My 6 year old daughter has selective mutism. The therapist said she is “not ready” for therapy. We are working on a behavior modification program at school with the teacher but it is very slow. We have finally gotten our daughter to use the bathroom at least once a day at school when she is told. She will only go if another student is standing at the door so no one will walk in. My husband is very reluctant to use medication. Do you think that medication is a beneficial part of the treatment program for SM? Thank you for your help.


Depending on the degree of mutism, often dictates the route of therapy. i.e., for a child who is totally mute at school (not talking, whispering with other children or teachers), who is not verbalizing with friends at school or other adults outside the home is a severe Selective Mute. I tend to recommend a combination of medication and behavioral therapy. For the child who is talking or whispering to children in school and at home and is not completely MUTE outside the home, I will speak with the parents and together, based on many circumstances, we will come up with a game plane. Perhaps the child has never been under therapy before, or perhaps the child has been seeing different professionals for two years…In other words, there are many determining factors to weigh when determining whether medication is warranted. I can say quite confidently, that YOUNG SM children (your daughter’s age) USUALLY respond incredibly well to medication. Knowing that I use VERY low dosages of medication for only 9-12 months, I believe that using medication with behavioral therapy is the route to go in the majority of cases. In other words, it can take an indeterminant amount of time with using just behavioral therapy. Using medication SPEEDS the process exponentially in most cases…especially younger children where there are not years of LEARNED behavior ingrained. Please consider this: What are the long term consequences of a child that becomes socially isolated and withdrawn?

Hope this helps.

Dr. Elisa Shipon-Blum