“Being speechless” is a phrase that each of us has uttered at least once in our lives. But not everyone knows that this can actually happen. And the name for this phenomenon is mutism. This is a condition when the functionality of the speech apparatus and the perception of speech in a person are preserved, but for some psychological or physiological reasons he stops speaking.
“I was speechless with horror,” “All the words flew out of my head out of fear,” “I swallowed my tongue out of timidity”—all these idioms perfectly describe the basic principle of the development of mutism. This severe speech initiation disorder gets its name from the Latin word mutus, meaning silence. Mutism is a disease, or rather a pathological condition in which a person is silent, but the functions of the speech apparatus and hearing, as well as the ability to understand the speech of others, are preserved. Neurology views mutism as a neurotic speech disorder, psychology as a loss of the ability to form social contacts, and psychiatry treats this condition as one of the main components of various mental disorders, for example, schizophrenia, hysteria or psychosis. Today, mutism is usually interpreted as a behavioral and emotional disorder, most often characteristic of children aged 3 to 9 years. But adults can also be at risk and join the ranks of mutists (this is what patients with this diagnosis are called). Much more often these are women. However, overly sensitive, emotional and vulnerable men can, under certain circumstances, become speechless, as they say.
Psychiatrists at the Yusupov Hospital are leading experts in their field and provide care to patients with many disorders, including mutism. Therapy of pathology includes complex treatment, thanks to which it is possible to achieve the most positive result. The high level of medical services and services contribute to the fact that the patient manages to resume his speech functions and cope with the primary causes of the disease.
General information about the disease
The phrase “selective mutism” itself is translated as “selective muteness,” that is, people (most often children) with well-developed hearing, the ability to understand speech and speak can remain silent under certain conditions.
At risk:
- first-graders who are not yet accustomed to school routines;
- socially anxious children who become silent when overly anxious or under pressure;
- emigrant children who simply experience a lack of vocabulary and are embarrassed about it.
Sometimes a child becomes silent during times of great stress or in social situations, and sometimes the silence is promoted by misunderstandings on the part of parents and teachers. It happens that adults define selective mutism as rudeness or bad manners, but the causes of the disease are much deeper.
List of sources
- Osipova A.A. General psychocorrection: textbook. allowance. M.: Sfera, 2002;
- Sidorov P.I., Parnyakov A.V. Introduction to clinical psychology: A textbook for medical students. Volume 1. M. Ekaterinburg: Academic project-Business book; 2000;
- Yakhno N. N., Shtulman D. R. Diseases of the nervous system: A guide for doctors in 2 volumes. - M.: “Medicine”, 2005;
- Konovalova A. N., Skvortsova V. I., Gekht A. B. Neurology: National Guide / Ed. E. I. Guseva. - M.: GEOTAR-Media, 2009.
Causes of selective mutism
There is no clear cause of the disease. The disorder can be caused by a person's tendency to shyness or by a certain social situation.
The main factors triggering selective mutism in children can be:
- delayed mental development or speech development (the child is not confident in his intellectual abilities, which activates shyness and silence);
- individual mental characteristics (when the baby has increased anxiety, timidity, sensitivity, impressionability, and a tendency to loneliness);
- lack of personal space to express negative feelings (unrealized aggressiveness).
- diagnosed schizophrenia, autism, neurosis;
- neurological disorders (the child has suffered an infectious disease of the brain, brain injury, he has been diagnosed with a hematoma or tumor);
- peculiarities of upbringing (if the parents themselves are shy, often suffer from depression, demonstrate a high level of social anxiety, and tend to behave aggressively towards children - this can cause selective mutism);
- experienced stress (accident, death of someone close, parental divorce, violence or physical punishment, family moving to another city/country).
In adulthood, women are more susceptible to selective mutism due to their tendency to more vivid emotions and experiences.
The disorder may develop in adults due to:
- excessive sensitivity and suspiciousness;
- suffered a stroke (an acquired malfunction in the blood supply system of the brain affects the area that is responsible for speech functions);
- pathologies of the vocal cords (damage, paralysis).
KINDS
The main symptom of the disorder is the lack of speech activity in the child. However, depending on the form of the defect, it can manifest itself in different variations and be accompanied by accompanying symptoms.
The most common types of mutism are:
- elective;
- psychogenic;
- endogenous-psychotic.
Selective mutism
It is also selective, or selective mutism manifests itself episodically, under certain circumstances. The child behaves relaxed, active, chatting incessantly in the family, but in the garden or at school, with strangers, he remains silent. That is, he retains the ability to speak and understand speech, but he does not want to use it in certain situations.
Selective mutism, as well as negativism, can manifest itself in relation to an individual or environment. In this case, the mutist withdraws, averts his eyes, “shrinks,” does not respond to someone addressing him, or communicates with gestures. This form of the disease becomes a sign of social phobia.
Typically, this form of mutism occurs in children over 4 years of age. Their speech development up to this point corresponded to the norm, and they began to talk on time.
If a defect manifests itself as a negative reaction to an individual person or circumstances, then it is accompanied by pronounced negative emotions. Against this background, the baby experiences spasms in the neck, caused by contraction of the vocal cords and clenching of the jaw. This provokes an attack of fear, which aggravates the child’s condition and contributes to the consolidation of a neurotic response to this person or situation.
At first, parents scold the silent person, interpret his behavior as whim or stubbornness. This position is fundamentally wrong. Since neglect of this circumstance leads to social disadaptation.
Psychogenic mutism
Psychogenic mutism often manifests itself in 2 forms: hysterical and logophobic.
Over-emotional children with unstable moods are susceptible to hysterical mutism. It manifests itself under the influence of a strong stressor, or it can become a way to attract attention and achieve what you want.
In front of a 10-year-old girl, a car hit and killed a man. For her it was a great shock. Her legs stopped working, she could not stand and fell. Speech was lost, she ignored all questions addressed to her. Then inhibition gave way to excitement. She started running and jumping with a smile on her face. After treatment with psychotic drugs, the consequences of the shock were eliminated.
Logophobic mutism becomes a manifestation of an obsessive fear of hearing oneself speak. More common among schoolchildren. It can manifest itself in certain cases, for example, during public speaking. Or the child has a fear of pronouncing certain words. But there are times when children are afraid to speak in principle.
The logophobic form of the defect can form for several reasons. For example, as a result of low self-esteem, when there is a fear of hearing negative feedback from others. Or as a result of chronic fatigue.
This may be a consequence of acquired fear, in which the child has instructed himself to remain silent. For example, a mother suffering from alcoholism, while intoxicated, showed physical and verbal aggression if her son approached her and began to tell or ask for something.
The language barrier also plays a role in the flourishing of logophobia when children find themselves in an area with a dialect that is new to them.
But there are also physiological causes of the disorder. One of them is halitosis, that is, a person develops bad breath, which is associated with the extensive growth of pathogenic bacteria in the oral cavity. The child is embarrassed to speak because he is afraid that if he opens his mouth, those around him will smell the stench and make him laugh.
Endogenous psychotic mutism
Such pathological silence manifests itself within the framework of endogenous diseases. Schizophrenia is a prime example of this. With this psychotic disorder, the list of symptoms often includes catatonic mutism, which is part of the catatonic syndrome. It usually manifests itself in the form of the disease of the same name and becomes a sign of negativism.
As a rule, this form of mutism is characteristic of the stage of catatonic stupor, and occurs along with motor retardation.
In addition, there are delusional and hallucinatory mutism, which appears within the framework of delusional ideas and visions, as well as manic, depressive and mixed.
Symptoms of selective mutism in children and adults
As we have already found out, the main symptom will be selective muteness. Children can chatter madly at home, but not talk at school or kindergarten; can communicate normally with peers, but become silent in the presence of teachers (all or one specific person).
If selective mutism is severe, the child may be so stressed by someone's presence that he will freeze in one position, avoid touching, hide his head and tuck his legs. With prolonged distress, ritual habits are formed that seem to help a person cope with stress - washing or rubbing hands, laying things out, and others.
The disorder can be complicated by phobias, depression, delayed speech development, nervous tics, and enuresis. Without the timely intervention of specialists, selective mutism can cause pronounced schizoid traits or lead to solitary behavior, problems with adaptation in a team, and a low level of verbal and logical thinking. Children may have problems with learning, and adults may have problems with their careers, communication and personal life.
Other symptoms of deviation
- heightened sense of right and wrong;
- difficulty expressing emotions and feelings even with close relatives;
- negative reaction to noise and large crowds of people;
- increased feeling of anxiety;
- reluctance to smile;
- problems maintaining eye contact;
- artificial social isolation;
- commitment to music and art;
- above average mental abilities;
- a tendency to empathize;
- having the ability to sympathize with the misfortune of other people.
Who diagnoses selective mutism and how?
To make an accurate diagnosis, the psychotherapist interviews the parents and observes the child. It will be necessary to visit several specialists in the complex: a neurologist, a psychologist, and sometimes a speech pathologist, an ophthalmologist, an otolaryngologist.
When diagnosing, autism, schizophrenia, neurological disorders, shock, and hysterical muteness must be excluded. If these diseases are not confirmed, then a clinical examination is prescribed, which includes:
1. information about the nuances of pregnancy in the mother;
2. craniogram, MRI and CT to determine the state of the brain;
3. ECG;
4. chest x-ray;
5. electroencephalography to determine the level of electrophysiological processes;
6. blood and urine tests to exclude hormonal disorders.
If selective mutism is confirmed during diagnosis, the specialist prescribes a treatment program.
How is selective mutism treated in children?
The main focus of treatment will be high-quality psychotherapy, with the help of which a specialist will eliminate phobias and anxiety-depressive syndrome, and improve communication skills. Depending on the specific case, the therapist will use methods of cognitive behavioral therapy, family therapy, and art therapy.
Psychotherapeutic tactics, if necessary, are supplemented by sessions with a speech therapist in order to correct articulation and improve the pronunciation of sounds, which will significantly reduce the patient’s uncertainty and anxiety.
The doctor also prescribes medication without fail. These can be antidepressants, tranquilizers, antipsychotics, benzodiazepines, nootropics. Medicines will not only help cure a mental disorder, but also provide a sedative and hypnotic effect.
To cope with selective mutism, it is additionally recommended:
- breathing exercises (to coordinate the spiritual and physiological reserves of the child’s body);
- massage/hydromassage (will help you calm down and quickly recover from injury);
- acupuncture (to cope with neurotic manifestations).
Our specialists talk about selective mutism and methods of its treatment in psychology courses. Having chosen and mastered a training program, you will be able to work as a psychologist and participate in the rehabilitation of children with various mental disorders, helping them become full-fledged members of society.
Advice for parents of children suffering from selective mutism
Selective mutism is more common in children. Of course, the chances of recovery will increase significantly if the baby’s parents take part in correcting the disorder.
The following tips will help moms and dads create a healing space for their child at home.
1. Create the most positive environment possible at home. Kindness, attention and a willingness to always listen to the baby will give him the understanding that he is always listened to, no matter what he says.
2. Eliminate physical punishment. It is always better to explain in words what exactly cannot be done and why.
3. Keep your promises; children always trust the words of close adults.
4. Try changing your child's environment. If selective mutism arose due to psychological trauma or conflict with peers or teachers, it would be advisable to change kindergarten or school/gymnasium.
5. Spend more time together. Watch cartoons, read books, discuss what you saw and read, teach your child to voice his impressions and desires by asking leading questions: “What exactly did you like about this story?”, “Why do you think that the hero behaved wrong?”, “What else?” Shall we watch a cartoon today?
