Once other possibilities for a child's mutism - developmental disorders, schizophrenia, seizures, for example - have been ruled out, contributing factors should be identified. Parents are obviously in the best position to track the child's usage of speech and should observe when, and to whom, the child does speak as opposed to when he/she does not. The activities which appear to promote speaking and those which make it impossible can then be determined. Treatment options take into account these contributing factors, as well if they are present, as the more evident ones such as language impairment, unfamiliarity with the required language (in the case of children of immigrant families), hearing problems and learning disabilities.

A therapist, with experience specifically in selective mutism, who must be given a complete medical, social and psychological family history is the best person to treat the child. This may be a psychologist, a psychiatrist or a social worker, but it is imperative that he/she has contemporary education in the disorder and is not working with out-of-date concepts about selective mutism.

Behavioural therapy and, more recently, cognitive behavioural therapy is proven to be the most effective and the program will involve the child's family members and teacher. An experienced therapist will very gradually include him or herself among the people in the circle to whom the child will talk and, from there, will begin to help the child to increase the circle. It is a slow process which requires a great deal of patience on the part of everybody concerned. It will, at first, involve play therapy, art, music or drama therapy, depending on the interests of the child rather than conversation. Sometimes, particularly when other anxiety disorders and/or depression are present, medication is necessary along with the behavioural therapy. Again, this must be supervised only by a psychiatrist or doctor who is experienced in treating selective mutism. Cognitive behavioural therapy, if undertaken, will include creation of specific goals in collaboration with the child.

The parents, and/or other family members, should consistently expose the child to examples of verbal interaction with different people by ensuring that they visit restaurants, shopping centres, places of worship and other community and social gatherings. They must also create opportunities for the child to speak by inviting both adults and children to their home. Any attempt on the part of the child to speak, outside the parameters he/she has set, should be reinforced physically, with hugs and pats, and verbally in words of encouragement and praise. Serious "do nots" include tricking or ridiculing the child into speaking, which will only increase the anxiety, and talking about the problem in the child's presence.

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