Thank you all for your interest. I will try to answer some of your questions shortly, but I also wanted to post some helpful links. These all will provide information on child anxiety, including SM, and help you identify professionals in your area:

Our clinic, the Youth Anxiety and Depression Clinic (YAD-C): http:yadc.rutgers.edu

APA Div 53 site for evidence-based treatments: http://www.effectivechildtherapy.com

ABCT Child Anxiety SIG: http://www.childanxietysig.com

Child Anxiety Network: http://www.childanxiety.net

Selective Mutism Group: http://www.selectivemutism.org

Regarding ques #2: Good question about the ice cream parlor example. And this will be difficult to describe in a blog post. We don’t want to punish kids or embarrass them or impart hopelessness. We use two separate, parallel, processes. First is the planful one. This is more akin to what I was describing in the talk. Here, we devise a fear hierarchy, we practice going up to the counter at home and in safe environments, and when we’re ready, we plan to go to the ice cream parlor. And in THAT context, we planfully tell the child, “Okay, I think we’re ready to try going to the ice cream parlor. When we get there, though, I want you to go up to the counter and ask for the ice cream yourself. I know this is still a challenge, so if you make it up to the counter without hiding behind me, you’ll get one point/sticker; if you say, “hello,” you’ll get two stickers; if you point at the ice cream you want, you get three stickers; if you reply to him when the attendant identifies the flavor, you get four stickers; if you actually verbally ask for the ice cream, you get a special bonus.”

Now, the decision on whether the child should get the ice cream that day depends on where you are in the “treatment” and how much practice the child’s had. If she’s at the beginning stages, you might want to encourage all that behavior leading up to asking, then, you might say, “If you do steps x, y, z, then you ALSO get the ice cream.” If you have been practicing this for days/weeks, and the child has been demonstrating increased skill, then, I would draw the line in the sand and say, “This is it. Today, we’re going there to practice asking for ice cream. I think you can do it. You will still get points for the other actions, but you will only get ice cream if you ask for it. It’s okay by me. I won’t think badly about you; I just want to help you get ice cream when you want it. Okay?” And then, you hold to your bargain.

All the while you are doing this, there’s the second process is: while you’re planfully doing this, you may find yourself in an ice cream parlor with a bunch of your child’s friends. In this case, continue to use empathize and encourage and expect them to behave up to the level that they have achieved on the fear hierarchy. But here, if they haven’t already gotten to asking for ice cream by themselves, I wouldn’t expect it here. Here, I would encourage them up to the level they can achieve and then help them with the rest (including buying the ice cream). I don’t think drawing a line in the sand in front of other kids helps too much.