Mutism

At the Mutism it is a language disorder that usually has no physical causes, such as Has defects in hearing or problems with the vocal cords. So this speech disorder is completely different from that of the deaf and mute. The cause is a mental disorder or damage to the brain. Mutism distinguishes between (s) elective mutism, total mutism and akinetic mutism.

What is Mutism?

Mutism is strongly favored by genetic disposition. People who have often shown extreme fear reactions in childhood are most often affected by mutism.
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The word mutism was derived from the Latin "mutus", which means something like "mute". Strictly speaking, this term is not correct, because affected people are not mute in the classic sense, but can speak 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, those affected suffer from so much 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 can also be responsible for akinetic mutism.

causes

Mutism is strongly favored by genetic disposition. People who have often shown extreme fear reactions in childhood are most often affected by mutism.

These fear reactions include e.g. Extreme separation anxiety, difficulty falling asleep, or crying fits. Research has come to the conclusion that in these people the fear center in the brain reacts much more violently than it should actually be. Even small dangerous situations can trigger extreme reactions to activate self-protection. In a healthy person, such a situation would not activate the fear center as strongly.

In selective mutism, the fear response is triggered by certain events. If the child speaks completely normally at home, however, it can persistently remain silent in kindergarten. The child feels in danger in kindergarten for an incomprehensible reason and therefore no longer speaks in this environment. In the case of total mutism, however, 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 adolescents do not speak, do not maintain eye contact, are shy and withdrawn. Fear of being the center of attention and the confidence to do something sporty, such as fear of swimming or learning to ride a bike, can also appear as further signs.

In addition, an increased volume of speech at home is possible, which is immediately terminated when strangers arrive. In selective mutism, these behaviors only come into play in certain situations, towards certain people or in very certain places, such as in kindergarten. The occurrence is precisely predictable and always the same.

Increased facial expressions and gestures partially compensate for not speaking. In a familiar environment, however, people talk 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 just as much a symptom as it occurs in every situation, towards all people and in all places. In addition, the body becomes frozen. This makes it impossible for the person affected to interact.

Diagnosis & course

Mutism can be diagnosed by doctors or psychologists. However, since this disease has not yet been fully researched and is relatively unknown, diagnosis is not always easy.

In the case of children, parents can provide crucial information that will guide 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 extremely important for further development. Affected children in particular suffer very badly from the situation, quickly become outsiders and problems can arise at school. In addition, depression can develop, which can often trigger suicidal thoughts. Social phobias are also often a result of mutism.

Complications

Total mutism can make treatment more difficult, as the person affected cannot communicate with a therapist or psychiatrist. With the help of suitable conversation techniques, however, empathetic practitioners can enable 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 experience 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. Treatment should usually start 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. In doing so, they poop or wet themselves, although they have actually already learned to control their excretions. Due to their mental illness, adult mutists are often restricted in their jobs and families.

Mutism often meets with incomprehension or helplessness in other people. If the mutism is triggered by trauma, adverse reactions from loved ones increase the likelihood of developing post-traumatic stress disorder.

When should you go to the doctor?

Communication disruptions must always be presented to a doctor. If the voice is impaired, if the child fails to learn to speak despite multiple efforts, or if the child suddenly falls silent, a doctor must be consulted. If the person concerned cannot express himself sufficiently using body language, if he can react appropriately to social interaction, or if the symptoms arise in a situation-related manner, the observations should be discussed with a doctor.

In many cases, under almost all circumstances, there is a normal exchange between the person concerned and people close to him. However, if the symptoms set in under certain very selective conditions, a doctor should be consulted. It is characteristic that the person concerned cultivates very lively communication in a different environment or that a traumatic experience has been experienced.

A visit to a doctor is recommended in the event of various behavioral problems, personality disorders or general development. If there are delays in learning progress or severe learning difficulties in direct comparison with peers, 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. A doctor should be presented with an averted posture and a supposed disinterest. If the person concerned replaces the vocalization with noises such as coughing, laughing or humming, there is an irregularity that should be clarified.

Treatment & Therapy

Mutism is treated with speech therapy as well as psychiatric and psychological means. Whether individual forms of treatment are sufficient or a combination of the various treatment areas is necessary must depend 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 fear. The person affected can experience their everyday life in a more relaxed manner 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 starts, the greater the chances of success. If the fear behavior has stabilized 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. Which is the right form of therapy can vary. There is no panacea.

Therapy for mutism is always a very tedious affair and is not completed within a few weeks. Depending on how strongly the mental disorder has already manifested itself, months or even years of regular therapy may be necessary to achieve permanent improvement.

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Outlook & forecast

A selective mutism, as it often occurs when entering kindergarten or in other strange 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 they are young and can only learn to speak again in unfamiliar situations through years of practice. A social phobia often develops in adulthood. The sooner the disease 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 during the illness and thereby encourage them to speak. Total mutism is much more difficult to deal with. The child speaks neither to friends nor to parents, which means that medical or therapeutic treatment is usually not possible.

The prospect of healthy development is only given if the child decides to speak again. Selective mutism often regresses in adolescence. The children maintain normal speaking behavior later in life. Further information can be obtained from the Mutismus Selbsthilfe Deutschland e. V. give.

prevention

There is no direct prevention of mutism. Parents who observe an enormously increased fear 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 contained.

Aftercare

Follow-up care is primarily an issue for cancer patients. Doctors promise to recognize the recurrence of a tumor at an early stage by means of a close-knit follow-up. Mutism, on the other hand, exists or could be successfully treated with suitable therapies. Also, unlike a malignant carcinoma, a shortening of the lifespan is not to be expected.

Therefore, aftercare is not primarily about preventing recurrence. Rather, patients with an ailment should experience support in their everyday life. Long-term treatment is ordered. The extent of the follow-up depends strongly on the severity of the mutism and the age. Frequent follow-up checks are recommended, especially for children, because mutism can cause serious developmental delays. These are difficult to fix in later years.

Follow-up care includes regular presentations, whereby the relatives and parents are usually of great importance. You experience your child in everyday life and are therefore best able to inform about changes and progress. If the mutism is accompanied by depression, temporary inpatient accommodation may be appropriate. The outpatient measures include speech and psychotherapy.

You can do that yourself

In the case of mutism, speech therapy combined with psychologist psychological treatment is indicated. Parents who notice signs of mutism in their child should consult a specialist early on.

If it is a question of selective mutism, the conversation must be sought with the educators 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 speak as soon as they experience affection over a long period of time. Parents of affected children must therefore show a lot of patience and understanding.

In addition to this, further therapeutic measures can be taken to make it easier for the child to cope with the disease. The child can often be encouraged to speak through early intervention. Attending a special school for children with language disorders can take away the child's fears and also provides suitable therapy options. A doctor or psychologist has to answer which measures can be taken in detail. They will first conduct a comprehensive examination and also speak to the parents. The actual therapy can then be specifically supported by the parents.