# Which ICHI health interventions apply to selective mutism?

Canonical: https://pinnacleblooms.org/ask/which-ichi-health-interventions-apply-to-selective-mutism-in-young-children
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

ICHI has no single selective-mutism code; applicable interventions are assembled across its Target–Action–Means axes — graded exposure-based behavioural therapy for anxiety, communication support, caregiver and educator training, and education-setting accommodations. Coding combines relevant components, with anxiety reduction prioritised over eliciting speech.

*Selective mutism rarely sits in one box — its intervention map spans communication, behaviour and family environment, and ICHI gives us a shared language for it.*

## In short
Selective Mutism (**ICD-11 6B06**) is an anxiety-based condition where a child consistently does not speak in specific social settings — typically school — despite speaking fluently at home. WHO's **ICHI** (International Classification of Health Interventions) does not list a single "selective mutism" code; instead, the applicable interventions are assembled across its **Target–Action–Means** axes — psychological and behavioural interventions on communication and anxiety functions, training and counselling delivered to the child and the family, and environmental adjustments in the educational setting. The practical map is graded exposure-based behavioural therapy, caregiver and school mediation, and communication support — never coercion to speak.

## The ICHI intervention map, briefly
Mapped against ICHI's structured axes, the interventions clinicians draw on for young children with selective mutism cluster as:

- **Psychological/behavioural interventions targeting anxiety and emotional functions** — graded exposure (stimulus fading, shaping, the "sliding-in" technique), positive reinforcement of communicative attempts, and anxiety-management strategies appropriate to age.
- **Interventions targeting voice and speech / communication functions** — supporting nonverbal-to-verbal transition, augmentative bridges, and reducing performance pressure rather than drilling articulation (the child's speech mechanism is typically intact).
- **Training and counselling provided to caregivers and educators** — equipping parents and teachers to lower demand, avoid reinforcing avoidance, and create low-pressure opportunities to communicate across settings.
- **Environmental and education-setting interventions** — classroom accommodations, structured peer interaction, and transition planning so that gains generalise from home to school.

Because selective mutism is generalised across two or more axes, accurate coding requires combining the relevant ICHI components rather than seeking one label — and the clinical priority is anxiety reduction and graded exposure, not eliciting speech on demand.

## When to refer
Refer when a child speaks competently in some settings but consistently fails to speak in others for **more than one month** (beyond the first month of school), where it is not explained by lack of language knowledge, hearing loss, or a communication disorder, and where it interferes with education or social participation. Early intervention markedly improves outcomes; co-occurring social anxiety and language difficulties should be screened.

## The Pinnacle way
A clinical AbilityScore® and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — never from an online form, a code list, or an app. Our clinicians translate the ICHI intervention map into a graded, family-and-school-mediated plan through [speech therapy](/speech-therapy) and [behaviour therapy](/behavioural-therapy), benchmarked with [the AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated). Begin your child's path on the [Pinnacle home page](/).

## Trusted sources
WHO ICD-11 (entity 6B06, selective mutism); WHO International Classification of Health Interventions (ICHI) Target–Action–Means framework; American Speech-Language-Hearing Association guidance on selective mutism.

**Next step —** Partner with a Pinnacle clinician to convert the ICHI map into an actionable, school-coordinated plan — [start here](/).

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 — selective mutism: https://icd.who.int/
- WHO ICHI (International Classification of Health Interventions): https://www.who.int/
- ASHA — guidance on selective mutism: https://www.asha.org/

## Connected topics and perspectives
- Conditions: https://pinnacleblooms.org/ask/conditions
- Therapist: https://pinnacleblooms.org/ask/lens/stakeholder/therapist
- Emotional: https://pinnacleblooms.org/ask/lens/domain/emotional
- Support: https://pinnacleblooms.org/ask/lens/intent/support
- Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen
- Speech Therapy: https://pinnacleblooms.org/ask/lens/route/speech-therapy
- Family Empowerment: https://pinnacleblooms.org/ask/lens/empowerment/family_empowerment

## Related question paths

### Understand the subject
- What is Selective Mutism, and what are its ICD-11 features in early childhood?: https://pinnacleblooms.org/ask/what-is-selective-mutism-and-what-are-its-icd-11-features-in-early-childhood
- Early Intervention Outcomes for Selective Mutism Under 7: https://pinnacleblooms.org/ask/what-does-current-research-show-about-early-intervention-outcomes-for-selective-mutism-in-children-under-7
- What is the ICD-11 classification for Selective Mutism?: https://pinnacleblooms.org/ask/what-is-the-icd-11-classification-for-selective-mutism
- ICF Functioning Domains in Selective Mutism (Early Childhood): https://pinnacleblooms.org/ask/which-icf-functioning-domains-does-selective-mutism-affect-in-early-childhood
- How Selective Mutism Affects a Child's Daily Life: https://pinnacleblooms.org/ask/how-does-selective-mutism-affect-a-child-s-daily-life
- Is Selective Mutism considered a disability?: https://pinnacleblooms.org/ask/is-selective-mutism-considered-a-disability
- Is Selective Mutism Genetic or Hereditary?: https://pinnacleblooms.org/ask/is-selective-mutism-genetic-or-hereditary
- What are common myths about Selective Mutism?: https://pinnacleblooms.org/ask/what-are-common-myths-about-selective-mutism
- What are the types or levels of Selective Mutism?: https://pinnacleblooms.org/ask/what-are-the-types-or-levels-of-selective-mutism
- What Causes Selective Mutism in Children?: https://pinnacleblooms.org/ask/what-causes-selective-mutism-in-children
- What is Selective Mutism?: https://pinnacleblooms.org/ask/what-is-selective-mutism
- What is Selective Mutism in Early Childhood?: https://pinnacleblooms.org/ask/what-is-selective-mutism-and-what-does-it-look-like-in-early-childhood

### Recognise signs & concerns
- Can Selective Mutism Be Cured?: https://pinnacleblooms.org/ask/can-selective-mutism-be-cured
- Can Selective Mutism Be Prevented?: https://pinnacleblooms.org/ask/can-selective-mutism-be-prevented
- Do Boys Show Selective Mutism Differently?: https://pinnacleblooms.org/ask/do-boys-show-selective-mutism-differently
- Selective Mutism in Girls: https://pinnacleblooms.org/ask/do-girls-show-selective-mutism-differently
- How a frontline health worker can spot possible Selective Mutism early: https://pinnacleblooms.org/ask/how-can-a-frontline-health-worker-spot-a-child-with-possible-selective-mutism-early
- Should I be worried my child might have Selective Mutism?: https://pinnacleblooms.org/ask/should-i-be-worried-my-child-might-have-selective-mutism
- Early Signs of Selective Mutism: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism
- Early Signs of Selective Mutism in a 1-Year-Old Boy: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism-in-a-1-year-old-boy
- Early signs of selective mutism in a 1-year-old girl: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism-in-a-1-year-old-girl
- Early Signs of Selective Mutism in a 12-to-18-Month-Old: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism-in-a-12-to-18-month-old
- Early signs of Selective Mutism in an 18–24-month-old: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism-in-a-18-to-24-month-old
- Early Signs of Selective Mutism in a 2-Year-Old: https://pinnacleblooms.org/ask/what-are-the-early-signs-of-selective-mutism-in-a-2-year-old

### Explore causes & influences
- Are boys more likely to have selective mutism?: https://pinnacleblooms.org/ask/are-boys-more-likely-to-have-selective-mutism
- Are girls more likely to have Selective Mutism?: https://pinnacleblooms.org/ask/are-girls-more-likely-to-have-selective-mutism
- Early Intervention for Selective Mutism: Advancing UNCRPD and the SDGs: https://pinnacleblooms.org/ask/how-does-early-intervention-for-selective-mutism-advance-un-child-rights-uncrpd-and-the-sdgs
- Contributing Factors for Selective Mutism: https://pinnacleblooms.org/ask/what-are-the-known-contributing-factors-for-selective-mutism-in-early-childhood
- What Causes Selective Mutism in Young Children?: https://pinnacleblooms.org/ask/what-causes-selective-mutism-in-young-children
- Cost-effectiveness of early therapy for Selective Mutism: https://pinnacleblooms.org/ask/what-is-the-cost-effectiveness-of-early-therapy-for-selective-mutism-in-young-children
- What is the prevalence and public-health burden of Selective Mutism among young children in India?: https://pinnacleblooms.org/ask/what-is-the-prevalence-and-public-health-burden-of-selective-mutism-among-young-children-in-india

### Understand assessment
- Standardised tools for assessing Selective Mutism in early childhood: https://pinnacleblooms.org/ask/which-standardised-tools-are-used-to-assess-selective-mutism-in-early-childhood
- How AbilityScore Tracks Progress in Selective Mutism: https://pinnacleblooms.org/ask/how-does-abilityscore-track-progress-in-a-child-with-selective-mutism
- How Selective Mutism Is Assessed in a Young Child: https://pinnacleblooms.org/ask/how-is-selective-mutism-assessed-in-a-young-child
- How Is Selective Mutism Assessed in Children Under 7?: https://pinnacleblooms.org/ask/how-is-selective-mutism-assessed-in-children-under-7
- What an AbilityScore of 0–100 Means for a Child with Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-0-100-mean-for-a-child-with-selective-mutism
- AbilityScore® 100–200 in Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-100-200-mean-for-a-child-with-selective-mutism
- What does an AbilityScore of 200–300 mean for a child with Selective Mutism?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-200-300-mean-for-a-child-with-selective-mutism
- What an AbilityScore of 300–400 Means in Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-300-400-mean-for-a-child-with-selective-mutism
- What an AbilityScore® of 400–500 means in Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-400-500-mean-for-a-child-with-selective-mutism
- What an AbilityScore of 500–600 means for Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-500-600-mean-for-a-child-with-selective-mutism
- What does an AbilityScore of 600-700 mean for a child with Selective Mutism?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-600-700-mean-for-a-child-with-selective-mutism
- What does an AbilityScore of 700–800 mean for a child with Selective Mutism?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-700-800-mean-for-a-child-with-selective-mutism

### Explore therapy & support
- Therapy for Selective Mutism: https://pinnacleblooms.org/ask/what-therapy-helps-a-child-with-selective-mutism
- How Therapy Supports a Child with Selective Mutism: https://pinnacleblooms.org/ask/how-is-selective-mutism-supported-through-therapy
- How does therapy help a child with Selective Mutism make progress?: https://pinnacleblooms.org/ask/how-does-therapy-help-a-child-with-selective-mutism-make-progress
- Evidence-Based Therapy Plan for Selective Mutism: https://pinnacleblooms.org/ask/what-does-an-evidence-based-therapy-plan-for-a-young-child-with-selective-mutism-include
- What therapy goals matter most for a child with Selective Mutism?: https://pinnacleblooms.org/ask/what-therapy-goals-matter-most-for-a-child-with-selective-mutism
- Supporting a Child with Selective Mutism Day to Day: https://pinnacleblooms.org/ask/as-a-grandparent-or-caregiver-how-can-i-support-a-child-with-selective-mutism-day-to-day
- Can a child with Selective Mutism attend a mainstream school?: https://pinnacleblooms.org/ask/can-a-child-with-selective-mutism-attend-a-mainstream-school
- Can a Child with Selective Mutism Attend a Regular School?: https://pinnacleblooms.org/ask/can-a-child-with-selective-mutism-attend-a-regular-school
- Can a Child with Selective Mutism Grow Up to Live Independently?: https://pinnacleblooms.org/ask/can-a-child-with-selective-mutism-grow-up-to-live-independently
- How can a classroom teacher help a child with Selective Mutism take part and learn?: https://pinnacleblooms.org/ask/how-can-a-classroom-teacher-help-a-child-with-selective-mutism-take-part-and-learn
- Selective Mutism in District Early Intervention Programmes: https://pinnacleblooms.org/ask/how-can-a-district-early-intervention-programme-identify-and-support-children-under-7-with-selective-mutism
- How can a teacher include and support a young child with Selective Mutism?: https://pinnacleblooms.org/ask/how-can-a-teacher-include-and-support-a-young-child-with-selective-mutism-in-a-mainstream-classroom

### At home & in everyday life
- How can I support my child with Selective Mutism at home?: https://pinnacleblooms.org/ask/how-can-i-support-my-child-with-selective-mutism-at-home