Mutism is a speech disorder that mostly has no physical causes, such as defects in hearing or problems with the vocal cords. This speech disorder is therefore something completely different from that seen in deaf-mutes. The cause is a mental disorder or damage to the brain. Mutism is divided into (s)elective mutism, total mutism and akinetic mutism.
What is mutism?
The word mutism was derived from the Latin “mutus”, which means “mute”. Strictly speaking, however, this term is not correct, because affected people are not mute in the classical sense, but can certainly speak purely physically. People who suffer from selective and total mutism are basically physically able to speak normally. They have no physical limitations that do not allow speech, such as disorders of the vocal cords or hearing. However, due to a mental illness, the affected individuals suffer from such severe anxiety that they stop speaking. This may be throughout or only in certain situations. Akinetic mutism is caused by damage to the frontal brain or by brain tumors. Creutzfeldt-Jakob disease may also be responsible for akinetic mutism.
Causes
Mutism is strongly favored by genetic disposition. People who have frequently exhibited extreme fear reactions in childhood are most often affected by mutism. These fear reactions include extreme separation anxiety, difficulty falling asleep, or crying spells. In research, it was concluded that in these people, the fear center in the brain reacts much more violently than it should. 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 so strongly. In selective mutism, the fear reaction is triggered by certain events. If the child speaks completely normally at home, he or she may, on the other hand, remain persistently silent in kindergarten. The child feels in danger in the kindergarten for some incomprehensible reason and therefore no longer speaks in this environment. In total mutism, on the other hand, the affected person remains silent throughout. A psychological disorder is also responsible for this, but the exact causes are not known.
Symptoms, complaints and signs
The absence of any kind of communication is the leading symptom of mutism. Affected children and adolescents do not speak, do not maintain eye contact, and are shy and introverted. Other signs may include fear of being the center of attention and athleticism, such as fear of swimming or learning to ride a bike. There may also be an increased amount of talking at home, which stops immediately when strangers join in. In selective mutism, these behaviors only ever occur in certain situations, towards certain people, or in very specific places, such as kindergarten. The appearance is exactly predictable and always the same. Increased facial expressions and gestures partly compensate for the fact that the child does not speak. In familiar surroundings, on the other hand, the child speaks and behaves normally. In total mutism, verbal and nonverbal communication is always completely avoided. Body sounds such as laughing, coughing and sneezing are compulsively suppressed. An averted posture is one of the symptoms, as is the appearance in every situation, to all people and in all places. In addition, there is a stiffening of the body. This makes it impossible for the affected person to interact.
Diagnosis and course
Mutism can be diagnosed by physicians or psychologists. However, because this disorder has not been conclusively researched and is relatively unknown, diagnosis is not always easy. In the case of children, the parents can provide decisive clues that lead the doctor in the right direction. A speech therapist can also be the right contact. Speech therapists are often more familiar with mutism than doctors and psychologists. Treatment by means of psychotherapy is enormously important for further development. Affected children in particular suffer greatly from the situation, quickly become outsiders, and problems can arise at school. In addition, depression can develop, which not infrequently can trigger suicidal thoughts.Social phobias are also often a result of mutism.
Complications
Total mutism can complicate treatment because the affected person cannot communicate, even to a therapist or psychiatrist. However, with the help of appropriate interview techniques, empathic treatment providers 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 present with other mental illnesses or medical conditions. Many mutists suffer from an anxiety disorder or clinical depression. It should be noted: Mutism should really only be diagnosed when 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 mutism persists, the more likely complications will occur. Personality development may be impaired. Encopresis and enuresis are also common complications in mutistic children. They defecate or wet themselves, although they have actually already learned to control their excretions. Adult mutists are often limited professionally and familially by their mental illness. Mutism is often met with incomprehension or helplessness by others. When mutism is triggered by trauma, adverse reactions from family members increase the likelihood of developing post-traumatic stress disorder.
When should you see a doctor?
Disorders of communication should always be presented to a physician. If there are impairments in phonation, if the child does not learn speech despite multiple efforts, or if there is sudden muteness, a physician must be consulted. If the affected person cannot express himself adequately through body language, react appropriately to a social interaction, or if the complaints occur situationally, the observations should be discussed with a physician. In many cases, normal interaction of the affected person with persons of his close environment takes place under almost all circumstances. However, if the complaints start under certain very selective conditions, a physician should be consulted. It is characteristic that a very active communication is maintained by the affected person in a different environment or that a traumatic experience has been experienced. In the case of various behavioral abnormalities, personality disorders or general development, a visit to the doctor is recommended. If there are delays in learnable progress or severe learning difficulties in direct comparison to peers, a doctor should be consulted. If there are disturbances in memory, orientation problems or a concentration deficit, medical examinations are necessary to clarify the cause. Averted posture and supposed lack of interest should be presented to a physician. If phonation is replaced by the affected person with sounds such as coughing, laughing or humming, there is an irregularity that should be clarified.
Treatment and therapy
Mutism is treated with speech therapy as well as psychiatric and psychological treatment. Whether individual forms of treatment are sufficient, or a combination of the various treatment areas is necessary, must be made dependent on the extent of the disorder. However, the actual cause also determines the form of treatment. In addition, mutimus can also be treated by medication, for which antidepressants are used. These ensure a more balanced mental state and thus also reduce feelings of anxiety. The affected person can experience his or her everyday life in a more relaxed manner and is less often afflicted by the speech impediment. In any case, it is important to start treatment as soon as mutism is diagnosed. The earlier therapy begins, the greater the chances of success. If the anxiety behavior has been consolidated over many years, therapy is much more difficult and will not lead to success as quickly. In the meantime, there are some forms of therapy that have been developed specifically for mutism. Which form of therapy is the right one can vary. A panacea does not exist. A therapy of mutism is always a very lengthy affair and not completed within a few weeks.Depending on how severe the mental disorder has already manifested, months or even years of regular therapy may be needed to achieve lasting improvement.
Outlook and prognosis
Selective mutism, which often occurs when a child enters kindergarten or other unfamiliar situations, often disappears after a few weeks or months. If it persists for more than six months, the prognosis for recovery is poor. Children usually remain relatively mute until adolescence and can only relearn to speak in unfamiliar situations through years of practice. Social phobia often develops in adulthood. The earlier the disorder is treated, the better the chance of recovery. However, the cause of 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 during the disorder and thereby encourage them to speak. Total mutism can be much more difficult to treat. The child does not talk to friends or parents, which usually means that no medical or therapeutic treatment is possible. The prospect of healthy development is only given if the child decides on his own to speak again. Selective mutism often regresses in adolescence. The children maintain normal speech behavior later in life. The association Mutismus Selbsthilfe Deutschland e. V. can provide further information.
Prevention
There is no direct prevention for mutism. Parents who observe an enormously increased anxiety behavior in their children should, however, strengthen their child accordingly to reduce the fears. Possibly already then the advice of a child psychologist can be appropriate, so that the self-confidence of the child is strengthened and excessive fears are contained.
Aftercare
Follow-up care is especially an issue for cancer patients. Physicians hope to detect tumor recurrence early through close follow-up. Mutism, on the other hand, exists or could be successfully treated by appropriate therapies. Nor can a shortening of life be expected, as is the case with malignant carcinoma. Therefore, the primary goal of follow-up is not to prevent recurrence. Rather, patients with a condition should receive support in their daily lives. Long-term treatment is ordered. The extent of aftercare depends strongly on the severity of the mutism and the patient’s age. Especially in children, frequent follow-up is recommended because mutism can cause serious developmental delays. These can be difficult to correct in later years. Follow-up care includes regular check-ups, in which the relatives and parents are usually of great importance. They experience their child in everyday life and can therefore best inform about changes and progress. If mutism is accompanied by depression, temporary inpatient placement may be appropriate. Outpatient interventions include speech and psychotherapy.
Here’s what you can do yourself
In cases of mutism, speech therapy combined with psycholo|psychological treatment is indicated. Parents who notice signs of mutism in their child should consult a specialist at an early stage. If it is a case of selective mutism, it is necessary to talk to the educators in the kindergarten or the teachers in the child’s school. It is possible that the refusal to speak is due to exclusion or bullying. If the cause cannot be determined, further investigation is necessary. In many cases, children begin to speak as soon as they experience affection over a longer period of time. Parents of affected children must therefore show a great deal of patience and understanding. Accompanying therapy measures can be taken to help the child cope with the disease. For example, the child can often be encouraged to speak through early intervention. Attending a special school for children with speech disorders can relieve the child’s anxiety and also provides suitable therapy options. Which measures can be taken in detail must be answered by a doctor or psychologist. This person will first conduct a comprehensive examination and also talk to the parents. The actual therapy can then be specifically supported by the parents.