Our daughter's social life is suffering greatly even though she has had a few breakthroughs at School. Her Pediatrician recommended a 6 to twelve month trial of Sertraline (Zoloft). I thought a timeline of medication, side affects and progress with anxiety would be useful to share with members of the forum.
Sertraline DIARY
Week 1: Introduction of 12.5mg per day. No side affects and no difference in anxiety. I didn't expect any results with the small amount of medication that was introduced to her in the first week. Friday November 21st My daughter speaks out loud in front of a few people at my Wife's place of employment. She was not speaking to any of my Wife's coworkers, but she did speak.
Week 2: November 28th: She is still taking the same dosage. There has not been any noticable side affects and there has not been any progress except for the fact that she spoke at my Wife's place of employment. Just a note, it is a small Office and she has been there numerous times. So it is quite possible her anxiety levels are low there.
Week 3: December 5th: The dosage is doubled as of today (now 25 mg). I had a very difficult time getting her to take the medication this morning, but she finally took the medication. Now the monitoring for side affects and/or improvement will continue.
Week 4: December 12th:One week at 25mg. Still no side affects. She spoke freely in front of a friend of mine, and she even smiled. She did not speak to him directly though. I will begin Cognitive Behavioral Theory with her next week.
Week 5: December: 19th: I didn't update on time this week on purpose. I thought that I would start Cognitive Behavioral Therapy on Saturday night. I invited a friend on mine over that my Daughter is familiar with, but hasn't spoken to in the past. She spoke freely in front of him, and jokingly called him a "name" to his face. It wasn't exactly what i was waiting for, but he has teased her a lot in the past and she knows that he is a Joker! Phase one of Cognitive Behavioural Therapy was deemed a success. It is just a small step, but it is a step in the right direction. She still will not go play at her friend's house, but we are going to take small steps. I expect that she will be silent for the holidays as there will be times when a lot of people will be present.
Week 6: December 26th: Everything went well through the holidays. My daughter didn't seem as timid with extra people around. She will talk to us in front of strangers when we are out in public. She has said a few words to people that she has not spoken to before. She is starting to take small steps in the right direction. We are going to have a few people over on New Years eve, I will keep everyone posted.
Week 7: January 2nd: She is more comfortable in slightly larger groups than she was in the past. She was able to speak in front of two people that she had not spoken in front of in the past. I would like her to speak to a few more people before I really try tackling her avoidance behavior.
Week 8: January 9th: Earlier in the week she went to the clerk working at the Bowling Alley and asked for a different size shoe. She has done this once before in the past. On January 9th our daughter spoke to her Teacher. The final bell rang and while heading towards the outside door, my daughter told her Teacher that she would hold the door open. This information was provided by one of her friends.
Week 9: January 16th: There are no advancements to report this week. I have been wondering if perhaps her dosage should be increased.
Week 10: January 23rd: We are preparing to move into a new home and have not made any time for Cognitive Behavioral Therapy, so there is nothing new to report in that aspect. Our daughter still speaks if strangers are nearby. She has not spoken to her Teacher again, but I'm sure she will speak to her again under the right conditions. I figure that she spoke the last time bacause she wasn't in the classroom and she was excited to come home.
Week 11: January 30th: I usually update on Fridays, but I needed to add the following information as soon as I could. January 30th: On Sunday January 25th my daughter's friend calls and invites her over to her house... and she agreed to go. For those of you who don't know, my daughter has not been able to go over to any of her friend's homes in approximately a year! While I waited at the door for my daughter to get ready she was actually talking to her friend's Mother. Before my daughter went to bed she said that she had a really fun time at her friend's house. She also said that her next step will be to go for a sleepover. January 28th - My daughter told me that she wants to go play at her friend's house again.
Week 12: February 6th: February 3rd and 4th my daughter went to a different friend's home. She had not been over to her house to play in a very long time. As a part of Cognitive Behavioral Therapy I wonder if she would go to a new friend's home. I hope that option becomes available in the near future.
Week 13: February 13th: My daughter is still making frequent visits to her Friend's houses. I have not had any reports of more speaking at School though. I sent more video of my Daughter reading at her Teacher's request. She did well, it looks as if she will be graded on her reading this year!
Week 14:February 20th: On February 17th we received a letter from our daughter's Teacher. In the letter she said that our daughter is speaking loudly in class to other Classmates, although she still doesn't speak to the Teacher. The last recordings of her reading prompted the Teacher to send home higher level reading books. Overall the Teacher is very pleased with her progress.
Week 15: February 27th: My daughter has been spending a lot of time playing at her friend's homes. The parents of her friends have heard her speak. She has not been as quiet as she has been in the past.
Week 16: March 6th: She has been to a new friend's house as well as another one of her old friend's homes. Things are getting better. She spoke in front of some of my Coworkers, and she has never met any of them before.
Week 17: March 13th: Still taking 25 mg of Sertraline each morning. People are telling us that they see a huge improvement in regards to her speaking. She has spoken if front of other people that she didn't know. I have not heard of any more progress at School.
Week 18: March 20th: All is going well. She spoke "in front" of her Teacher when my Wife went in to talk to her about an incident that involved another child hitting our daughter. Just a note, the incident had nothing to do with her SM.
Week 19: March 27th: Report card came out on March 24th and the report was excellent . She actually was graded on her reading. No more N/A on her report card! We went to Parent Teacher and our daughter actually spoke to one of her Teachers as she was walking away from her. Her Teachers also told us that our daughter has spoken to at least six Staff members (Teachers and Principal). After we had our meeting we ran into the Principal and he told us about his conversation with our daughter - he was so excited to share this information with us. We had no idea that things had progressed so much at school. I no longer need to video tape our daughter reading as they are able to assess her in class now.
Week 20: April 3rd: A relatively quiet week. Our daughter is still speaking in front on strangers.
Week 21: April 10th: Family was home for the Holiday. Some family members that my daughter would not have remembered, but she did speak to some of them. I think that it is possible that some of them didn't know about her SM, but nobody asked if she was shy. Perhaps her SM is not showing as obvious as it had at previous family get togethers. We went out for a family meal and my Wife ordered for our daughter, but when the Waitress asked my daughter was actually saying what she wanted. She stopped when she realized that her Mother was ordering for her. My wife didn't realize (or expect) that she was talking.
Week 22: April 17th: Our daughter still continues to talk to familiar people that she has never spoken to in the past. She also continues to talk in front of strangers, and sometimes speaks to them. It seems that most of our daughter's progress has been in the past few months. We are so proud of her.
NOTE: Although I may not mention it in each update, Cognitive Behavioral Therapy is taking place on a consistent basis. It is extremely important for Selective Mute children to be in situations where the opportunity to speak to someone that they may not have spoken to in the past. We began by having a friend of the family over to our place, someone that our daughter has seen at least once or twice a month since she was born. She has never spoken to him in the past, but she was one of the first that she has directly spoken to after she started taking her medication. We then would invite over another person that she was a little less familiar with and she spoke to her as well.
We noticed that as she spoke to more people the avoidance behaviors (actions she took to avoid situations where talking was necessary) seemed to diminish. I am not sure if that is just a natural progression as she becomes more comfortable with speaking, but nonetheless, we are happy to see that she seems to be improving at a good pace.
Week 23: April 24th: Our daughter had her birthday party on Saturday. It is the first year that you could see the joy in her face. In the past she had a blank face during most of her birthday parties, especially when opening presents (mainly because all of the attention was focused on her). I have noticed that she is making friends much easier now. She has a number of new friends in our new neighborhood! It was a very happy birthday.
Week 24: May 1st: Our daughter still continues to make improvements. We went out for a meal with almost a dozen people and she was fine. She didn't initiate any conversations with any of the people that she was not familiar with, but she did speak quite freely with her Aunt and Uncle. She rarely ever spoke to her Aunt a year ago. She was at ease and didn't seem stressed out being in a group group of people.
One of my friends commented that she seemed happier and much more at ease! Her blank stare was not present. I had doubts that a low dose of 25mg would make a difference, I was proven wrong.
Week 25: May 8th: We went on a short vacation and my daughter spoke to the Border Patrol Officier. He asked us where we were going and I said that we were going shopping. My daughter added "we are going rollerskating too!". She also spoke to a Store Clerk.
Week 26: May 15th: There is no stopping her progress. She still exhibits the desire to speak to new people. She still has shy moments, but she is doing really well. It has been 26 weeks and there have not been any side effects. Itis hard to believe that she has been on this low dose of Sertraline for only six months.
Week 27: May 22nd: She almost ordered her own food at the Drive Though this past weekend. At the last minute she changed her mind. I think that she really wants to use her "public" voice more frequently, but she sometimes can't go through with it. I think it will just be a matter of time before she is able to speak anywhere to anyone. She has already spoken to complete strangers without being prompted to do so.
Week 28: May 29th: There is nothing new to report in the past week.
Week 29: June 3rd: On Wednesday our daughter's Teacher called us over as the Sstudents were leaving school for the day. She said that she did an excellent job on the oral presentation of her book activity. Her marks:
8/10 for the written portion
9/10 for her oral presentation to the class
The biggest breakthrough just weeks before school is finished for the summer!
