After a year of play-based, trauma-informed speech therapy in Vancouver, a 4-year-old who had been completely withdrawn at school began participating in classroom activities, seeking out adults for help, and engaging in flexible play with peers.

The Challenge: Severe Selective Mutism in the Classroom

A 4-year-old bilingual girl in the East Vancouver / Hastings neighbourhood was referred to West End Speech with a diagnosis of selective mutism alongside a history of cleft palate repair. Her family described debilitating shyness that went far beyond typical temperament. At school, she would not participate in any classroom activities and was entirely unable to approach adults for help. While speech sound difficulties secondary to the cleft palate were also present, the selective mutism was the primary barrier to her daily functioning and learning.

At the time of referral, she was significantly behind peers socially and academically, not because of a lack of understanding, but because anxiety made participation impossible. Her family was understandably worried about the growing gap between her and her classmates.

Speech Therapy Goals for Selective Mutism

Working collaboratively with the family and school team, our Vancouver speech-language pathology clinic set the following goals:

• Reduce anxiety-driven avoidance so she could begin participating in structured classroom activities
• Build her ability to independently approach adults for help
• Expand social communication to include more flexible, varied play with peers
• Address speech sound errors related to cleft palate history once communication confidence increased

Our Approach: Trauma-Informed Selective Mutism Therapy

Over the course of one year, she worked with Vancouver bilingual Speech-Language Pathologist Maëlle Le Rudulier, M.Sc., R.SLP, using a combination of therapeutic approaches chosen for her specific situation.

Play-based therapy formed the foundation of every session. Rather than placing direct demands on speech, sessions were built around her interests and comfort level, gradually shaping opportunities for communication within motivating, low-pressure activities.

Trauma-informed care guided how sessions were structured and how communication expectations were introduced. Her silence was never treated as defiance. Instead, the therapeutic relationship was built on safety, predictability, and her own readiness to take each next step.

Augmentative and alternative communication (AAC) strategies were introduced early to give her a way to participate and express needs without the pressure of spoken language. This bridged the gap while confidence grew and allowed her to experience the social rewards of communication.

As her comfort and confidence increased, therapy also began addressing the speech sound difficulties related to her cleft palate history.

Results: Overcoming Selective Mutism at School

After one year of consistent therapy:

• Classroom participation went from nonexistent to consistent. She began joining group activities and responding to teachers during structured tasks
• Self-advocacy emerged as a real strength. She started independently going to adults to ask for help, something that had been completely absent before
• Social play became more flexible and varied, with her initiating interactions with peers rather than retreating
• Communication levels caught up significantly compared to same-age peers, closing a gap that had previously been widening
• Speech clarity improved as targeted articulation work addressed the cleft palate-related sound errors

Her family and school team reported she was, in their words, a completely different kid: present, engaged, and beginning to thrive.

Tips for Parents of Children With Selective Mutism

• Safety first, speech second: When selective mutism comes alongside something like cleft palate, the child needs to feel safe before anyone asks them to speak.
• AAC bridges the gap: AAC can be a powerful bridge for children with selective mutism, giving them agency while verbal confidence builds.
• Go at the child’s pace: Play-based, trauma-informed therapy produces lasting change because it doesn’t force anything.
• Bilingualism is an asset: Bilingualism is never the problem. With the right support, bilingual children with selective mutism make excellent progress.

Next Steps

If your child is experiencing selective mutism, anxiety-driven silence, or communication difficulties related to cleft palate, book a free consultation to learn how selective mutism speech therapy in Vancouver (including AAC support and articulation therapy) can help your family.