Child Psychology Clinic Illawong  + 61 2 9541 1177

Child Psychology Clinic Westmead  + 61 2 9541 1177

The Anxiety & Selective Mutism Clinic

Anxiety is generally defined as feelings of worry, fear and apprehension or nervousness. When people present with an anxious presentation, they report experiencing excessive levels of anxiety, quite frequently, which may prevent them from carrying out their day to day activities. They simply become overwhelmed with their feeling of fear and worry.

Anxiety impacts three main areas:
1) Our Body (physiological)
2) Our Thoughts (cognitive) and
3) Our Actions (Behaviour).

In other words, when someone is anxious and perceive a situation as threatening, they are likely to experience a number of physiological reactions (e.g. racing heart, hyperventilation, nausea etc.). They are also likely to think more catastrophically and negatively than non-anxious people (Beck, 1976). Common Examples may include "What if I make a mistake?" or "What if I say something and people laugh at me?" or "What if something bad happens to me?" or "What if I make a fool out of myself?". Consequently, anxious people begin to avoid the objects or situations they fear in order to feel calmer and gain a sense of relief.

Many parents and families often wonder what causes anxiety in children and adolescents, and it is often a combination of biological (e.g. genetic predisposition) and environmental factors (e.g. changes, death of a family member/ pet, family life stressors, an emotional shock following a traumatic event, some form of abuse/ trauma) which can lead an individual into developing anxiety.

It is important to note that individuals may present with anxiety as part of another presentation (e.g. autism spectrum, developmental delay, ADHD, learning/ language difficulty) or present solely with an anxiety presentation.

At Azza's clinic, we receive many referrals in relation to various Anxiety presentations including Selective Mutism due to the many successful cases which we have assisted. We provide several different types of psychological treatments, including cognitive behaviour therapy (CBT) and behaviour therapy. These psychological therapies can be undertaken with an experienced psychologist via structured sessions at our clinic

Types of Anxiety

There are different types of anxiety. The most common anxiety presentations, as listed in the Diagnostic and Statistical Manual of Mental Disorders: , Fifth Edition (DSM-5) in children and adolescents are displayed in the following table: 

    Type of Anxiety

     Short Description

    Separation Anxiety 
     Excessive anxiety regarding separation from home or from people to whom the individual has  a strong emotional attachment (e.g. a parent, caregiver, or siblings).
    Generalised Anxiety 
     Excessive, uncontrollable and often irrational worry, that is, apprehensive expectation about events or activities, which often interferes with daily functioning. 
    Social Anxiety 
     Intense fear of being criticised, embarrassed or humiliated in everyday situations, such as speaking to others, presenting a speech, or being assertive. 
    Specific Phobia 
     Intense fear about a particular object or situation and may go to great lengths to avoid it, for example, a fear of an animal (e.g. dogs), having an injection or travelling on a plane.
    Obsessive Compulsive Disorder
     Experiencing ongoing unwanted/intrusive thoughts and fears that cause anxiety. Despite the person acknowledging that these thoughts are irrational, they often engage in certain behaviours or rituals to try to relieve their anxiety
    Post Traumatic Stress 
    May occur when a person experiences a traumatic event (e.g. abuse, war, assault, accident, disaster). The symptoms can include difficulty relaxing, upsetting dreams or flashbacks of the event, and avoidance of anything related to the event.
    Panic Disorder
     Experiencing recurrent panic attacks that individuals believe that they are having a heart attack or are about to die. Panic attacks are intense, overwhelming and often uncontrollable feelings of anxiety combined with a range of physical symptoms (e.g. shortness of breath, chest pain, dizziness & excessive perspiration. 
    Selective Mutism
    Failure to speak in certain situations where speech is expected of them despite being fully capable of speech and understanding. They may be perceived as "shy" or "rude" by others. 

    About the Anxiety & Selective Mutism Clinic

    The Anxiety and Selective Mutism Clinic aims to provide children and their families that attend our cur clinic best practice interventions suitable for their needs.

    The clinic is supervised by Clinical Psychologist and Director, Ms. Azza Brown, along with the contribution of Senior and generalists psychologists, who possess extensive training and expertise in treating anxiety disorders and associated presentations.

    Similar to all referrals to our clinic, a comprehensive assessment is conducted with famiilies for the purpose of creafing an intervention plan specific to the individual needs of your child and family. The assessment and treatment process at The Anxiety & Selective Mutism Clinic also includes:

    Standardised assessment and screening measures that assesses social, emotional, and behavioural developmental issues associated with Anxiety Disorder and Selective Mutism (SM). These measures may include:

    • Anxiety Disorder Interview Schedule - Fifth Edition (ADIS-5) Child and Parent Interviews
    • Gold standard therapeutic interventions derived from evidence based research specific to anxiety disorders
    • Pre and post outcome measures to enhance treatment outcomes

    In some cases where children with Selective Mutism and social anxiety have strong fears towards new situations and unfamiliar people, our psychologists ensure that several strategies are used to increase the child's sense of security when attending the clinic.

    This may include but is not limited to; allowing parents to remain in the room until the child feels more at ease with the new surroundings, is able to explore objects or toys in the room and feel comfortable, or engaging the child in several activtiies which involve non-verbal interactions during games and activities.

    It is also important to note that with parental consent, Azza's clinic works closely with preschools and schools to provide strategies to enhance communication and interactions beteween the child and peers/ staff should the presenting problem occur in the preschool/ school envrionment.

    What is Selective Mutism?

    Selective Mutism (previously known as Elective Mutism) is usually identified in early childhood when a child begins to "freeze" in a specific social situation, and fails to talk despite being exposed several times to the same situation or environment. The child may however speak freely in other situations (i.e. at home only). For example, a young child may refuse to speak to his/her peers or preschool teachers during preschool years and only speak to family members, OR an older child may talk within the classroom but may not be able to talk with ease at home with immediate family members.

    Selective Mutism is described to be a form of social anxiety such that the child fears being humiliated or scrutinised (i.e. negatively evaluated) following any attempts to communicate. Children with selective mutism usually present with poor eye contact, a freezing appearance, and a blank facial expression.

    There is an assumption that children with selective mutism are only 'shy' and that they may 'grow out of it'. It is important to note that this is a 'myth' and that early intervention is crucial. Without early intervention, children with selective mutism are likely to continue to display social anxiety, and develop other mood/anxiety disorders as well as associated issues (e.g. social difficulties, alcohol dependence etc.).

    Please Contact our clinic for a Consultation!
    Call: +61 2 9541 1177

    Our goal is to ensure your advocacy needs are met through the process of continuous engagement and genuine understanding of your needs