Selective Mutism Questionnaire (SMQ)©
Please consider your child’s behavior in the last two weeks and rate how
frequently each statement is true for your child.
AT SCHOOL
1. When appropriate, my child talks to most peers at school.
Always Often Seldom Never
2. When appropriate, my child talks to selected peers (his/her friends) at school.
Always Often Seldom Never
3. When my child is asked a question by his/her teacher, s/he answers.
Always Often Seldom Never
4. When appropriate, my child asks his or her teacher questions.
Always Often Seldom Never
5. When appropriate, my child speaks to most teachers or staff at school.
Always Often Seldom Never
6. When appropriate, my child speaks in groups or in front of the class.
Always Often Seldom Never
HOME/FAMILY
7. When appropriate, my child talks to family members living at home when
other people are present.
Always Often Seldom Never
8. When appropriate, my child talks to family members while in unfamiliar
places.
Always Often Seldom Never
9. When appropriate, my child talks to family members that don’t live with
him/her (e.g., grandparent, cousin).
Always Often Seldom Never
R. Lindsey Bergman
Treatment for Children with Selective Mutism: Appendix B: Pretreatment Materials. Copyright © 2012 by
Oxford University Press
Oxford Clinical Psychology | Oxford University Press
10. When appropriate, my child talks on the phone to his/her parents and
siblings.
Always Often Seldom Never
11.When appropriate, my child speaks with family friends who are well-known
to him/her.
Always Often Seldom Never
12. My child speaks to at least one babysitter.
Always Often Seldom Never N/A
IN SOCIAL SITUATIONS (OUTSIDE OF SCHOOL)
13. When appropriate, my child speaks with other children who s/he doesn’t know.
Always Often Seldom Never
14. When appropriate, my child speaks with family friends who s/he doesn’t
know.
Always Often Seldom Never
15. When appropriate, my child speaks with his or her doctor and/or dentist.
Always Often Seldom Never
16. When appropriate, my child speaks to store clerks and/or waiters.
Always Often Seldom Never
17. When appropriate, my child talks when in clubs, teams, or organized activities
outside of school.
Always Often Seldom Never N/A
Interference/Distress*
18. How much does not talking interfere with school for your child?
Not at all Slightly Moderately Extremely
19. How much does not talking interfere with family relationships?
Not at all Slightly Moderately Extremely
20. How much does not talking interfere in social situations for your child?
Not at all Slightly Moderately Extremely
21. Overall, how much does not talking interfere with life for your child?
Not at all Slightly Moderately Extremely
R. Lindsey Bergman
Treatment for Children with Selective Mutism: Appendix B: Pretreatment Materials. Copyright © 2012 by
Oxford University Press
Oxford Clinical Psychology | Oxford University Press
22. Overall, how much does not talking bother your child?
Not at all Slightly Moderately Extremely
23. Overall, how much does your child’s not talking bother you?
Not at all Slightly Moderately Extremely
Scoring: Always = 3; Often = 2; Seldom = 1; Never = 0
*These items are not included in total score and are for clinical purposes only.
Copyright © 2008 R. Lindsey Bergman, Ph.D., Associate Clinical Professor,
UCLA Semel Institute for Neuroscience and Human Behavior
R. Lindsey Bergman
Treatment for Children with Selective Mutism: Appendix B: Pretreatment Materials. Copyright © 2012 by
Oxford University Press
Oxford Clinical Psychology | Oxford University Press