Dear doctor, I have a 5-year-old girl who never talks in school except giving one or two-word answer. She does not play with others, never makes friends. At home, she talks just fine. She pays attentions to what we said, asks a lot of questions, plays with us, laughs… We took her to see two psychiatrists and both diagnosed her to have social phobia caused by high level of anxiety. Although they never mention she has SM but we think she does based on the information we get here. The only thing I’m not sure is that as very much relaxes as she is with us at home, she never answers our open-end questions. She only answer yes/no or multiple choices questions. She can speak full sentences very well or even argues with us. But she never tells us what she does at school when asked. We found out recently quite by accident that a boy has been picking up on her. She never reports it to her teacher or talks to us about it. She just became anxious about going to school. She seems defenseless when someone gives her trouble. Is this a common behavior for SM children to hold such information even from her own family? Is it common that they don’t answer open-end questions even to her parents? Also do you know any doctor or psychologist in Austin, Texas area who is specialized in SM? Her current psychiatrist wants to use med on her (Pexil or Prozac starting at 10mg) but we are not sure if this is a right dosage to start with. We really appreciate any help you can give us. It just makes us extremely worried that our little girl can not even protect herself due to her inability to speak. Thank you very much!


From the information that you provided about your daughter if she truly does speak in school…even one or two word answers she does not meet the definition of Selectively Mute.. But, it does sound as if she is socially phobic…so, basically, the treatment is the same in the majority of cases.

This Website will help you tremendously with your child. I am a bit concerned about her expressive language development. You mentioned that she does not ‘elaborate’ on answers and prefers answering multiple choice questions and will answer in one or two words…The reasons for this can vary. First of all, it is possible she has a speech and language problem. I am going to have our speech and language specialist answer this question regarding the specifics….but, just so you know, approximately 20-30% of SM’s have a speech and language problem…. Another reason for her ‘lack of elaboration’ could be that she is a perfectionist in many senses and does not want to say the wrong thing. Many of our SM kids have that characteristic. They are (subconsciously) concerned about what they say and how they say things. If this is the case, treating her Social phobia/Selective Mutism and building her confidence with her speech and language will cure this. One of the members of our advisory board lives in Texas, I will ask her about specialists in your area…then we will get back to you.

Addendum to Q 9

You mentioned Medication, The dosages you suggested of Paxil and Prozac are appropriate dosages, but I NEVER EVER start a child on this level. I start with a much lower dose than 10 mg and slowly build up this dose and then slowly over a few weeks-months move up (if need be). By starting low I am accomplishing three things. First, I am minimizing side effects. Secondly, I am starting low and my kids will eventually end up on a much lower dose than the average. Third, starting low enables me to use behavior modification and other psychological therapies to work hand-in-hand with medication.

Dr. Elisa Shipon-Blum