Selective mutism is a psychiatric disorder characterized by consistent failure to speak in specific social situations despite speaking in other occasions.

To demonstrate different therapeutic approaches: Cognitive Behavioral Therapy (CBT)/ CBT besides medication.

The material used comes from the archives of the Child/Adolescent Clinic of the Community Mental Health Center (CMHC) of Katerini, Greece.

Two six-year-old children visited the Child/Adolescent Clinic of the CMHC of Katerini. They both presented reluctance to speak at school while interaction in other activities varied between them. Although they were both initially treated with CBT, the severity of symptoms in one case led to the administration of Fluoxetine in addition to CBT. Fluoxetine was initiated at 4 mg/day and gradually titrated to 20 mg/day. Two years later, both cases show clear improvement. The first one treated only with CBT has begun to speak at school, mainly when asked to do so, and appears more willing and comfortable among strangers. The second one shows signs of progress especially after the initiation of Fluoxetine. The patient interacts with strangers, speaks to children out of school and appears in better mood. Despite the progress, she still mutes at school.

In accordance with other international references, this presentation shows that cases of Selective Mutism respond to variant therapeutic approaches. Although CBT can be proved quite effective, Fluoxetine can be used to provide extra benefit.