Ask The Doc Archives

Where do we start in helping my daughter through this?

Dr. Elisa Shipon-Blum — 2007-12-15T05:49:56Z

Dear Doctor, I am a new member of the Selective Mutism Group. Upon finding your website, I was thrilled. Without a doubt, I am convinced my daughter suffers sm. She has just turned 4 this month, and with the passage of time her speaking in most social settings is worsening. She began a preschool program (2 mornings per week) this past fall. Both the teacher and the school administration informed me that they have never encountered a child such as my daughter. S....not only does not speak, but also does not engage in any play with other children, nor does she complete any projects independently. When entering the classroom, she basically stiffens, making even her entry to the classroom very difficult. However, she does not fuss about going to school; she tells me about the activities quite extensively when she returns home.

By recommendation of a friend, I have contacted an early childhood specialist, who specializes with children exhibiting social behavioral delays. She has met with my daughter at our home. S.... loves her playtime with the teacher, but has never spoken to her. The "special instructor" has also visited the classroom, and has written up her observations and several recommendations for the teachers. The teachers implemented some of her ideas after the Christmas holidays and had limited success. My daughter began walking on her own to the playground instead of being carried; sat at the snack table; and, on occasion worked on a craft (with a lot of assistance from the teacher). But there has been no speaking at all to her classroom teachers. Since the start of school, S.... has extended her non-speaking to other family members and friends to whom she had previously spoken. On one occasion, she spent an entire day not speaking to her favorite cousin (age 12); then suddenly told me "I've decided to talk to Amy" and then talked and played all evening with her. I have given you probably more background than necessary. My question is: Where do we start in helping her through this? Our pediatrician does not feel this is a problem. Whatever guidance you can provide us would be greatly appreciated.

Sincerely, H D

Do you think this is a power struggle with her anxiety?

robataka — 2007-12-15T05:56:53Z

I have a girl that is turning 5 in two weeks and has been SM for about 2 years now, but has always shown signs since birth. We have not tried meds yet. I'm getting to the point that I'm starting to push in that direction. But, sometimes I feel it is more of a power struggle with her anxiety. Have you found this to be the case with some SM children. If yes that is why I wonder if meds are the way to go. I should add she was diagnosed by two different therapists one feels it is all anxiety, the other feels she has some anxiety but for some reason she needs to control others. What is your input? I understand that you will not be able to analyze my daughter but I hope with your expertise you can give me something to go on. Also, do you know of any programs on California in LA or Orange County?

Is it typical for a SM child to outwardly appear happy?

Dr. Elisa Shipon-Blum — 2007-12-15T05:48:21Z

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:

Is it typical for a child with SM to outwardly appear happy and interactive most all the time?
Does the fact that she has now stopped talking to everyone indicate this is a more severe or intractable case of SM?
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.

Do you recommend Meds for my daughter?

Dr. Elisa Shipon-Blum — 2007-12-15T05:43:55Z

I have a 5-yr-old girl that we suspect she has SM. She started pre-K (3 days a week) at three-and-half and that's when we found out she did not talk, interact, or play with any one. She might, occasionally, give one-word answer in a very soft (whisper) voice. There are a couple of girls at her age that she knew since babyhood. She does not talk or play with them either, not even in our own home! When they come to visit, she just clings to me and let them take over her toys. She does not seek for help at school (she rather not drink her favorite drink than ask someone to open it) and does not speak up when she is being hit by other kids. She speaks to me and asks me a lot of questions at home. She argues and reasons with me quite often. Although she often does not answer my open-end questions (like "what did you do at school today?"). We tried play therapy for over 6 months to no avail. We had her evaluated by child psychologist and behavior specialist and they determined that her social skill is much behind her age but her academic level is ahead of her age. They suspect that she has "Pervasive Development Disorder" (PDD). We took her to see a psychiatrist and he wants to use Meds on her. He suggests either "Prozac" or "Paxil" since they both come in liquid form. I'm hesitate to try drugs mainly because of her young age. My questions are "do you think she indeed has SM?" "Does she has PDD?" "Do you recommend the Meds for her at this stage? or should we try something else?" "Which Meds may have better results - Prozac or Paxil?" "What's the proper dose?" "Does she have to stay on drug for a long time? - that is, will she regress if we take her off the drug?" We want to do anything we can to help her but we like to make sure we are doing the right things. Thanks so much for your help.

Should we seek professional help?

Dr. Elisa Shipon-Blum — 2007-12-15T05:54:33Z

Our 4 yr. old daughter has not actually been diagnosed with SM at this point but shows all the signs. We just found that there is a name for this condition after contacting a school councilor and explaining her situation. Which led us to this site; we are so thankful to have this information! We have learned that we have unknowingly done many things right for her over the years (ie: playdates, social situations, gymnastics, not pressuring but encouraging) and have seen significant improvement. She will be going to Kindergarten next year and she is already beginning to develop a positive relationship with her soon-to-be teacher (she is working on speaking more to her preschool teachers this year). My question is: should be seek professional help as well? I have a list of children psychiatrist/psychologists; should we interview them? What criteria would you recommend? We have seen continual improvement; I would hate to see her regress because she is scared of this new situation. Thanks!

Does my daughter have SM?

Dr. Elisa Shipon-Blum — 2007-12-15T05:47:52Z

Our 3 y.o. daughter, who absolutely loves her preschool, stopped talking at school at the end of October. Her teacher informed me immediately and the only "incident" we can attribute this to was a group of 4th graders who were rambunctious on the bridge to recess. Our daughter will speak, sing, yell, etc. at home, at her grandparents' home, at our close friends' homes, in public, etc. and will actually speak to me in her classroom (where I spend a lot of time each week thanks to your Web site advice) and will even talk to other classmates if I am in there. We also have classmates over to the house (1-3 at a time) and she is verbal and enjoys being with them. She does, however, clam up with adults she is not very familiar with. A little girl in her class has never spoken and my daughter has asked three or four times: Why do S and I not talk at school? Except for the one time I asked if she would like my help learning to speak at school, we have not mentioned it.

Is she SM? If so, can I help her overcome this with the support of her school, her teachers and a "team" leader, such as a therapist? Which discipline is the best for this leadership position (I met with a counselor who has a great reputation in our area but seemed at a huge loss on SM)? Are you suspicious as to why our daughter has taken on personality traits such as those of the classmate who has been SM from the beginning? Lastly, our daughter is far and beyond smart - I do not know national standards but she is do much more progressed than her classmates. Is this a factor? We do not push her in that way but do follow her lead in what she needs for stimulation. If all of this is too in-depth, I would love the opportunity to discuss it in a phone conference. I do not want it to get to be an enormous issue rather than one that affects 10% of our lives. Thank you for your kind attention.

Will medication help my daughter talk?

Dr. Elisa Shipon-Blum — 2007-12-15T05:59:48Z

My daughter M...... who is almost six has been mute in school and with adults since the age of three. She has been on 10mg of Prozac since May of this year and began treatment the end of March. She has been making good progress with eye contact and talking to her immediate family in front of others but she still refuses to talk in school, even to the children (one is her neighbor who she always talks with at home). She started Kindergarten last week and she said she will not talk because she is shy. I don't know what to do. I know her psychiatrist will want to increase her dose but I have heard that 10mg is usually the magic number. Also, is medication going to make her talk? I am trying so hard to be patient but I know this is a critical year for her.

Thank you.

Should we hold our son back for another year?

Dr. Elisa Shipon-Blum — 2007-12-15T05:58:15Z

My six year old male student has not said a word in school for the last three years. He speaks on going at home and at relatives. He has told his mom he will not speak at school. Could this really be SM? He plays, runs around, smiles and does everything else the other students do except for talk. He gets along real good with everyone and seems to like his teacher. Could he possibly just be spoiled? I heard an audio tape of him, and it sounds like he pretty much rules the house hold. He does say and do what he wants at home, you can tell by listening to the tape. He is in school a whole day and also never uses the bathroom. He has never had an accident. As a teacher it is very frustrating and I really can't test him very well. He is far behind the other students. Should he stay back for another year? Any information you can give us would greatly be appreciated.

How can we build up his self esteem and confidence?

Dr. Elisa Shipon-Blum — 2007-12-15T05:57:35Z

My son has not spoken in school this year. We invited a classmate from school to our house. He still did not talk with him. He talks with us and relatives. He does not talk to us when he knows people are listening to him. He said that he is embarrassed. He is a very happy boy yet... We now have him being assessed. How can we build up his self esteem, confidence and lessen his anxiety?

Do we just not focus on her behavior and hope that she'll get past it?

Dr. Elisa Shipon-Blum — 2007-12-15T05:50:26Z

My daughter R will be 5 in 5/01. We have had multiple changes in our family, including the death of my father suddenly and a very close aunt and uncle, and the fact that a close sister in law is no longer babysitting twice a week. SM was brought to our attention by a pre school teacher 1 year ago. We are seeing a neuropsychologist who has been helping, but there doesn't seem to be very many people who have even heard of SM. We have been educating ourselves and everyone around us, hoping that because she is so young we could get a head start on helping her instead of just waiting it out, but we have so many questions. R has made significant progress--she is a ball of fire at home with us, and has started to whisper to her grandma. She talks to some of her peers, but to no other adults. She has never talked in preschool and our concern is the upcoming start of kindergarten. We have talked already to the school psychologist and have requested the same kindergarten teacher that my son had (he's 7), hoping that the familiarity with the teacher and the classroom would be helpful. They both seem very willing to help! She shows no signs of any other "problems". She is developmentally where she should be and her speech and vocabulary are excellent. She has made strides socially--she is quite popular with her peers, she is compliant in every aspect, she has eye contact with those addressing her and she actually is a show off with her gymnastic skills and just being silly. She just doesn't talk!!!!!!!! We are concerned that she has fallen into a "comfort zone", and that she doesn't need to verbalize because all of her needs are being met and she has mastered the art of non-verbal communication. Our therapist feels that she is past the "major anxiety" issues and that there is a lot of manipulation going on. I'm not so sure. We have tried behavior modification, forcing the issue, bribery, etc. with no success. She closes down completely if we pressure her, so we have decided to drop the issue or just not make it such a big deal and it seems to relax her. The therapist feels that we should start depriving her of privileges, and start some hard core behavior modification or meds. We don't feel that we have exhausted all of our options yet, and she really has made progress. Do we just forget about it and hope that she'll just get past it? Do we try modifying her behavior by taking things away from her?? We don't want to do anything that will harm her in any way--she is so precious. Please help!!

What can you tell me to help me understand?

Dr. Elisa Shipon-Blum — 2007-12-15T05:58:53Z

Our daughter is 6 and we have recently been in touch with our local Speech Pathologist (who specializes in SM)-she came to our home to observe K..... and told me K......appears to have SM from what she can tell, and she seems to be emerging. My concern is that she uses words and phrases such as," these kids know exactly what they are doing." They want to control everything. This may be hard to hear but they are very manipulative. She doesn't say this in a mean way, and says it is from the anxiety. She seems to know something that I don't understand and don't see myself. She brought me a copy of the Personal DSM IV, so I believe she has recent info about SM. I am not understanding this (am I being defensive?) I try to be open to positive AND negative aspects of SM, but when I look at K..... in her most difficult situations I see fear, apprehension and anxiety, not manipulation or control. I want to be open to learning, but my instincts are telling me that K..... is not doing this on purpose. Is there anything you can tell me to help me understand? Why am I not getting this aspect of SM. Please help?

Should we pursue a different therapist?

Dr. Elisa Shipon-Blum — 2007-12-15T17:44:13Z

Our daughter is 6 years old and has Selective Mutism. She's been in therapy since November of 2001. Her therapist is using 'play therapy' without drugs. Our daughter has progressed from no talking at all during sessions to talking openly with the therapist, but she still won't talk to teachers, etc. Over the past couple of months it seems as though she has plateaued. Are there any other forms of therapy or treatments (short of drugs) that could help her progress through this disorder to a normal childhood quicker? The therapist seems to only want to use the play therapy, should we pursue a different therapist?

Could you tell us where to go from here?

Dr. Elisa Shipon-Blum — 2007-12-15T17:41:53Z

My daughter is 8 years old. She was diagnosed with Selective Mutism when she was 6. She has not spoken to any adult besides my husband and myself. She has been in Therapy for 2 years. She never spoke to therapist. We have stopped therapy. Could you tell us where to go from here?

Should I go to a therapist who has experience with SM?

Dr. Elisa Shipon-Blum — 2007-12-15T17:43:06Z

My daughter is 4 years old and has selective mutism. At the age of 2 1/2, I enrolled her into preschool three half days a week, which I thought would help her with her socialization skills, because I thought she seemed to be shy. During her first year of preschool, I noticed and was informed that she hadn't spoken to anyone, and basically that pattern has continued. She speaks only to the immediate family, and to the immediate family around other people, but not to other people. Last November I had her see a therapist at our HMO for approximately 6 months. I believe only play therapy was used, and no improvements were attained. However, the therapist was able to get my daughter to speak with her by having the two of them begin with animal noises, which lead to laughing, and then to speaking. The reason why we quit going, was that her visits were reduced from once a week to once a month, and I believe it was because the therapist had too many patients that she needed fit into her schedule. So, based on that I've decided to go outside of my HMO, and see a private therapist. Unfortunately, I'm finding, that out of the twenty therapist I've called so far, only two have had some experience with it. Certainly, I have not found someone who specializes. So, I was wondering do you know of anyone in the San Diego, CA area that could help my daughter? If not, should I go to the therapist who have had some experience, but seem to be resistant to Prozac i.e. meds? I'd appreciate any help/suggestions you could give me. Thanks

p.s. In your opinion, if behavioral therapy alone was tried and there were no results, keeping in mind that my daughter is of good health, weighs 45lbs, and is 42 inches tall, what dosage of Prozac would you start my daughter at, and how long would you keep her at that dosage before upping it if no results were found at the previous dosage? Also, what would be the highest dosage you would prescribe to her? The reason why I'm asking is if I have to go to someone that doesn't know that much about selective mutism, at least I'll have a reference of what the prescription they issue should be close to.

How do I know when it's time for medication?

Dr. Elisa Shipon-Blum — 2007-12-15T17:42:18Z

I have been aware of my daughter's selective mutism since 09/01. She is 4 and has been under the treatment of a psychiatrist w/experience w/SM since 02/02.(these dr.s are hard to find.) Office visits are every other week alternating 45 minutes to 1 1/2 hr. Longer visits started recently -my idea. We meet at restaurants or the park-my idea. The dr.is 1 hr away so we travel there. After a warm up of about 5-10 min. C will speak with the Dr in a whisper unless she forgets herself and will speak normal tone. Our concentration has been to build her self esteem-(dance lessons) & to have her feel comfortable @her daycare. I spend 1 afternoon there per week and she will whisper to me in front of others. She doesn't like crowds-too many kids she just walks away. What's next? I felt that after 7-8 months of Dr visits it would be more than playtime-them getting comfortable together. What should the Dr be doing w/ my daughter? The Dr & I email as I do not discuss in front of C who believes the Dr is my old friend. We've discussed meds for the future-she likes Paxil. How do I know when it's time for that? We have not set any goals but I feel we are at a standstill. I need directions-am I doing enough?