Answer

Sounds like your son’s case of SM is very severe. From everything you have described (persistent SM at home, soiling in the past, severe separation anxiety) he has a very severe anxiety disorder. I am also concerned by his ‘behavior’. You did not describe, in detail, the characteristics of his negative behavior. But, it is not uncommon for anxious children to have co-morbid conditions… i.e., anxiety and conduct disorder. I would have a doctor evaluate him for ‘behavior’ disorders.

Many of the characteristics you have described can almost be classified as ‘obsessive compulsive’ another manifestation of anxiety. The fact that your son is so ‘obsessive and compulsive’ about not talking just goes to show you how controlled he is. Unfortunately the more severe the anxiety, the more pronounced the symptoms. I completely understand your frustration. I believe some of your son’s ‘acting out’ of bad behavior is due to his tremendous frustration over all of this. But, as mentioned a complete ‘behavior’ evaluation should be done. His mutism is not done maliciously or to ‘control’ you…but rather a manifestation of his severe anxiety. Very often, with severe anxiety, individuals need to feel some sort of control over their environment…in SM cases it is mutism.

You mentioned medication. I am curious as to how much Prozac, and then Paxil he was taking? I have had many patients who have been put on these medications by physicians, but did not show improvement due to too low of dosage. Also, if a physician did not SLOWLY titillate the dosage upwards…it is possible he was getting too high a dose too soon. With Prozac this could mean extreme hyperactivity and pronounced negative behavior.

I hope this information has helped you. I do believe your son needs further evaluation by a psychologist or physician. And, based on his severe anxiety manifestations, I would possibly consider medication again. There are a variety of different medications to choose from. One thought with your son may be LUVOX. This drug is approved for Obsessive Compulsive Disorder (type of anxiety) and may be a good choice for your son. Please keep us up to date on your son’s progress. I wish you the best of luck. You have a tough case to deal with.

Dr. Elisa Shipon-Blum