|ICD-10||F 94.0 94.0|
|ICD-9||309.83 309.83 , 313.23 313.23|
|eMedicine||ped / 2660|
Selective Mutism, also known as elective mutism - constant inability to talk in special social situations, when the individual is expected to speak. Despite the inability to speak in specific social situations, in other situations the individual is able to speak. Most often, this disorder first appears in early childhood (usually up to 5 years).
For diagnosis according to the International Classification of Diseases of the 10th Revision (ICD-10), selective mutism must be longer than 4 weeks, there must be no pervasive developmental disorder (F 84 84., for example, childhood autism), and mutism should not be caused by a lack of sufficient knowledge of spoken language required in the social situation in which you want to talk.
The criteria for the American Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) are similar to the diagnostic criteria for ICD-10. In order to make a diagnosis, there must be an inability to speak in specific social situations, the disorder must impede educational or professional achievements or social communication, a duration of at least 1 month and the inability to speak should not be associated with a lack of knowledge.
Elective (aka selective) or psychogenic mutism is an anxiety disorder. Children feel good and speak normally in conditions comfortable for them (home, family, friends).
If you have to change the familiar environment, children stop talking and lose communication skills. A child just can't say a word (fear of speaking), and not just doesn’t want to.
Elective mutism can persist in adulthood, manifesting itself in the form of various sociophobia.
Elective mutism is found in families with an uncomfortable psychological climate. A number of experts consider this type of mutism a manifestation of a neurotic disorder.
In children, in addition to sudden dumbness, symptoms of depressive tendencies, vulnerability, timidity, and sensitivity are expressed. The disease is especially severe in adolescence. It has the property of being transmitted by genus.
Elective mutism in children happens in the presence of such character traits:
- tendency to isolate from others,
- apparent indifference rapidly growing into aggression,
- anxiety when contacting him personally,
- mental retardation,
- disturbances or defects in speech development,
- acute reaction to a change of scenery, relocation, change of environment.
- lack of emotional contact with people
- lack of need for communication,
- mention of oneself using pretentious words, expressions, pronouns of verbs in inappropriate forms (in the second or third person).
Hysterical mutism is characterized by the presence of acute paresis of verbal manifestations. The child retains the ability to communicate through gestures, facial expressions, writing (articulation function).
Sometimes the baby makes a lowing or other inarticulate sounds. But he cannot even whisper. Often, hysterical mutism in children is combined with other neurotic diseases (encopresis, enuresis).
Apallic syndrome is similar to akinetic, but has more severe manifestations and consequences. The apallic form of mutism is called “awake coma” and rarely ends with a full recovery.
Symptoms are characteristic of all types of mutism:
- lack of speech in certain circumstances,
- the presence of a clear consciousness and a sober assessment of what is happening,
- maintaining emotional coloring,
- preservation of active motor functions,
- external reaction to negative moments and pain stimuli.
Drug therapy is not essential for mutism. Prescribing tranquilizers without special need for children is not recommended. If the drugs were still used, then they should be canceled gradually, preventing the development of addiction in the child.
Modern medicine is developing the use of new techniques (selective serotonin inhibitors), the treatment of which minimizes side effects.
The treatment of mutism is carried out by specialists: psychologist, psychiatrist, psychotherapist, speech therapist. The treatment of mutism in children is prescribed using the “multimodal approach”, family, behavioral and individual therapy.
Selective mutism is treated by specialists, taking into account the cause of the disease. Lesions of the central nervous system with akinetic mutism are difficult to treat, and the prognosis is not always optimistic.
Psychologist’s treatment for selective mutism is based on a behavioral method by establishing communication with peers and with strangers.
Often the problem of the disease comes from school, so it is important for the school psychologist to use the help of teachers and classmates of the child. The child is taught elementary behavior and the ability to speak in large groups of people (class, group of friends).
The prognosis for any kind of mutism depends on many factors: the duration of the disease, deformation of the child’s personality, his personal qualities.
If mutism occurs when a child enters school, then the ailment usually has a transient character and passes through 6-12 months. Often in the middle classes this condition goes away. However, sometimes there are behavioral abnormalities in the child and many years (5-10) after the disease.
It is important to start treatment for any type of mutism on time, because lost time can do evil work and lead to complications when the disease becomes persistent and fraught with many abnormalities in adulthood (social phobia, neurosis, obsessive states, mental disorders).
- If silence occurs, contact a specialist no later than two months from the onset of problems.
- The attention of the teacher or teacher to the behavior of each child, the ability to establish individual contact with each ward is important.
- Find an individual approach to an anxious child for parents and teachers, combining benevolence and hardness.
- The correct position of the child’s parents is crucial. They should avoid conflicts in the family, in every way encourage the child’s attempts to overcome the communication barrier and start talking.
With this strangeness, I came across as a clinical psychologist in the Department of Oncohematology. This was a patient of pre-adolescence, he was 10 years old, although it is believed that more children from 3 to 8 years old are more likely to be affected. Unfortunately, I also fell into the circle of his selective communication. But this condition was in no way connected with the problem of finding the child in the clinic.
According to my mother, “this” lasts from the time she entered school. At school, he is known as "dumb." And scolded, and persuaded, and explained. All without effect. Well, he doesn’t speak (or speak) he is at school! Neither with teachers, nor with classmates.
Me: - And what about academic performance?
Mom: - Good. He writes control dictations.
In short, all answers are in writing. There are no special problems, the settlement where the child lives is small, everyone knows each other ...
Me: - And how does he behave at home?
Mom: - He is moderately sociable, he tells all the news of the school and the streets including.
Me: -And now, here, in the clinic? Talking to someone?
Mom: -No, only with me, "closed again." Doctor, what to do and how to cure a child?
As you understand, we are talking about such a pathology as selective mutism (literally, selective lack of speech). This is a complex anxiety disorder characterized by a child's inability to speak and communicate effectively in some public places. These children can talk and communicate in safety, tranquility, in a familiar environment, for example, in their family.
The scientific world still has not figured out the causes of this ailment. They admit the problem of processing specific sensory information, a lower threshold of excitability in the amygdala of the brain, but in their studies, most children with selective mutism have a genetic predisposition to anxiety. And in the history of their lives there are frequent tantrums and tearfulness, moodiness, sleep problems, and extreme shyness from infancy.
And 90% of children have real fear in social interactions, but with different variations.
For example, some children simply become numb in certain situations, for example, at school, some speak very little, or there may even be a whisper.
But there are children who look relaxed and carefree, but can only communicate with one or more children, but are not able to communicate with teachers or with a large number of peers.
And the false impression is created that these children are shy and timid. And the thought creeps in about abuse, psychological trauma. But, alas, there is no clear evidence. For children, their selective mutism, their dumbness, is a way to avoid feelings of anxiety during social contacts.
For such children, a collective visit to the cinema, theater, or any social event is quite energy-consuming. All signs of physical symptoms appear: abdominal pain, nausea, vomiting, joint pain, shortness of breath, spontaneous diarrhea, general nervousness.
And all this affects the behavior of the child.
It is important for parents and teachers to know, as these symptoms at the physical level and behavioral responses against the background of dumbness are caused by anxiety. The appearance of a stranger, especially in babies, can cause stupor. You need to know this to help your child, to teach him skills that reduce the feeling of anxiety. Less pay on his "unsmiling" face, on the not always clear "body language", avoidance of eye contact, on an imaginary love of loneliness.
They, like healthy children, want to have friends, do not confuse with autism spectrum disorders.
Remaining “dumb” in society, they can show a “character” at home. Stubborn, imperious, capricious, assertive, with sharp mood swings. All these manifestations are nothing more than compensatory mechanisms, again, of the fight against anxiety.
At school, this feature of the child falls into the field of view of teachers, primarily as an autistic child (teachers are more or less familiar with this pathology), or begin to indicate serious learning difficulties.
It is more difficult for parents of toddlers and preschool children, therefore, you need to be careful about the communication of the child outside the family. Often, this can pass under the guise of "shy, shy, pass ...".
What to do if the diagnosis of selective mutim has been confirmed?
If mutism persists for more than a month, two, then this should alert parents. Forcing to speak violently, that is, approaches based on discipline, can only increase anxiety and only an opposition-minded child can be achieved here.
Depart from the thought that the child is doing all this to control and manipulate you. Understanding, supporting the child, recognizing your own difficulties and disappointments will help your child, including you.
The next task for you will be the search and find of a family doctor, pediatrician who understands what is at stake, a child psychiatrist or a child psychotherapist.
You, as a parent, are simply obliged to understand: it’s not enough to remove the child’s anxiety through medication, you need to look for opportunities to engage in the child’s communication, move on to speech, move away from gestures and other non-verbal forms of communication, teach the child communication skills and create conditions for environmental comfort.
And where can this be achieved? Only in the real world, that is, in the school environment, only there among people, are strategies and interventions drawn up by doctors and psychotherapists implemented.
General characteristics of mutism. The causes of the pathology and its main symptoms. Diagnosis and correction of voiced psychomotor disease.
The content of the article:
Mutism (mutus) is a serious disease that is associated with a violation of psychomotor in humans. Such a disorder implies the fact that the subject is not able to answer the questions posed to him. At the same time, he is not diagnosed with problems with the speech apparatus and he perfectly hears the interlocutor. In order to most effectively deal with this problem, you need to know all the nuances of the sounded ailment.
Description of the disease mutism
First of all, K.O. became interested in a similar psychomotor disease. Yagelsky, who among the main symptoms of hysterical disorder indicated mutism. Then the famous German psychiatrist E. Kraepelin joined in the work, taking the research of Karl Ludwig Kalbaum (the founder of the doctrine of catatonia) as the basis of his activity. Both experts believed that mutism is one of the components of the disorders that occur due to motor disorders. This theory has been practiced in German medicine for quite some time until French psychiatrists set to work.
Teacher of Sigmund Freud, JM. Charcot, considered mutism in the context of a disease such as hysteria. He explained his findings by the fact that his patients, after suffering stress, were speechless for a while, understanding the questions addressed to them. In addition, they could clearly describe on paper all that they felt at the time of their disappearance the opportunity to speak.
Today, among experts, the points of view regarding mutism are somewhat different. Psychologists consider him an inability to find his place in society. Neurologists are of the opinion that he is the most common neurosis. Psychiatrists are not so loyal in their findings. They attribute the described disease to mental disorders along with schizophrenia and hysteria.
Factors provoking the development of mutism in children
The voiced state in the younger generation is in some cases confused with severe mental illness. Such conclusions do not quite correspond to the truth, because the following factors become the sources of specific dumbness in children:
- Deformation of the speech organs . With a short bridle or “cleft palate”, the child's verbal activity is disturbed, as a result of which he may become silent.
- ZPR . With a delay in mental development, children do not always fully understand the questions posed to them. At the same time, a “voluntary” dumbness may become their protective reaction.
- Schizophrenia . Severe mental illness is always characterized by a distortion of consciousness, which is often accompanied by persistent mutism.
- Autism . With this ailment, children differ from their peers not only by immersion in their inner world, by graceful and elaborate movements, but in some cases by mutism.
- Genetic predisposition . If in the family of a child there have already been cases of a similar psychomotor pathology, then he has an increased risk of receiving the voiced disease by inheritance.
- Severe shock . In this situation, we can talk about physical or sexual violence, the death of parents or the observation in the past of a critical situation (terrorist attack, natural disaster, murder, accident, etc.). An example is the 6-year-old girl Sally (the heroine of the movie "House of Cards"), who, after the death of her archaeologist, became silent. Her mother had to make every effort to make her baby speak again.
- Change in social status . Many children at the age of 3 for the first time cross the threshold of a preschool. For some of them, such an experiment becomes a real shock, so educators recommend that parents take their baby out of the garden immediately after dinner for a couple of weeks. However, this time is not enough to adapt the child to the new environment. Silence in some cases becomes a protective shield from society for small persons. A similar process can occur when children become first graders.
- Inappropriate family upbringing . Some parents believe that screaming, prolonged moralizing, and even physical violence will only benefit their offspring. At the same time, they are not at all embarrassed to find out between themselves directly in the presence of the child. As a result, their son or daughter closes in and stops talking with domestic tyrants.
Reasons for the formation of mutism in adults
At an older age, mutism is usually manifested in the fair sex. However, experts give examples when this diagnosis was made and adult men. The following factors can be considered prerequisites for the formation of mutism in adults:
- Hypersensitivity . If this quality is accompanied by hypertrophic suspiciousness, then it is quite possible that after the next impulsive-emotional reaction, the person will acquire the described syndrome.
- Stroke . After suffering a circulatory disturbance in the affected side, a lesion of those parts of the brain that are responsible for speech activity is detected.
- Vocal cord problems . They can be caused both by their damage, and complete paralysis of these muscle folds.
- Larynx removal . A similar surgical intervention is carried out in case of diagnosis in this area of malignant neoplasms.
- Transferred coma . When leaving this state, the victim first recognizes loved ones, understands them, and only then restores his own speech activity.
Note! If mutism is caused by hysteria in an adult, then the course of the disease will be temporary. However, with the next emotional outburst, dumbness may return.
Varieties of mutism
This pathology has five forms, each of which has its own characteristics:
- Catatonic mutism . Such a disorder is an unmotivated factor, because the mechanism of its formation does not depend on the influence of external circumstances. At the same time, nothing prevents a person from communicating, but such a concept as negativity lies at the base of his mutism.
- Psychogenic mutism . The very name of the variety of the described disease suggests that we are talking about a post-traumatic reaction to the past disturbing or tragic events.
- Hysterical mutism . With such a conversion personality disorder, some people in silence want to attract public attention. The pronounced psychological dumbness is usually inherent in children and women. Experts noted the fact that in seniors, the sounded phenomenon is quite rare.
- Akinetic (organic mutism) . In this case, we will talk about serious brain damage. Tumors and gunshot wounds can cause the development of this disorder.
- Selective mutism . In a certain situation and only with a limited circle of people, a person with such a diagnosis is ready to start a dialogue. In other cases, dumbness attacks him.
The main symptoms of mutism syndrome
Some people are taciturn by nature and try to get away with gestures when asked by a question (nodding their head, raising their hands). However, one can suspect a person of mutism even when meeting someone, if he shows the following personality traits:
- Nervousness . Each of us is afraid of the moment that he might be ridiculed by someone. Some people who do not have a sense of tact can even “roughly” support the dialogue with the phrases “deaf people taken” or “pull cotton wool from your ears”. As a result, a child or an adult with a voiced problem will already wait in advance for ridicule and begin to get nervous.
- Social clumsiness . It is difficult to feel like a fish in water, in a team or alone with one person, if the resulting dumbness does not allow you to enter into a dialogue. It is for this reason that people with mutism syndrome look like a black sheep in society.
- "Spiky" . Some people (especially children) not only show painful silence, but also build an invisible wall around them. Anyone who tries to cross its borders, they perceive with hostility.
- Excessive shyness . Even very shy person monosyllabic answer their interlocutor. People diagnosed with “mutism” can, with gestures, respond maximally to a question posed to them.
- Retardation . In the presence of psychological dumbness, which is accompanied by a delay in mental development, others in the end are dealing with a special one who practically does not respond to them.
The signs by which this pathology can be determined are quite pronounced. Symptoms of mutism in children and adults are usually as follows:
- Avoiding Verbal Communication . Some people may speak, but for some reason they flatly refuse to do so. As a result, they will try to respond either with gestures, or will avoid any contact with the environment.
- Clarity of thought . If we are not talking about ZPR, schizophrenia or hysteria, a person with signs of mutism can perfectly analyze what is happening around him.
- Ability to state lucid on paper . With the same aphasia, people will not be able to perform the voiced actions. During the "vow of silence" a person does not lose such skills.
- Propensity for non-verbal communication . For such persons, it is sometimes quite enough to answer the question with a nod of the head, a parting of the hands or with the help of facial expressions.
Diagnosis of the disease mutism
The most difficult thing is to make a conclusion about the child, because the line between his simple whim, an act of protest and psychological disorder is very arbitrary.
Some optimistic parents believe that “voluntary” dumbness will pass by itself as their offspring matures. As a result, the disease takes a chronic form, and its treatment will require a large amount of time. In order to avoid the sounded consequences at the first alarming symptoms, the following diagnosis of mutism is carried out:
- General Information Collection . The therapist first of all will analyze how the pregnancy of the future mother proceeded and what injuries / infections she suffered during the gestation. Then he will reveal the reaction of the small patient to vaccinations, as well as follow the dynamics of his development. Further, the psychologist, relying on the therapist’s diagnostics, will talk with the child to reveal all his secret and obvious phobias, in order to correctly organize the course of treatment in the future.
- Neurologist examination . The voiced specialist will conduct a series of studies that will include an assessment of the quality of speech, reflexes, and the respiratory rhythm of the baby or adolescent. Then he will measure the child’s pressure and analyze the presence / absence of any neurological pathologies in the patient (strabismus, facial asymmetry, etc.).
- Craniogram . To make conclusions about what the patient’s brain looks like (volumes, structure), an X-ray of the skull is made.
- CT (computed tomography) and MRI (magnetic resonance imaging) . Sound diagnostic methods perform the same function as the craniogram, but with a more accurate and detailed result.
- EEG (electroencephalography) . Without an analysis of the level of electrophysiological processes that occur in the brain of a child, it is impossible to create a complete clinical picture of such a psychomotor disease as mutism.
- Urine and blood tests . In addition to the main indicators, the specialist will need to become familiar with the level of hormones in the voiced biological fluids.
Features of the treatment of mutism
Modern practice allows you to get rid or smooth out the symptoms of this specific dumbness. It should be remembered that it is necessary to act in many directions of influence on the patient: psychological, neurological, psychiatric and speech therapy.
Sound pathology is primarily a childhood ailment. At the first deviations in the behavior of the child, it is imperative to undergo an examination with specialists. If necessary, they will prescribe medication and even surgery (with deformation of the speech organs).
In turn, at home, the older generation of the family with mutism in children can help them as follows:
- Creating a welcoming atmosphere . In a home where peace and understanding reign, children rarely fall silent for no apparent reason. The child should feel that they love him and listen to everything that he says.
- Adequacy in Punishment . Indulging in any whim of their offspring is definitely not necessary. However, practice shows that the children's psyche often does not withstand cruelty and injustice on the part of adults. Instead of physical punishment, it is better to succinctly explain to your son or daughter what their fault is.
- Ban on excessive demands . Painful silence is often formed in those children on whom the parents put on an excessive load for their age. If the once cheerful child suddenly became silent, then the criterion of the requirements raised for him should be reviewed.
- Keeping Promises . Children believe that their parents are omnipotent and always keep their word. Experts described one case when a girl did not respond to dad and mom for almost six months, because instead of spending time together they preferred to start a new project.
- Change of environment of the child . If selective mutism was formed after the psychological trauma, then parents need to find a new child care institution or stop communicating with a special offspring frightening them.
- Role-playing games . As the main character, you can choose a toy dog that does not want to talk to anyone. The following situations are recommended as themes: the animal is lost - passers-by cannot help the silent poor fellow or the owner is very ill - his four-legged friend with mutism is not able to call for help. The child is invited not only to feel the proposed scene, but also to come up with its completion, at least with the help of gestures or writing on paper. Over time, he will have a desire to express his opinion out loud about what is happening.
- Regular visits to specialists . Do not underestimate the help that the same neurologist and psychologist can provide. Especially such family visits are necessary in case of psychogenic and hysterical mutism. Classes with a speech therapist are also needed with a diagnosis of “voluntary” dumbness.
Traditional therapy for mutism syndrome
There are a large number of techniques that allow you to help a patient with "voluntary" silence. Correction of mutism using traditional therapy is usually carried out as follows:
- Breathing exercises . In this case, it is best to find an experienced instructor. He will teach his ward deep / superficial, frequent / rare, lower / middle / upper and mixed breathing. Having mastered these basics, you can try to do yoga, which will help coordinate the spiritual and physiological functions of the body.
- Massage . It will be needed not only in order to stretch the muscles. With it, the body will calm down and recover faster after a physical or psychological trauma. As an alternative to voiced therapy, you can use hydromassage.
- Acupuncture . Acupuncture with mutism will help the patient fight some pathologies of the nervous system. It is appointed by a specialist, and in the case of unauthorized actions, acupuncture will result in disability.
- . Some people believe that this technique is applicable exclusively to children. However, the correction of mutism in adults also involves working with the color scheme and searching with it for the most unexpected solutions.
- Phototherapy . People of any age love to consider pictures (especially family ones). If a person is silent in protest, then he can speak if he sees an exciting moment for him in the photo.
In some cases, the use of drugs is still not enough. It should only be remembered that self-medication will not only not help, but will also cause significant harm to the injured party. Usually, after a thorough examination, the following medications are prescribed to the patient:
- Antidepressants . Their reception is especially necessary with psychogenic mutism. The doctor usually prescribes drugs such as fluoxetine or prozac.
- Antipsychotics . These antipsychotics are necessary for the treatment of mental disorders. Medications such as Frenolone, Gidazepam, and Risperidone can help with this.
- Benzodiazepines . Such psychoactive drugs have a sedative, hypnotic and anxiolytic effect. With mutism, experts most often recommend the use of Gidazepam, Fluorophenazine and Alprazolam.
- Nootropic drugs .