Could you give me any advice to the best treatment plan for my 14 year old son? He is selectively mute in school and social settings, he has anxiety problems, and he is depressed in school, which is affecting his grades.


It seems that your son is manifesting the unfortunate ramifications of untreated anxiety; depression symptoms, falling grades, social withdrawal. He most definitely needs to be involved in treatment. Since I have not evaluated your son personally, I cannot make specific treatment recommendations. However, based on his age and debilitating symptoms, medication is a viable treatment approach WITH behavioral therapy to help him build the coping skills. Medication alone will help him to a point, it is the behavioral tactics that will help him build the necessary coping skills. Medication will enable for lowered anxiety, just enough, to do the behavioral tactics necessary to build the necessary coping skills.

Since over 90% of SM suffers have social anxiety, I will assume your son fits this profile. With this in mind, if you are unable to find a professional who understands SM, searching for a professional who understands social anxiety is an ideal choice. Focus of treatment behaviorally should be a combination of: Cognitive behavioral therapy using desensitization and positive reinforcement. Imagery and talk therapy also work well with our children. Goals of treatment should focus on helping your son communicate comfortably.

As mentioned in many other ASK THE DOC questions, building self-esteem is also crucial. Understanding SM as a communication anxiety will help you and your son understand the approaches that need to take place. i.e., is your son comfortable responding nonverbally? Initiating nonverbally? etc. In other words, your son’s individual characteristics will dictate the specific treatment tactics and techniques.

I also recommend that you read through the entire member site. There are many other ASK THE DOC questions that focus on your specific concerns. I cannot emphasize the importance of prompt treatment. With the symptoms your son is portraying, he needs treatment immediately.

Dr. Elisa Shipon-Blum