spectrum disorder in that SM symptoms tend to "disappear" when the person with SM is in a comfortable environment with familiar people, such as being at home with family.
Selective mutism
Lifts at home, with familiar people, in a comfortable setting.
Autism
Present in every setting, including the ones where a child is most at ease.
In the simplest description, selective mutism often goes away when a child goes home. Autism does not.
Dr. Clarissa Gosney, PsyDIn neurodivergent children with SM, the mutism can be an additional barrier to obtaining a thorough assessment and a diagnosis.
Dr. Joanna Kennedy, PsyDIt is also possible to have both, which is why we evaluate rather than assume.
What to bring to an intake: an audio or video recording of your child speaking freely at home. That recording lets the clinician rule out an autism spectrum disorder or another language or communication difference that might otherwise be missed. If both are present, that matters too, and we evaluate for it. See our autism evaluations page.
Our approach
How we treat selective mutism
Pinnacle is one of the only counseling centers in Southern California that specializes in the treatment of selective mutism. We use a combination of Cognitive Behavioral Therapy, Exposure Therapy, and Parent-Child Interaction Therapy for Selective Mutism (PCIT-SM).
PCIT-SM involves the counselor building a strong and trusting relationship with the client in order to promote "brave talking." Advanced sessions move outside the office, where the therapist accompanies the client to a school or a store to practice, generalize the skill, and bring the anxiety down.
Our counselors have specialized training in treating clients with SM, regardless of age, and are led by Dr. Joanna Kennedy, PsyD at our Escondido office.
What the progression looks like
01
Talking with a parent present
Parents are trained and stay in the room. Therapy often starts with the child speaking to the parent while the clinician is present.
02
Talking with the clinician
Using PCIT-SM skills, the child begins answering the clinician directly. Then the parent quietly steps out, and the talking continues.
03
Fading in new people
A new person joins while the child is already talking, rather than being introduced to silence. The talking carries across to them, then to the next person, and the circle widens.
04
Talking out in the community
Ordering at a restaurant, asking a clerk for help, speaking to a teacher and to peers in their own classroom. Brave talking has to happen in the places where the silence has been costing them something.
Once a child can use their brave voice with me in the office, we take it into the world: ordering food at a restaurant, asking someone for help.
Dr. Joanna Kennedy, PsyDFor children who need more than a weekly session, our Outside Voice Selective Mutism summer camp compresses months of this progression into four days. More reading in our guides for parents.
Each summer · Escondido
Our Outside Voice Selective Mutism summer camp
Four days of intensive exposure practice, several hours each day, directed by Dr. Carissa Douglas, PsyD. Progress at camp often outpaces what weekly therapy achieves in months.
Two separate tracks run side by side, one for younger children and one for teens, with the older campers taking junior counselor roles so they build assertiveness alongside brave talking. More on how we approach this in our guides for parents.
Parents are shocked when I tell them their child talked to new adults, talked in a group setting, or even raised their hand.
Dr. Carissa Douglas, PsyD, Director
Teens and adults
Selective mutism does not end at childhood
Nearly everything written about selective mutism pictures a five year old. Teenagers and adults who still have it are managing a real anxiety disorder with resources built for someone half their age.
Many have spent a decade being called shy, quiet, stuck up, or rude. By adolescence the silence has usually built a structure around itself: classes avoided, jobs not applied for, friendships that stayed shallow because the first conversation never happened.
Where anxiety has spread beyond speaking, we treat that alongside the mutism through anxiety counseling and exposure therapy.
Left untreated, symptoms can worsen into a lifetime habit of mutism that lasts into adulthood and becomes much more difficult to treat. The underlying principles hold at every age, and what changes is the execution: which exposures are chosen, how they are paced, and who is in the room while they happen.
A younger child
Parents are trained alongside them and stay in the room. Adults execute the plan.
A teen or adult
The plan is handed to them directly. They decide the pace, and they own the progress.
It is why our specialized Outside Voice Selective Mutism summer camp runs a separate track for teens and puts them in junior counselor roles rather than grouping them with the younger campers.
Our counselors have received specialized training in the treatment of clients with selective mutism and have a talent and passion for working with them, regardless of age.
Questions parents ask
Before you call
Is this just shyness? Will my child grow out of it?
Most parents of children with selective mutism initially thought their child was shy, until they reached a point where it was clearly more than that. The distinction is impairment: shyness does not stop a child from functioning at school, and selective mutism does. Left untreated, symptoms can worsen into a lifetime habit of mutism that lasts into adulthood and becomes much more difficult to treat.
How do you tell selective mutism apart from autism?
In the simplest description, selective mutism often goes away when a child goes home, and autism does not. Making that distinction properly takes a licensed clinician with specialized experience in selective mutism. It is also possible for a child to have both, which is why we evaluate rather than assume. See our autism evaluations page.
What should I bring to the first appointment?
An audio or video recording of your child speaking freely at home. It lets the clinician hear your child's language without the anxiety present, which is what makes it possible to tease out an autism spectrum disorder or another communication difference.
Will I be in the room during my child's sessions?
Yes, at the start. Parents stay in the room for the first several sessions and are trained in the skills themselves. Therapy often begins with the child speaking to you while the clinician is present, then moves toward the child answering the clinician directly, and only then does the parent step out.
Does treatment ever leave the office?
Regularly. Advanced sessions include exposure therapy in real settings: a store, an ice cream shop, or the child's own school, speaking with their teacher and peers. Generalizing brave talking into the places where the mutism is most limiting is the point of the work.
What is the Outside Voice Selective Mutism summer camp?
Our specialized summer camp for selective mutism. It is an intensive four day program for children and adolescents, with separate tracks for younger children and teens, directed by Dr. Carissa Douglas, PsyD. Campers do several hours of exposure practice each day, and progress is often much faster than weekly therapy alone.
What ages do you treat?
Children, teens, and adults. Our counselors have a talent and passion for working with clients who have SM, regardless of age. Selective mutism that persisted into adulthood is treatable, though it generally takes longer than it would have in childhood.
What if my child will not speak during psychological testing?
We adapt standardized testing so that a child who does not speak in clinical settings can still receive an accurate evaluation. That is one of the reasons families travel to us specifically. See psychological testing.
From our clinical team
Guides for parents
Brave talking starts with one conversation
Selective mutism treatment for children, teens, and adults at our Escondido office, serving North County San Diego and southwest Riverside County.
One of the few SM specialty centers in Southern California