The Role of Family Accommodation in SM Treatment

Immediate family members are usually the most comfortable speaking partners for children with selective mutism. In fact, many parents of kids with SM describe their children as outgoing, talkative, friendly, and even loud when they are at home. This makes it that much more difficult to watch these kids struggle to interact with extended family, friends, and community members. Often, family members will try to bridge the gap for their loved one in order to facilitate communication with other people. This article will discuss common behaviors and identify helpful practices for family members to employ to promote brave speech long term.

Consider the following scenario: you’re spending a lovely day at the park with your family, playing games, having a picnic, and enjoying the warm weather. Your child asks for a treat from the ice cream cart nearby, so you both head over to survey the options. The vendor beams as you two approach, then says to your child “Hi! What flavor would you like? But your child tenses up and does not respond. What would you do?

A natural response in this situation is to answer for them. It alleviates the distress your kid is feeling, and any parent who has ever seen their child in an uncomfortable situation is familiar with the completely valid urge to rescue them. Plus, you already know their favorite ice cream flavor, so speaking for them prevents an awkward lull in conversation and saves time.

Providing that escape from aversive feelings is called accommodation. Unfortunately, being overly accommodating unintentionally furthers the cycle of anxiety for kids with selective mutism by negatively reinforcing the avoidance behavior. That sense of relief your child feels following the removal of the source of distress — in this case, the speaking demand placed by the ice cream vendor — teaches them that allowing others to speak for them is a reliable way to reduce their anxiety, which communicates to them that they are unable to push through that distress themselves. So what should you do instead?

There are a number of ways to reduce accommodation in this moment. Providing 5-10 seconds of wait time after the vendor’s question gives the child the opportunity to find their brave voice and respond on their own. If they do not, prompting the vendor to ask again or shift to a forced choice question like “would you like chocolate or vanilla?” gives your child another opportunity to answer independently. If necessary, you can even prompt your child to direct their answer to you, audibly, in front of the vendor. All of these adjustments modify the speaking demand to make it more manageable without allowing your child to escape speaking altogether. The more opportunities that are provided for them to use their brave voice, the more evidence they have that they can face their anxiety head-on, and the more likely they are to do so in the future.

Tiny adjustments go a long way in selective mutism treatment. By reducing accommodation and facilitating bravery, parents can empower their child to navigate the world freely. If you’re interested in additional support breaking the avoidance cycle, Thriving Minds is here to help! Contact us at (734) 433-5100 or visit this link to learn more about our treatment options.