Training, Practice and Service Provision for Selective Mutism: Findings From a UK-Wide Survey of Therapists

Selective mutism (SM), an anxiety disorder often beginning in early childhood, can impair communication, social interaction, and educational progress. When left untreated, problems may persist into adulthood and impact longer term mental health. Although effective interventions exist, many children with SM are unable to access support services, in part due to the lack of suitable training for professionals in SM, the absence of national guidelines, and unclear professional responsibilities which together create gaps in provision.

To survey UK therapists working in the National Health Service (NHS), Local Authorities or Health and Social Care (HSC) services who support preschool and primary school-aged children (3-12 years) with SM to identify the training therapists have received, their perceived training needs, the professions providing interventions, and the nature of the interventions delivered.

A 32-item online survey was distributed via professional organisations and specialist networks, charity forums, and social media using snowball sampling. Results were analysed using descriptive statistics and free text quotes depicting therapists' opinions or experiences were used to triangulate the quantitative data.

Of 244 responses, 201 met eligibility criteria. Most respondents were speech and language therapists (81%), followed by clinical psychologists (11%), educational psychologists (5%) and other professions (3%). Just over half (59%) had received some form of SM training, but only 15% received training during their professional qualification. The majority (85%) expressed the need for additional training in SM to do their jobs particularly in the areas of delivering intervention, addressing co-occurring conditions and working within multidisciplinary teams. Three quarters of the sample (75%) had provided intervention for children with SM, predominantly within schools, involving parents/carers (95%) and teaching staff (96%). Intervention complexity and number of components increased with child age; the most common components across ages were exposure, rapport building, transfer of control and psychoeducation. However, there was extensive variability in the dosage of the interventions provided.

This exploratory survey with a non-representative sample suggested that the intervention components used, the people involved, and where the intervention occurred generally reflected the available evidence base. However, even in this sample who are more likely to have an interest in SM, there are still gaps in professional training and variability in service provision for children with SM. To promote consistent, evidence-based care, we recommend development of national cross-profession guidelines and quality standards for professional training and clinical management of children with SM.

What is already known on the subject Effective interventions for selective mutism (SM) exist, but many children cannot access appropriate support. Inadequate professional training, absence of national guidelines, and unclear responsibilities across professions have been identified as key barriers to provision. What this paper adds to the existing knowledge This first UK-wide exploratory survey of therapists highlights that SM training is rarely included in professional qualification courses, leaving most practitioners seeking additional training post-qualification. Intervention components used by the sample of therapists reflected the current evidence base and increased in complexity with age; there was wide variation in dosage and delivery. The findings provide new evidence on which professions deliver SM interventions in a sample of UK therapists and the training gaps they experience. What are the potential implications of this study? There is a pressing need to embed SM training into professional qualification programmes and to provide accessible cross-professional specialist training post-qualification. Developing cross-profession guidelines and quality standards will help ensure consistency, accountability and equitable delivery of evidence-based interventions for children with SM across the UK.