Mutism is a speech disorder that usually has no physical causes, such as hearing defects or problems with the vocal cords. So this speech disorder is something completely different from that of the deaf and dumb. The cause is a mental disorder or damage to the brain. In mutism, a distinction is made between (s)selective mutism, total mutism and akinetic mutism.
What is mutism?
The word mutism was derived from the Latin “mutus”, which means something like “dumb”. Strictly speaking, this term is not correct, because affected people are not mute in the classic sense, but can speak physically. See eshaoxing for Lenz-Majewski Syndrome Definition and Meaning.
People who suffer from selective and total mutism are basically physically able to speak normally. You have no physical limitations that prevent speech, such as problems with the vocal cords or hearing. Due to a mental illness, those affected suffer from such severe fear that they stop speaking. This can be continuous or only in certain situations.
Akinetic mutism is caused by damage to the frontal lobe or by brain tumors. Creutzfeldt-Jakob disease may also be responsible for akinetic mutism.
Mutism is strongly favored by the genetic disposition. People who have often shown extreme fear reactions as children are most often affected by mutism.
These fear reactions include, for example, extreme separation anxiety, difficulty falling asleep or fits of crying. Research has shown that in these people, the fear center in the brain reacts much more violently than is actually necessary. Small dangerous situations can already trigger extreme reactions to activate self-protection. In a healthy person, such a situation would not activate the fear center as much.
In selective mutism, the fear response is triggered by specific events. If the child speaks completely normally at home, it can remain silent in kindergarten. The child feels in danger in kindergarten for an incomprehensible reason and therefore no longer speaks in this environment. In total mutism, on the other hand, those affected remain silent throughout. A mental disorder is also responsible for this, but the exact causes are not known.
Symptoms, Ailments & Signs
The lack of any kind of communication is the leading symptom of mutism. The affected children and young people do not speak, do not maintain eye contact, are shy and withdrawn. Other signs can be fear of being the center of attention and having the courage to do something sporty, such as fear of learning to swim or ride a bike.
In addition, an increased volume of language at home is possible, which is stopped immediately when strangers come along. In selective mutism, these behaviors only come into play in certain situations, towards certain people or in very specific places, such as in kindergarten. The occurrence is precisely predictable and always the same.
Increased facial expressions and gestures partially compensate for the fact that nothing is spoken. In a familiar environment, on the other hand, people speak and behave normally. In total mutism, verbal and non-verbal communication is always completely avoided. Body noises such as laughing, coughing and sneezing are compulsively suppressed. An averted posture is also one of the symptoms, as is the occurrence in every situation, towards all people and in all places. In addition, the body freezes. This makes it impossible for the person concerned to interact.
Diagnosis & History
Mutism can be diagnosed by doctors or psychologists. Since this disease has not yet been fully researched and is relatively unknown, the diagnosis is not always easy.
In the case of children, the parents can provide crucial information that leads the doctor in the right direction. A speech therapist can also be the right person to talk to. Speech therapists are often more familiar with mutism than doctors and psychologists.
Treatment with psychotherapy is extremely important for further development. Affected children in particular suffer greatly from the situation, quickly become outsiders and problems at school can arise. Depression can also develop, which can often trigger suicidal thoughts. Social phobias are also often a consequence of mutism.
Total mutism can make treatment more difficult because the sufferer is unable to communicate with a therapist or psychiatrist. However, with the help of appropriate conversational techniques, empathetic therapists can facilitate communication. The same applies to selective mutism. In both cases, a good relationship of trust with the therapist or doctor is particularly important.
Children with selective mutism often have other mental illnesses or conditions. Many mutists suffer from an anxiety disorder or clinical depression. It should be noted that mutism should only be diagnosed if the anxiety disorder or depression cannot fully explain the psychogenic silence.
Without adequate therapy, there is a risk that the mutism will persist. As a rule, treatment should begin as soon as possible. The longer the mutism lasts, the more likely complications become. Personal development can be impaired.
In mutistic children, encopresis and enuresis are also common complications. They defecate or wet themselves, although they have actually already learned to control their excretions. Adult mutists are often restricted professionally and family-wise due to their mental illness.
Mutism is often met with a lack of understanding or helplessness in other people. When mutism is triggered by trauma, adverse reactions from loved ones increase the likelihood of developing PTSD.
When should you go to the doctor?
Disruptions in communication must always be presented to a doctor. A doctor must be consulted if speech is impaired, if the child does not learn to speak despite many efforts, or if the child suddenly falls silent. If the affected person cannot express themselves sufficiently through body language, react appropriately to social interaction, or if the symptoms occur in a situation-related manner, the observations should be discussed with a doctor.
In many cases, under almost all circumstances, a normal exchange between the person concerned and people in his or her immediate environment takes place. However, if the symptoms set in under certain very selective conditions, a doctor should be consulted. It is characteristic that the affected person maintains very active communication in a different environment or that a traumatic experience has been experienced.
In the case of various behavioral problems, personality disorders or general development, a doctor’s visit is recommended. If, in direct comparison to peers, there is a delay in learnable progress or severe learning difficulties, a doctor should be consulted. In the case of memory disorders, orientation problems or a lack of concentration, medical examinations are necessary to clarify the cause. Averted posture and apparent disinterest should be presented to a doctor. If the affected person replaces the vocalization with noises such as coughing, laughing or humming, there is an irregularity that should be clarified.
Treatment & Therapy
Mutism is treated both speech therapy and psychiatric and psychological. Whether individual forms of treatment are sufficient or whether a combination of the various treatment areas is necessary depends on the extent of the disease. But the actual cause also determines the form of treatment.
In addition, Mutimus can also be treated with medication, for which antidepressants are used. These ensure a more balanced psychological state and thus also reduce feelings of anxiety. The affected person can experience their everyday life more relaxed and is less often afflicted by speech inhibition.
In any case, it is important to start treatment as soon as mutism is diagnosed. The earlier the therapy begins, the greater the chances of success. If the anxiety behavior has become established over many years, therapy is much more difficult and will not lead to success as quickly. There are now some forms of therapy that have been specially developed for mutism. The right form of therapy can vary. A panacea does not exist.
Therapy for mutism is always a very lengthy affair and not completed within a few weeks. Depending on how severely the mental disorder has already manifested itself, months or even years of regular therapy may be necessary to achieve lasting improvement.
Outlook & Forecast
A selective mutism, which often occurs when entering kindergarten or in other unfamiliar situations, often disappears again after a few weeks or months. If it persists for more than six months, the prognosis for recovery is poor. The children usually remain relatively mute until adolescence and can only learn to speak in unfamiliar situations again through years of practice. Social phobia often develops in adulthood. The earlier the condition is treated, the better the chance of recovery.
However, the cause of the mutism and the child’s character and environment also play a role. Children who suffer from mutism need the support of several caregivers who encourage them early on in the illness and thereby encourage them to speak. Total mutism can be much more difficult to treat. The child does not speak to friends or parents, which means that medical or therapeutic treatment is usually not possible.
The only chance of healthy development is when the child decides to speak again. Selective mutism often resolves in adolescence. Later in life, the children maintain a completely normal speaking behavior. Further information can be obtained from the Mutismus Selbsthilfe Deutschland e. V. give.
There is no direct prevention for mutism. Parents who observe an enormously increased anxiety behavior in their children should strengthen their child accordingly in order to reduce the fears. The advice of a child psychologist may then be appropriate, so that the child’s self-confidence is strengthened and excessive fears are curbed.
Follow-up care is especially important for cancer patients. Doctors promise to be able to detect the recurrence of a tumor at an early stage through close monitoring. Mutism, on the other hand, exists or could be successfully treated with suitable therapies. Also, unlike with a malignant carcinoma, a shortening of life expectancy is not to be expected.
Therefore, follow-up care is not primarily about preventing recurrence. Rather, patients with an ailment should experience support in their everyday lives. Long-term treatment is ordered. The extent of follow-up care depends heavily on the severity of mutism and age. Frequent follow-up checks are recommended, especially for children, because mutism can cause serious developmental delays. These can be difficult to fix in later years.
Follow-up care includes regular visits, with relatives and parents usually playing a major role. They experience their child in everyday life and are therefore best able to inform them about changes and progress. If mutism is accompanied by depression, temporary hospitalization may be appropriate. The outpatient measures include speech and psychotherapy.
You can do that yourself
In the case of mutism, speech therapy combined with a psychologist|psychological treatment is indicated. Parents who notice signs of mutism in their child should consult a specialist at an early stage.
In the case of selective mutism, a discussion must be sought with the pedagogues in the kindergarten or the teachers in the child’s school. The refusal to speak may be due to exclusion or bullying. If the cause cannot be determined, further investigation is required. In many cases, children begin to talk as soon as they experience affection over a period of time. Parents of affected children must therefore show a lot of patience and understanding.
At the same time, further therapeutic measures can be taken to make it easier for the child to deal with the disease. The child can often be persuaded to speak through early support. Attending a special school for children with speech disorders can take away the child’s fears and also provide suitable therapy options. A doctor or psychologist must answer which measures can be taken in detail. This will first carry out a comprehensive examination and also speak to the parents. The actual therapy can then be specifically supported by the parents.