Selective mutism occurs when children speak in certain situations but are completely silent in others, e.g., children who speak to members of their immediate family in the home, but not to less-familiar people, especially outside the home environment. These children often show particular impairment at school. Effects on social and academic functioning can be severe. With no “gold standard” for treatment of these children, comparing treatment approaches for this debilitated population creates the opportunity for dialogue about best practices. Four cases of children with selective mutism are presented; exploring a diverse range of settings and various modalities of treatment. Case presentations include video footage of children and adolescents; and discussion explores treatment efficacy.