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Selective Mutism — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatrySelective MutismMRCPsych Paper B

A 12-year-old girl has spoken normally and fluently at home throughout childhood but, for the past 9 months, has consistently been unable to speak at school despite understanding what is said to her. Hearing and speech-and-language assessments are normal, and selective mutism is diagnosed. Which is the most appropriate initial intervention?

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Correct answer: B — A CBT-based behavioural programme using graded exposure, coordinated with her family and school

The best answer is B. Selective mutism is an anxiety-related inability to speak in particular settings despite normal speech elsewhere. Initial treatment should reduce speaking-related anxiety through a developmentally adapted CBT or behavioural programme, using graded exposure and techniques such as stimulus fading or shaping. Coordination with parents and school is important because treatment targets the settings in which speech is inhibited. Family involvement may support treatment, but family therapy alone is not the primary intervention. Psychodynamic psychotherapy is not first-line. Fluoxetine should not be used as first-line monotherapy; medication may occasionally be considered alongside behavioural treatment when anxiety is severe or engagement has failed. Speech and language therapists may contribute to assessment and delivery, but speech therapy alone is inappropriate when basic speech and language abilities are normal.

Reference: NHS, “Selective mutism”, section ‘Treating selective mutism’, last reviewed 17 February 2023. https://www.nhs.uk/mental-health/conditions/selective-mutism/