My daughter is 4 1/2 years old. She was diagnosed with social phobia (and SM), and began treatment this past summer with both a psychologist and psychiatrist. Her doctor prescribed Prozac, and we have seen wonderful results in alleviating her anxiety. However, there has been no progress in her speaking. She currently speaks to only my husband and myself, and her grandmother. (She stopped speaking to her grandfather about six weeks ago, while he was hospitalized.) To give you some background to her treatment: she was initially started at 4 mg of Prozac, and remained at this level for approximately 9 weeks. It was during this period, we saw her anxiety dramatically decrease. She was increased to 10 mg of Prozac over a three week period, and has remained there for the last month. We have seen some changes in her behavior (but not as noticeable) since this increased level of medication. We have visited both her psychiatrist and psychologist in the past week. There has been no change in her medication; we will “wait and see” how she does over the next 6-8 weeks. Additionally, the psychologist feels that there is really not a whole lot else we can do at this point in order to prompt her speaking. While we are thrilled with her general progress, we cannot help feel frustration with the “non speaking”. We appreciate the conservative approach to medication, but also feel that the sm is a habit, and this behavior is becoming more engrained with time. Our professionals view the lack of speaking as simply part of the overall anxiety issue. While we know this is true, we need help with encouraging her to speak. The “play therapy” is a 50 minute session, now every 3-4 weeks. The therapist talks to myself &/or my husband for approx. 20 minutes, then plays with my daughter for the remaining time. We are questioning the value of these sessions, as they usually play with a dollhouse, sometimes my daughter draws pictures, and occasionally a puppet show. The cost for these sessions is high; our medical coverage does not include these services. My question is: in your professional opinion, do you feel we are doing all we can do for our child? Is there any other intervention we can try? I feel we are definitely on the right track with the treatment thus far, but I have doubts that our daughter will just one day talk on her own. Please advise. I am a member of the SM Group, and read everything on your site I possibly can. This site has been my lifeline for the past several months!! Thank you for your time


You are right, I see minimal value in the play therapy she is receiving as far as helping her with her social anxiety. You are not getting tools or tactics to help your child outside of the therapist office, something that needs to be done or your child will not make progress. What is the therapist doing to attend to her needs within the school? at home? and in other social situations. If she is helping you with this, that is great.

Your daughter needs to have an individualized plan drawn up to help her develop the skills needed to begin to talk. You are correct, her mutism is a result of anxiety. But a behavioral approach needs to be in place. I see way too many children who are JUST placed on medication and no behavioral plan at all. These are the children who make minimal progress overall. Then when meds are discontinued, children often resort back to severe anxiety because they never developed the skills necessary to combat their anxiety. Medication is used as a jump start to therapy, not a cure-all. Please speak to your therapist and prescribing physician about this.

Also, I do not recommend raising her medication dosage at all. MUTISM will not improve until BEHAVIORAL tactics are set into place. The only thing that will occur with raising medication dosages are tendencies for side effects.

Dr. Elisa Shipon-Blum