Differential Diagnosis and Treatment with Fluoxetine of Selective Mutism: A Case Presentation

Abstract

Introductıon: Selective mutism (SM) is a pediatric psychiatric disorder that occurs when a child consistently fails to speak in specific situations in which speaking is expected, such as at school and social gatherings, but speaks appropriately in other settings. Selective mutism is often diagnosed when a child starts school anddoes not talk to teachers or peers, but talks to family members at home; the condition is frequently accompanied with anxiety and shyness. Case Presentatıon: This case report provides information on the treatment of selective mutism in a 4-year-old Turkish male patient with preexisting behavioral inhibiton. In this case report our patient’s diagnosis is selective mutism predominated by behavioral inhibition. Management and Outcome: Our patient was referred to the pediatric outpatient clinic with an initial diagnosis of autism due to autistic symptoms such as avoidance of strangers and lack of eye contact. The patient was diagnosed with selective mutism and play therapy was attempted with the child twice but he did not interact with us. Finally we decided to start fluoxetine suspension (5 mg/day). During follow-up, it was seen that there was a marked improvement in behavioral inhibition within one month. It was also seen that the social anxiety-like symptoms of selective mutism were almost resolved. Conclusıon: Selective mutism is rare with a prevalence below 1% in the general population, but with a higher prevalence in populations at risk. It should be recognized in pediatric and psychiatric clinics. Its differential diagnosis is important for prognosis and treatment. Evidence for treatment strategies is very rare. Fluoxetine is recommended for selective mutism, and we found that it is useful for SM treatment.