Dear Doctor: Thank you so much for giving me the opportunity to talk about my daughter’s condition. My daughter is 4 and a half now. She has always been extremely shy just like me at her age. I myself didn’t talk to any of my teachers for the first several years in my early education in China. Due to my own experience, I’m quite concerned about my daughter’s shyness. She started preschool two years ago and it took her 6 months to start to talk to her friends in school occasionally and just after this summer, she started to talk a little bit to her teachers when alone. She still can’t answer questions when asked in front of the class and she can’t participate in group activities. But one good thing is I think she is improving, though very very slowly. My question is, since you have seen probably a lot of kids her type, do you think at this stage she will keep improving slowly, or I need to seek some professional help? Next year will be public school, if she still won’t talk to the teachers in the classroom, how is she going to be scored? I’m pretty sure in the first 6 months she won’t be able to say a word in the classroom due to her shyness, which was what happened in her in both of her preschools. She started talking at very early age (about 10 months) and has always been very talkative at home. Thank you very much for listening and I’ll appreciate any advice from you. Thank you


A 4 yr old child with the degree of SM you are describing most definitely should receive help or, in my opinion, she will continue to be SM in most situations. Most children make considerable improvement as the school year progresses. In fact, by the end of the year, many children may be speaking to teacher(s), some children ,etc…but then, once the environment is changed…going to camp, starting a new school year, etc. MUTISM and anxiety resumes. Also, understand that treating a 4 yr old is so much easier than treating an older child. The treating professional will help your child learn the coping skills to FUNCTION in school and other social situations.

Regarding ‘scoring’ or ‘grading’ your child:

If your child is still SM when she starts public school, I recommend an IEP (Individual Educational Plan) or 504 Plan that will enable for the school to provide special accommodations to help your child feel less anxious. However, if you start with effective treatment now, your child should improve greatly by the time the next year roles around.

Also, the fact that you were Mute and ‘very shy’ is further proof that SM is indeed a genetic disorder.

Dr. Elisa Shipon-Blum