I have a 5 year old daughter with SM who will be entering kindergarten in the fall. My question is this: I was supposed to start my daughter on Paxil in July so that she would be as prepared for Kindergarten as possible. She was in therapy for about 6 mos., but we eventually got to a point where we couldn’t make any more progress IN the therapy sessions, although OUTSIDE of the therapy room, I was starting to see improvement. Anyway, just when I resolved myself that I was going to medicate, I started seeing tremendous strides in my daughter’s behavior. She went to a 1 week camp at her former preschool, where she had never spoken a word, and spoke to the NEW teacher on the first day and continued to do so the whole week (not just one word answers). She even asked for a drink of water. My daughter even told me on the way home from camp that first day that she didn’t speak in preschool, but she did talk in camp. She also expressed to my husband one evening that it was easier to talk, than not to. Also, around the same time, she began to order her own food when we went out to eat. She’s never done that before. Overall, she seems to be more comfortable with new people, she’ll talk to more kids now than she ever did, but there are still a lot of adults and kids, sometimes, that she will not talk to. It almost seems like people she has a “history” with of not talking, she still won’t speak to, but she’s talking more easily to new people. So based on all this, we decided to hold off on the medication and see how she does in the fall.

I have a psychiatrist who is ready for my call, if we see she is mute that first week in school, I will jump right on it and start her on the medication so as not to let her non-verbal pattern become to ingrained in her, in this new situation. My problem is that I am starting to second guess my decision. As you know, SM does not just disappear over night. Should I be starting her on Paxil anyway, even though I am seeing all these positive steps? Just to guarantee that she will at least start the year off speaking in school? Am I taking too much of a risk by letting her start the year without any medication? Do you medicate a child who is showing progress, just to help take the edge off? If she doesn’t speak that first week and I jump right on it and start the Paxil, will it more difficult for the med. to help, than if we had started her on it before school started? If it were your daughter and you saw these positive signs, even if she still showed some signs of the mutism, would you still medicate her or would you give her the chance to see if it could be worked through without the medication?? I truly respect your personal and professional opinion and I look forward to your response. There are so few “experts” out there, thanks so much for all that you do!


Wow, you certainly have a lot of information in this question. IF this were my child I would HOLD OFF on medication at this point.It is not uncommon for SM kids to start talking in brand new situations…in fact this is very common! Another common trait is they will be mute with most of the people they were mute with in the past…in other words, if you were to take her back to her preschool, she would probably resort to her old, non-talking state; simply because that is how she saw her self there….mute.

In some circumstances, all it takes is a new situation and the ability to ‘realize’ that they CAN talk…to be able to come out of their SM! I hope this is the case with your child! If your child is mute in K, give her a few weeks before ‘jumping right’ to Paxil. K is a major adjustment for any child, and so much harder for children with an anxiety disorder. It sounds by your letter that you are indeed knowledgeable about SM, so I think you will ultimately make the right decisions with your child. Bottom line……wait, encourage your child to speak in public as much as possible…ask her questions with other children around and just take a wait and see attitude.I wish you and your child all the best. Sounds like you are right in-tune, so I have confidence this will all work out!

Dr. Elisa Shipon-Blum