My daughter will be 5 in November. She has “mild” SM in that she speaks freely to peers, teachers aides (younger than teachers) and some friend’s parents. She does not speak to older teachers, grandparents, aunts and uncles, and most other adults. Also, she refuses to toilet train (has never and says she will never). We have been in therapy 3 months and the therapist wants to try Prozac during the next phase of treatment. We are concerned about her age and whether this is necessary. She seems very happy and relaxed as long as we don’t push her to verbalize or toilet train, but we do have to start pushing a little now and the therapist feels she would go very smoothly and quickly with the meds. We are inclined to wait and try some behavior therapy. Any advice? Thanks


I do not know the specifics about your child, but I can tell you from (a lot) of experience working with children in your child’s age range. Medication most definitely speeds the process. You mentioned that your child ‘does not seem anxious’ when you do not push her. However, children with SM do not necessarily LOOK anxious. Their mutism is a form of anxiety. If your child is MUTE, but looks comfortable, she is still anxious. You also mentioned that your child is not yet toilet trained. Although I am an advocate of ‘not pushing a child,’ your child is 5. Unless there is a medical reason (or psychological reason) there should be no reason as to why a 5 yr. old is still wearing diapers. ANXIETY can most definitely HALT toilet training progress. For many SM children who have had bathroom issues, medication has helped tremendously. Since the majority of children with SM have social anxiety, there is a condition called; ‘Paruresis,’ or shy bladder/bowel condition. We are learning that more and more children with SM and social anxiety have this disorder, which is a manifestation of social anxiety. Perhaps your child’s inability to train properly is partly due to Paruresis. Behavioral therapy and medication helps tremendously.

Dr. Elisa Shipon-Blum