Selective Mutism, A Multi-Modality Sensory Approach
- carriebslp
- Nov 2
- 3 min read
I recently sent this success story to one of my mentors, Sonia Story who is publishing it on her website at moveplaythrive.com. It's so exciting to see clients arrive in their bodies and bloom into childhood. I hope you enjoy reading this and can get a sense of the joy felt by this child and her family!
Dear Sonia,
I wanted to share a story with you about a client who is finishing therapy with me this week because she no longer needs my support.
When she came to me she was 4 years, 10 months old and her parents were very concerned because she was selectively mute around anyone who was not a family member. In addition, she was still wearing pull-ups and not using the toilet at all.
I did a speech-language evaluation and her language skills were above average. She had just a few misarticulations in her speech, but nothing that would interfere with her being understood. She liked to be in control and she told her mom, "I'll use the potty when I'm ready".
Here's the definition of Selective Mutism that I was working from:
Selective mutism is a social anxiety disorder characterized by a consistent inability to speak in specific social situations, such as school or public settings, despite being able to speak comfortably in other familiar environments. It is not a choice or a behavior problem, but rather a manifestation of anxiety. Factors contributing to selective mutism can vary from person to person, but common factors include genetic predisposition, temperament, and environmental influences. It is important for students with selective mutism to receive appropriate support in order to facilitate development of academic and social emotional skills, which will allow them to participate in the classroom, access their school curriculum and form friendships.
Helping Your Child with Selective Mutism, Angela E. McHolm, Ph.D., Charles E Cunningham, Ph.D., Melanie K Vanier, MA., New Harbinger Publications, Inc., 2006
https://www.selectivemutism.org/what-is-sm/
What was important for me as a clinician was to discover the "why" of the anxiety. For this young girl, I believe it was partially or even mostly due to her underdeveloped sensory system. I don't think her body felt reliable or "safe", and so she was reserving her resources and attempting to control her environment.
When I did a sensory assessment, I found that she had not yet differentiated head and eye movement, she was unable to converge her eyes, she was unable to independently cross midline, her balance was poor, she was unable to sit still for more than a few seconds, and she demonstrated overflow in her arms, hands, and mouth with motor activities. She had many unintegrated primitive reflexes (Spinal Galant, TLR, STNR, ATNR, FPR, Moro and more) and several underdeveloped postural reflexes.
We started right away with rhythmic movements during sessions and at home. We began moving through reflexes as her brain/body became more organized and she was able to coordinate movements. The cognitive side of therapy consisted of visuals and talking about age appropriate social situations/skills. We also talked about sitting on the toilet, underwear and related topics. We focused on scaffolding skills with very small and doable changes, which would increase the difficulty level only slightly. We made sure she agreed with each change.
Over 10 months, she went from saying nothing to non-family members, to joining activities with others at school and talking with school mates. She now talks to children she doesn't know at the park and other non-home environments. She wears underwear 24/7, uses the toilet, and is dry at night. She is still "shy", but she understands that she can choose to use her voice when she wants to and that her body is working for her in a more predictable and organized way. I've talked with you before about seeing children "arrive" in their bodies and I definitely observed this phenomenon several months ago with this child.
All of this is to say that, once again, I see the power of sensory and reflex integration! I am so grateful for your teachings and for being able to give this gift to others.
Warmly,
Carrie Eskenazi
*Below are the child's drawings of a house, person, and tree from when she first came to me in December 2024, 5 months later in May 2025, and 10 months later in October 2025 when she graduated from my services. Notice how her drawings show us her developing sense of her body and brain and how much organization happens over 10 months!
