Phone: 301.593.6554

Cool, Confident and Courageous (CCC) Kids Programming for Children and Adolescents with Selective Mutism

Selective Mutism (SM) is an anxiety disorder that has a significant impact on a child’s life. Children with SM are often observed to be “chatty” or talkative in situations where they are comfortable, whereas they demonstrate minimal or no speech in the specific situations that they experience anxiety. This lack of speech can interfere with academic achievement (for example, the inability to demonstrate their knowledge through reading aloud, giving presentations, or answering teacher questions). SM can also impact the development of age appropriate social relationships with peers, teachers, and the community. It can impact other important areas like the ability of the child to seek help and express needs and wants to others. The major goals of our SM program are to expand the variety of situations and conditions under which children are able to speak, as well as the quality of that engagement (for example, voice volume, elaboration, spontaneity, and self-advocacy). We strive to increase the child’s confidence and sense of mastery across situations. Effective treatment for SM usually requires a combination of services so that children are supported across contexts. We offer individual treatment, parent coaching, school consultations/observations, school training and consultation. We may offer peer dyad or small groups when there is sufficient interest.

Theoretical Orientation

Our program is grounded in the Parent-Child Interaction Therapy as modified for SM (PCIT-SM) model developed by Steven Kurtz, Ph.D. Traditional PCIT has been proven effective in encouraging positive child behavior and adult-child interactions in numerous large-scale studies. In the PCIT-SM approach, PCIT skills are utilized with the unique goals of positively reinforcing children’s engagement and speech and minimizing factors that discourage verbal responding. Caregivers, counselors and school staff learn to use a high “dose” of positive attention, including specific praise, descriptions of the child’s actions, and reflections of the child’s verbalizations. Adults are coached to avoid leading the interaction through commands or questions to reduce pressure for speech. These specialized interaction strategies are referred to as the Child-Directed Interaction (CDI). The PCIT-SM approach also includes Verbal-Directed Interaction (VDI) strategies to help adults encourage speech when children are ready, with careful consideration of the timing, context and delivery of each prompt to speak and consistent reinforcement for verbal responding.


Treatment targets the expansion of the child’s rules and boundaries around speech through step by step challenges that are individually tailored. We use specialized behavior therapy strategies to encourage and reinforce speech and brave interactions. We craft engaging and fun activities, simulate typical classroom and social environments, and use frequent praise and reward systems to encourage and increase brave talking. We encourage the generalization of speech by taking our practice outside the clinic to community locations. We may offer peer dyad or small groups when there is sufficient interest.

Parent Coaching 

Through didactic training and hands-on feedback during play with their child, we coach parents on how to use an effective approach for encouraging speech and brave behavior. We also help parents develop appropriate treatment goals and effective reward systems for their child with SM. Parents utilize these techniques to increase speech and brave behavior in the community, such as in restaurants, on playdates, the playground and at school.

Teacher/School Training and Consultation

We think that it is critical for teachers, and any other individuals interacting with children with SM at school to have an understanding of SM and evidence-based strategies for encouraging speech. Education and consultation is provided to the school team in the form of school observations, school meetings with individual team members. We provide guidance in implementing and adjusting goals throughout the treatment process. We also participate in IEP and 504 Plan meetings to establish and refine appropriate accommodations and intervention plans for children with SM. Our goals are to support the school in using skills to help children make systematic progress in the areas of speech and social interactions at school.

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