Selective mutism

Selective mutism (also: Selective mutism; Latin: eligere "Select ", mutus "mute" ) refers to child and adolescent psychiatry an emotionally related mental disorder in which linguistic communication is severely impaired. Selective mutism is characterized by selective speaking with certain people or in defined situations. In contrast to the "total mutism " is the dumbness not complete.

Articulation, language comprehension and expression of those affected other hand, are usually in the normal range, at best they are slightly developmentally delayed.

According to current knowledge, the concepts of " selective mutism " appears as a more appropriate description, because the silence is not freely chosen, and so therefore is not " elective " in the literal sense.

Description

Selective mutism is not a speech disorder in the traditional sense, but a time-limited, fear -related talk abortion in certain social situations or in the presence unconsciously selected persons. This can go so far that affected children only with certain people, mostly from the narrower family area, speak.

Since the child is no longer in a position despite actually intact verbal skills to communicate spoken language, mutism is counted among the " secondary language disorders ".

Reciprocal effects

Silence is a great burden for all stakeholders and contact persons. The children and young people affected quickly come to the sidelines and can become outsiders.

Since the person is not generally speechless to communication partners who meet the selective silence, often provoked and helpless, respond disappointed or angry feel.

As part of the school created for teachers quickly a contradiction between the desired educational attitudes such as acceptance and patience and institutionally justified claims as timely material placement and performance assessment. Misperceptions of the real school functioning are common.

Occurrence and course

With a narrow definition of selective mutism can be assumed a rate of 0.8 % in children between five and nine years. Other authors speak of up to 1 to 2 % of the total population. Although a small study, according to the typical gender distribution is repeatedly given as 2:1 for girls to boys, the selective mutism generally considered the only " language disorder ", as frequently affected in girls as boys.

'Selective mutism is a relatively persistent disorder whose duration is often up to the late school age, sometimes into adulthood, pulls. Although silence is obviously overcome even without therapy, the risk of damage to the self-concept and linguistic Inkompetenzgefühle without therapy is expanding.

Approximately 30 to 50 % of mutis matic children and adolescents show in a Katamneseintervall 5-10 years a normal speech behavior and relatively good psychosocial adjustment. The other stakeholders have a much improved, but further disturbed crosstalk behavior which is characterized by speech shyness, withdrawal tendencies and fear of social contacts.

Today, it can in principle no longer be assumed that it is a purely psychogenic disorder in selective mutism. Empirical studies rather suggest that a developmental delay, ( b ) premorbid personality disorders, and ( c ) the general family pathology in creating the conditions for the tables mutis behavior by (a); the silence is triggered upon the addition of external load events.

Diagnosis

The diagnosis can the exploration of parents on symptoms and details of the communication behavior as well as the survey of teachers and educators, but also a behavioral observation of the child and a physical- neurological examination include.

ICD -10

In ICD -10 the World Health Organization, the selective mutism is described as clearly emotionally determined selectivity in speaking, in which the child speaks in certain situations and in other well-defined situations, it is not. This also certain personality traits such as social anxiety, withdrawal, special sensitivity or resistance can be found in the child normally.

Keynotes by ICD -10:

• Selectivity in speaking: in some social situations the child is fluent, but in other social situations, it remains silent or almost silent
• Consistency that speak regarding social situations, or not spoken
• Frequent insertion of non-verbal communication ( facial expressions, gestures, written records ) by the child
• Duration of the disturbance at least one month
• Age Appropriate competence in the linguistic expression of the situation-dependent language

DSM-IV

Cardinal symptoms according to DSM- IV:

• Persistent inability to speak in certain situations where normal speech ability exists in other situations
• The disorder hinders the educational or professional services, or social communication
• The disorder lasts at least a month ( and is not limited to the first month after the start of school )
• The inability to speak is conditional or not thereby by a lack of knowledge of the spoken language that the person does not feel comfortable in this language

These symptoms, the DSM -IV describes further characteristics and disorders that are often made in addition to selective mutism. Here symptoms such as anxiety, compulsive behaviors, controlling and oppositional behaviors, but also mental disability, hospitalization and extreme psychosocial stress factors are given.

Differential Diagnosis

The selective mutism must be distinguished in his diagnosis of other diseases that have a certain similarity in their phenomenology of permanent silence.

So the talking anxious silence in certain public situations can be made and promised light -consciously than consciously used avoidance strategy, at least in retrospect. Mutism, however, is not a conscious, deliberate act; also a self-reflexive thinking on the meaning of this behavior is not possible with selective mutism.

As selective mutism also does not apply the reluctant Talk shy children towards the unknown, the silence out of spite or as a grief reaction, the mutation Stay due to low language skills, the silence of autistic children or the muteness in profound personality disorders and the silence due to organically related speech and language disorders. The disturbance must not be better accounted for by a communication disorder and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder.

Comorbidity

A particularly frequent associated disease is found with social phobia. In 97 % of cases there is this anxiety or avoidance behavior.

Other comorbidities are:

• Conduct disorder Oppositional behavior ( F91.3, where calls for a passive-aggressive attitude possibly other therapeutic procedure )
• Phobic disorders ( F40 )
• Other anxiety disorders ( F41 )
• Reaction to severe stress and adjustment disorders ( F43 )
• Depressive symptoms ( F3)
• Dysregulation of sleep, food, excretion function

Therapy

Coincidentally, a multidimensional scale approach to therapy is now recommended, ie it should include various treatment elements. In addition to individual treatment and the environment should be included. Psychoanalytically oriented therapies and behavioral concepts are in the treatment of mutism in the foreground, since in most cases a neurotic cause is assumed, or mutism is interpreted as a learned behavior.

In the psychotherapeutic treatment is urged among other things, a reduction of the causal factors continue to promote the personal development and to reduce communication problems attempted. Therapeutic behavior can be achieved relatively quick results compared to the psychoanalytic approach. In a family therapy approach, the cause of the mutism is seen both in the behavior of the parents to each other and in the relationship between child and parent. The language curative treatment attempts to promote universal joy of speaking and to provide the function of language as a useful communicative tool in the foreground. In the medical- psychiatric treatment is often attempted to influence the positive symptoms with the help of a drug therapy.