My daughter is 4 years old and has selective mutism. At the age of 2 1/2, I enrolled her into preschool three half days a week, which I thought would help her with her socialization skills, because I thought she seemed to be shy. During her first year of preschool, I noticed and was informed that she hadn’t spoken to anyone, and basically that pattern has continued. She speaks only to the immediate family, and to the immediate family around other people, but not to other people. Last November I had her see a therapist at our HMO for approximately 6 months. I believe only play therapy was used, and no improvements were attained. However, the therapist was able to get my daughter to speak with her by having the two of them begin with animal noises, which lead to laughing, and then to speaking. The reason why we quit going, was that her visits were reduced from once a week to once a month, and I believe it was because the therapist had too many patients that she needed fit into her schedule. So, based on that I’ve decided to go outside of my HMO, and see a private therapist. Unfortunately, I’m finding, that out of the twenty therapist I’ve called so far, only two have had some experience with it. Certainly, I have not found someone who specializes. So, I was wondering do you know of anyone in the San Diego, CA area that could help my daughter? If not, should I go to the therapist who have had some experience, but seem to be resistant to Prozac i.e. meds? I’d appreciate any help/suggestions you could give me. Thanks

p.s. In your opinion, if behavioral therapy alone was tried and there were no results, keeping in mind that my daughter is of good health, weighs 45lbs, and is 42 inches tall, what dosage of Prozac would you start my daughter at, and how long would you keep her at that dosage before upping it if no results were found at the previous dosage? Also, what would be the highest dosage you would prescribe to her? The reason why I’m asking is if I have to go to someone that doesn’t know that much about selective mutism, at least I’ll have a reference of what the prescription they issue should be close to.


First of all, check our professional advisory board, Murray Stein is in the San Diego area and may be able to see your child. He is at the Univ. of Calif. San Diego (UCSD). If he cannot see your child, perhaps he will recommend someone in your area.

Secondly, before you consider medication, I am not sure you have EXHAUSTED all of the behavioral tactics that can be instituted. You mentioned that your therapist did play therapy. What did she do to help your child in the outside world? In other words, she got her to speak to her in the office, but did she work with you on ways to help her with increasing comfort in school? public places, how to desensitize her to her environment to lower anxiety etc?

From what you wrote it does not seem that way.

We work with many four year olds, and MOST do very well with behavioral alone. IF after three- 6 months of ‘correct’ behavioral tactics medication may be considered. Tactics should be geared towards LOWERING ANXIETY, BUILDING HER SELF-ESTEEM and INCREASING CONFIDENCE IN SOCIAL SITUATIONS using a combination of various approaches that are individualized to your child’s needs. i.e., desensitization. How often have you worked one on one with another child? Have your spent time in her school before and after school and SPOKE to her and asked her questions to begin the verbalization process in school. There is no way she will begin speaking to ANYONE until she is comfortable speaking to you.

Thirdly, You asked about medication. The drugs of choice are the SSRI’s such as Paxil, Prozac, etc. Dosages should start as LOW a possible and increase is based on RESPONSE, not just weight. GOALS are to move slow and stay low. MORE IS NOT BETTER when it comes to using these medications. A physician needs to use your daughters reaction as his GUIDE as to how to DOSE Her. There is no hard and fast rule. Wish there was. Hope this helps.