Contrary to popular belief, people suffering from selective mutism do not necessarily improve with age, or just grow out of it. Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing, with the person being known as the one who doesn't speak which makes it all the harder to then speak. Sometimes in this situation, a change of environment (such as changing schools) to a place where the condition is not known can make the difference.

Occasionally, treatment in teenage years becomes more difficult, though not necessarily.

Forceful attempts to make the child talk are not productive, usually resulting in higher anxiety levels and so reinforcing the condition. The behavior is often viewed externally as willful, or controlling, as the child usually shuts down all communication and body language in such situations, which is perceived as rudeness.

The exact treatment depends a lot on the subject, their age and other factors. Typically stimulus fading is used with younger children.

Some in the psychiatric community believe that anxiety medication may be effective in extremely low dosages and that higher doses may just make the problem worse. Others in the field believe that the side-effects of psychiatric medications- in any dose and on any child- are so dangerous as to negate any temporary benefit, preferring behavioral and psychological interventions.

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In this technique the sufferer is brought into a controlled environment with someone who they are at ease with and can communicate. Gradually another person is introduced into the situation involving a number of small steps.

These steps are often done in separate stages in which case it is called the sliding-in technique, where a new person is slid into the talking group. This can take a relatively long time for the first one or two faded in people.

The subject is allowed to communicate via non-direct means to prepare them mentally for the next step. This might include email, phone, taped recordings, web chat, until they are in a position to try more direct communication.