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.


Based on your letter it is virtually impossible to make a definitive diagnosis of your daughter. But, I have to say, the preliminary diagnosis of PDD, can have serious, long-lasting repercussions. You need to educate yourself completely on PDD and autism so you are confident in the diagnosis.

Unfortunately, many children with Selective Mutism are mistakenly diagnosed with autism (a form of PDD), and the diagnosis is carried through much, if not all, of their school life. You need to understand that children with Selective Mutism DO indeed have the ability to speak normally and to interact completely normally in certain situations; children with autistic disorders do not!!! Therefore, if your child can communicate normally with you, show true, appropriate emotions, make good eye contact with you, have the ability to laugh, talk, cry; hence show emotions; and to communicate…then autism or PDD sounds doubtful. The fact that your child was diagnosed as ‘socially behind’ can happen quite often with Selectively Mute children; simply because they do not interact appropriately with the examiners…due to their inability to speak (at the time).

My advice to you, is to continue to seek out advice from professionals, read and educate yourself completely. If Selective Mutism is diagnosed, and social phobia is the cause, then I do recommend considering a trial of medication. You asked about the types of medication. Paxil and Prozac are very similar, differences are subtle.. I would consult your physician as to which he/she is more comfortable prescribing. We usually start on very low doses. gradually increasing every week to two weeks until a safe therapeutic level is reached.

As far as response when a child is taken off the medication…it varies, some children continue to talk, and socialize normally, while others regress and need to continue on medication for an indeterminate amount of time. The use of these drugs in children is relatively new, so scientists are still studying the short term and long term affects. Preliminary studies are indicating that these drugs are very safe to use, and no long term detrimental effects have been found.