Our six year old daughter was diagnosed with SM two years ago after a year of not talking at kindergarten. We did a year of family therapy (with a good therapist, but she had no personal experience with SM) and although A…….. still does not talk, she is socially much more relaxed – better eye contact, holds hands with friends, etc. It is now a year since we finished therapy and we felt it was time to get A……. on medication. Our physician is being very helpful and yesterday we started her on 5mg fluoxetine. Our physician has no experience with SM – how often and by how much do we increase the dose to get her up to 10mg? Also, you mention behavioral therapy a lot. We have not, in the past two years, found anybody who specializes in SM. Can you not build a page on the web site to guide those of us who must instigate behavioral therapy for our SM child on our own? I don’t want her progress on fluoxetine to be hampered be lack of behavioral therapy. Thank you for all your marvelous help and advice to all of us struggling with SM in the family.


Sounds like your child is moving right along. You are right, you need an individualized behavioral plan for her to be in school and at home. Medication without the use of a behavioral plan is inappropriate. Coping skills need to be implemented. Behavioral plans include various forms of desensitizing your child to their social environments, positive reinforcement (rewards for progress) and quite a few other techniques. What techniques work with one child may or may not work with another simply because every child is unique. A professional needs to GUIDE you and monitor your child’s progress. He/she has gone through years of training to know when and how to use these tactics. So there is NO one-plan-fits-all behavioral approach. This is the same for medication usage. Starting at 5 mg is higher than I usually start, but that is just my approach. As far as how to dose, again, each child is different. Some children can be progressed more rapidly than others. Timing of progression is based on the child’s positive and negative response to medication. My experience is to start very, very low, move very, very slow and to try to maintain the child on as low a dose as possible. Your prescribing doctor needs to monitor your child and should be able to make judgments as to the progression rate of the meds.

Dr. Elisa Shipon-Blum