My daughter M. is seven yrs. old. She has a younger sister, almost 5, and a baby brother, 14 months. We speak English at home, but all of my children were born outside of the U.S. where we reside (I am in contact with SMA/CAN coordinator in our country). When M. was two and two months, she started a private daycare program for 2 yrs, although at that time her English was superior to her age, but she was not very fluent in the local language of our country. The staff tells us that she did speak there to them and to other children, although still a shy and timid child (she learned the second language). When she was just over 4 yrs. she entered pre-K in the public system in our city (it is pre-K and K together for 2yrs.). Her teacher there was the first one to notice and/or mention to us that possibly she has selective mutism. She did not speak to the teacher, her helper, or any of the children there. She ended up repeating kindergarten (three yrs. in that school) because it was suggested to us that one more year in kindergarten would help her to be mentally ready for first grade, considering her selective mutism problem. During that time, my husband and I sought the advice or help of over 10 different professionals, including a year and a half of art therapy (M. is an incredible artist, but now I realize that that method of therapy was only feeding her silence) and several sessions at a child psychiatrist who after seeing her just wrote a recommendation for therapy. This past summer, we finally found a child psychologist/behavioral therapist who has some past experience with SM patients and seems to be the most knowledgeable professional thus far (most of the sessions have been with my husband and I, which I prefer).

M. has never been on medication and is constantly making progress. Last April we were visiting my mother in Florida and my brother and sister were there with their kids. M. spoke and played with her cousins for the first time! She even jumped in the deep end of the pool and yelled “look at me!” She started first grade and made one new friend that she talks to. She doesn’t speak to the teacher or any of the other kids. She doesn’t have any problem to use the restroom at school, which was a big issue in the past. During the summer, she started to ask for and pay for her own ice cream at our pool. Last week we were at a park and she bought her own popsicle. A few weeks ago some of our friends that she has always known but never spoken to, came for dinner. They have a 10 yr. boy, 4 1/2 boy and a baby. For the first time, she spoke to the two older boys, played and laughed with them and just acted like a regular little girl. She even spoke to their mother when she asked her a question. About a month and a half ago the same thing with some other friends of ours, they asked her how is first grade and she answered them. She does have a few friends not in her school that she speaks to as well as some friends that she plays with that she doesn’t speak to.

Recently, at school she has had a problem because a group of girls that she wants to play with don’t really include her and even started to get a little nasty. I told her that because she doesn’t speak they don’t know that she wants to be their friend or play with them. She said she wants to talk but she just can’t. My husband even bought her healing stones and told her that they will help her not to be so shy. Our therapist saw her last week and is trying to push her to say one word to her teacher or to anyone else that she has difficulty with. She became so anxious that she began to sweat profusely. I do not feel that she is ready to make that step. All of her previous progress has been on her own initiative.

MY QUESTION: Although, I have read about other cases that seem much worse than M., I am wondering if medication would now push her to that point that she could more easily overcome her anxiousness and get over this thing. She is full of desire and motivation to speak and have friends and be like every other kid her age. She says she wants to talk, but it just doesn’t come out. I don’t want to pressure her too much, but I also feel that if other kids will be mean to her it could have long term damage (the kids that she does speak to love to play with her and think that she is funny). In the beginning ,I was adamantly against medication, but I see that she is so fed up with her SM and I want to help her. Do you have a suggestion about meds or a way that I can get her to make more progress on her own initiative? Thank you so much for your time!


From what you have written, it seems that you are just embarking on the behavioral therapy. I would not necessarily go to medication just yet. The therapist you are seeing seems to be expecting too much at this point. Your child is MUTE in school with children and the teachers. Why then expect her to say a word? What needs to be done is to help her assess her feelings of her anxiety, then use her feelings as a goal. Is she able to respond and initiate nonverbally? If not, then you need to help her do that first, prior to any verbalization.

Does she speak to her school friends when at your home, or even one at a time when home? If not, that needs to be done first. Has she spoken to YOU in the school? If not, then she needs to work on that. But understand that you need to know that by trying these goals she is OKAY with this and not feeling too anxious about these goals (which should be rewarded with positive reinforcement of some sort).

A child goes from mutism—> Nonverbal (response, initiation)—> verbal ( response, initiation) but the steps in-between are based on her degree of anxiety and what SHE CAN accomplish without too much anxiety. Spending time alone with the teacher is easier than in a large class setting, spending alone time with ONE child at a time or just a few is easier than a large group, etc. Understanding the steps that need to be taken is crucial to helping your child overcome her anxiety and mutism.

Dr. Elisa Shipon-Blum