Your loved one with Selective Mutism might often have other challenges as a result of a combination of factors such as coexisting conditions and SM and Social Communication Anxiety. The most common are eating, sleeping, and toileting. Here are some of Dr. Elisa Shipon-Blum’s recommendations on how to approach these co-occurring challenges!

Eating and Social Anxiety

Approximately 25% of individuals with Social Anxiety Disorder have a fear of eating and/or drinking in front of others. Since over 90% of individuals with Selective Mutism have social anxiety, these issues are not uncommon with children who suffer from SM. This can manifest as the inability to eat or drink in school or social functions.

Individuals with social anxiety often do not want to bring attention to themselves. Even opening their lunch, ripping open food wrappers, etc. are often challenging for the person with Social Anxiety Disorder. Initiating (asking for help to unwrap) is difficult. Anxiety can also cause eating slower and the slowness itself can lead to insecurities.


  • Drink first.
  • Eat soft foods first.
  • Pack items that require little opening.
  • Provide extra time to eat.
  • Set up a picnic in classroom after school with a buddy or small peer group such as a “lunch bunch”
  • Use a Verbal Intermediary® to ask for help with eating.
  • Use a communication board.
  • Parent understanding of “picky eating” and the need for alternative meals at dinner, etc.

Eating and Sensory Processing Issues

A common characteristic is picky eating. It may feel bothersome to parents and teachers, but it is important to understand the reason behind the picky eating, i.e. sensitivities to certain tastes/textures. Recommendation: Pack your child’s lunch and encourage school staff awareness and understanding of the underlying issue.

Sleeping Issues:

  • Separation Anxiety
  • Difficulty regulating and calming
  • Lack of scheduled bedtime routine
  • Frequent night awakenings
  • Child sleeps with parent (not a good idea!)


  • Children with SM thrive on order and consistency so develop a bedtime routine
  • Exercise during the day to provoke tiredness at nighttime
  • Minimize exercise or stimulating activities (video games) before bed
  • Sleep with a sibling
  • Parents can cuddle for a set time to offer comfort


  • Children with SM tend to take longer to toilet train than others. Use behavior or reward charts to help them feel in control.
  • Prevent accidents in school by asking the teacher to monitor and set times to go to the restroom.
  • Medication like Prozac or Zoloft affect serotonin receptors on the bowel/bladder so you can also ask the teacher to monitor this and schedule bathroom breaks. Click here for more information on Medication Usage in the Treatment of Selective Mutism. 
  • Students with SM might not be able to ask to leave class to use the restroom. Use communication boards, hand signals, or a timer in this situation.
  • Prevent bed wetting by limiting drinks before bedtime and schedule time “awakening” by parent.
  • Shy bladder syndrome? Try using a separate bathroom or single-toilet bathroom instead of stalled facilities.

Children with Selective Mutism (SM) do not just have difficulty with speaking and communicating, but they often have other challenges that are a result of a combination of factors, such as coexisting conditions and SM (i.e. reasons why a child may have developed SM and what may be maintaining their SM). Dr. Elisa Shipon-Blum’s 30-minute webinar, Challenges in Raising a Child with Selective Mutism: The QUAD, will focus on a variety of challenges that children/teens often have that contribute to their struggles. These challenges need to be determined and addressed and hence incorporated into a comprehensive treatment plan. This webinar will discuss the ‘The Quad’ of challenges that often exist: Eating, Sleeping, Toileting, and Difficult Behaviors, the reasons for such challenges, and ways to help/support the child with SM. Additional “common” challenges will also be shared and explained to help the child with SM feel more comfortable, confident and communicative.

To effectively overcome Selective Mutism and all anxieties, an individual needs to be involved in an Individualized or Group Treatment program, such as those rooted in the evidenced-based Social Communication Anxiety Treatment® (S-CAT®). Developed by Dr. Elisa Shipon-Blum, this holistic or “whole child” treatment approach is designed to reduce anxiety, build self-esteem, increase social comfort and communication in all settings.

As a physician, Dr. Elisa Shipon-Blum (“Dr. E”) and her team at the Selective Mutism Anxiety & Related Disorders Treatment Center (SMart Center) views SM as a social communication anxiety where mutism is merely a symptom. The key to an effective treatment plan is understanding factors into the development and maintenance of SM as well as understanding an individual’s baseline level of social communication on the Social Communication Bridge©. Then, working as a team, the treatment professional, parents, and school staff members help the child build coping skills to combat anxious feelings and to progress across the Social Communication Bridge©.