Friend of my daughter, Miss A 6 years old, will not speak in School. I have
known A since she was a baby, watching her and two younger siblings pass through
the baby clinic and reach normal development milestones. A was always a quiet
child in company, but I was surprised to hear my daughter, in A's class at
nursery, remark one day, "You know Mummy, A never speaks at school." There was
no hint of developmental delay, and at home A interacted quite normally with her
family. The transition to primary school saw a persistence of A's determined
silence, no verbal interaction at all with her class mates or her teachers,
although her basic literacy and numeracy skills developed in line with those of
her peers. By the beginning of her second year at school A had still not uttered
a single word at school. She also refused to remove her shoes and socks for
physical education in front of others and would eat nothing all day, neither
school dinners nor a packed lunch. A's parents asked for a specialist review,
wondering if any form of therapy would lead to more normal childhood
interaction. No specific help resulted from this psychiatric assessment, but at
least A now had a label "selective mutism," and in today's world a label by
itself can begin to unlock doors.
I have to say my heart sank a little at the sight of sheets of internet
printouts in A's mother's hand when she came in to see me a couple of weeks
after the psychiatric clinic appointment. A series of case reports and parents'
stories of children seemingly similar to A who had responded dramatically to
short courses of fluoxetine.
This drug is not licensed for children in the United Kingdom, but our local drug
information pharmacist was able to locate a small trial describing its use in
children with selective mutism.A's parents and I talked about the concerns
relating to the use of unlicensed medication, and I thought that I had to share
my reservations explicitly.
Within two weeks of starting the drug, A was recording taped messages for her
teacher and beginning to participate in physical education. After six weeks she
is chattering happily with her friends at school and has been to her first party
alone. She has been transformed into a totally "normal" 6year old, and her
parents are slowly withdrawing the fluoxetine.I am convinced that the use of
fluoxetine has played a central part in this huge change in A's behavior, and I
am equally sure that without the Internet her parents could not have accessed
this information.