Thank you for your compassion and dedication to children with Selective Mutism. Please allow me to briefly ask my questions again. My daughter C…….. is four years old. She is in her first year of preschool, which she enjoys very much. She participates in all activities and interacts well with her peers. She has never spoken to her friends or teachers at school. (My five year old son did exactly the same thing in preschool. His SM resolved almost spontaneously the first couple of weeks after he started kindergarten.) As of February 1, 2000, C…….. has stopped talking to everyone, including myself, my husband and my two sons. We know of no trauma. We are blessed with a happy home and extended family. C……….will very quietly whisper in play, to herself and to her toys. She will not whisper to people. She imitates animal and baby sounds in a normal voice. Recently she has been saying “uh huh” and “uh uh” for “yes” and “no” (Normal volume. I suspect that she does not view this as talking.) She acts shy in appropriate situations, like new settings or strangers etc, but otherwise appears to be cheerful and happy most of the time. She interacts well with everyone she is comfortable with, though she doesn’t speak. She only occasionally appears mildly “anxious”. She has been seen by our pediatrician for a general and neuralgic exam. I have read a lot etc and understand that SM is considered to be a social anxiety. My husband and I see a psychologist to guide us in activities to help lower C………’s anxiety thus encouraging her to speak. (She evaluated C……… at school, in a normal course of a preschool day). I have four questions:

  1. Is it typical for a child with SM to outwardly appear happy and interactive most all the time?
  2. Does the fact that she has now stopped talking to everyone indicate this is a more severe or intractable case of SM?
  3. How do you feel about Prozac in this situation? After consulting a psychiatrist, my pediatrician has prescribed it, at my request. She started on 2 mg two weeks ago, and just increased to 4mg. The plan is to increase every two weeks as needed, up to 10 mg at most. C……… weighs 39 lbs.

Answer

J…., I have read through your question very thoroughly; I appreciate all of the pertinent information that you conveyed to me. Who formerly diagnosed your daughter with SM? I am a bit concerned as to why she all of a sudden stopped talking to everyone…including your immediate family. It is possible for SM children to abruptly stop talking to immediate family members, but it is not typical. Any new changes in your family life? Did anyone she love leave? Like a caretaker or grandparent? Did her talking stop abruptly soon after she started school? Basically, is anything new occur in your daughter’s life. Some SM children stop talking when they feel ‘out of control’ with a situation. It is their way of ‘controlling’ a situation. This is just their way of dealing with an ‘out of control’ situation….it is not done in a manipulative manner.

I would advise you to see a developmental pediatrician. Your pediatrician should be able to recommend one. I would like a more definitive diagnosis. There are other conditions that can cause a child to ‘withdraw’; I would like those possibilities to be ruled out.

  1. Is it typical for a child with SM to outwardly appear happy and interactive most all the time?
    Absolutely, many children play along next to the other children laughing and smiling…just not talking. SM children become ‘experts’ in nonverbal communication and can really get their needs and wants across to their teachers and classmates. What usually happens with younger children is that their peers become their ‘verbal interpreters’ and tell others exactly what the SM child is trying to communicate.
  2. Does the fact that she has now stopped talking to everyone indicate this is a more severe or intractable case of SM? Before I can accurately answer this question, I would need to be 100% sure other reasons for total muteness were ruled out. If they were, then YES… this child has a more severe case of SM. Whether or not it is intractable is indeterminate at this time.
  3. How do you feel about Prozac in this situation?
    If your child truly has SM, then YES, Prozac is an excellent choice. 10 mg is a reasonable dose for your child.