Is selective mutism a communication disorder?
In addition, since children with Selective Mutism often have difficulty responding and/or initiating nonverbally, Selective Mutism can be viewed as a communication disorder. In addition, children with autism, PDD-NOS, Aspergers and other developmental disorders can manifest mutism that is selective in location.
What is the prevalence of conversion mutism?
Conversion mutism is an uncommon disorder that was in the past most frequently reported during wartime. Other than during wartime, young women are the most commonly affected and usually present shortly after a traumatic event.
What is the future of selective mutism research?
Future directions. While studies have helped to elucidate the phenomenology of selective mutism, limitations and gaps in knowledge still persist. In particular, the literature on selective mutism consists primarily of small sample populations and case reports.
Is mutism a conversion disorder?
Conversion mutism is an uncommon disorder that was in the past most frequently reported during wartime. Other than during wartime, young women are the most commonly affected and usually present shortly after a traumatic event.
What type of disorder is selective mutism?
Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.
What are some conversion disorders?
Common examples of conversion symptoms include blindness, diplopia, paralysis, dystonia, psychogenic nonepileptic seizures (PNES), anesthesia, aphonia, amnesia, dementia, unresponsiveness, swallowing difficulties, motor tics, hallucinations, pseudocyesis and difficulty walking.
What is now known as conversion disorder?
Functional neurologic disorder — a newer and broader term that includes what some people call conversion disorder — features nervous system (neurological) symptoms that can't be explained by a neurological disease or other medical condition.
Is selective mutism autism?
Myth 5: Selective mutism is a form of autism. Some people confuse selective mutism with autism, but it is important to know that they are not the same disorder.
Is selective mutism a neurodevelopmental disorder?
Collectively these findings point to the possibility that selective mutism is a neurodevelopmental disorder involving speech and language that may be impacted by changes in auditory efferent feedback pathways, vagal responses, genetics, or other physiological factors (Heilman et al., 2012; Young et al., 2012; Muchnik ...
How do you know if you have conversion disorder?
Conversion disorder is a disorder in which a person experiences blindness, paralysis, or other symptoms affecting the nervous system that cannot be explained solely by a physical illness or injury. Symptoms usually begin suddenly after a period of emotional or physical distress or psychological conflict.
What is La Belle Indifference conversion disorder?
The term “la belle indifference” is a French term, which translates to “beautiful ignorance.”[1] La belle indifference is defined as a paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition.[2] This condition is most commonly associated with ...
Which of the following is a basic feature of conversion disorder?
7) Which of the following is a basic feature of Conversion Disorder? Correct! Conversion Disorder: The presence of symptoms or deficits affecting voluntary motor or sensory functionIncorrect.
Is conversion disorder a somatic disorder?
Conversion disorder is a form of somatization—the expression of mental phenomena as physical (somatic) symptoms. In a recent terminology change, the American Psychiatric Association now refers to the condition as functional neurological symptom disorder.
What is the difference between conversion disorder and somatic symptom disorder?
Unlike somatic symptom disorder, a person with illness anxiety disorder generally does not experience symptoms. Conversion disorder(functional neurological symptom disorder) is a condition in which the symptoms affect a person's perception, sensation or movement with no evidence of a physical cause.
What is the new name of conversion disorder in DSM-5?
DSM-5 lists these criteria for conversion disorder (functional neurological symptom disorder): One or more symptoms that affect body movement or your senses. Symptoms can't be explained by a neurological or other medical condition or another mental health disorder.
Symptoms
The onset of selective mutism is usually between the ages of 3 and 6. Most children who develop selective mutism also suffer from social anxiety ,...
What are some signs of selective mutism?
Children who suffer selective mutism may appear: Shy, socially awkward, anxious, insecure and clingy, embarrassed, rude, indifferent or aloof, stif...
Causes
Children with selective mutism often have a family history of anxiety disorders. The neurological basis for selective mutism is thought to be a cas...
Can selective mutism lead to mood disorders?
Selectively mute teens may also experience mood disorders like depression , and they can suffer conditions such as agoraphobia, a fear of leaving...
Are selective mutism and autism spectrum related?
Individuals on the autism spectrum have problems with social skills and communication abilities; while they do feel empathy for others, they do n...
Treatment
It is best to seek behavioral therapy or family therapy as early as possible for a child with selective mutism because the condition may not go awa...
What happens when selective mutism is left untreated?
If untreated, selective mutism can in some cases follow a child into adulthood. It will affect school, family, social life , and work. All of whic...
How can schools and teachers help a child with selective mutism?
Schools and teachers can help a child in various ways: • Do not pressure the child to speak • Allow time for counseling and speech therapy • Allow...
What Is Selective Mutism?
Selective mutism (SM) is a childhood anxiety disorder characterized by an inability to speak or communicate in certain settings. The condition is usually first diagnosed in childhood. Children who are selectively mute fail to speak in specific social situations, such as at school or in the community.
When was selective mutism first used?
The use of the term "selective" was adopted in 1994 , prior to which the disorder was known as "elective mutism.". The change was made to emphasize that children with selective mutism are not choosing to be silent, but rather are too afraid to speak.
What happens if you don't catch selective mutism early?
When selective mutism is not caught early, there is a risk that your child will become used to not speaking, and as a result, being silent will become a way of life and more difficult to change.
What is the term for a lack of movement or movement when in feared situations?
Fidgeting, eye contact avoidance, lack of movement or lack of expression when in feared situations
Can a child with selective mutism stop talking?
Finally, a lack of speech must interfere with your child's educational or social functioning. Children who stop talking temporarily after immigrating to a foreign country or experiencing a traumatic event would not be diagnosed with selective mutism.
Is selective mutism a good prognosis?
In general, there is a good prognosis for selective mutism. Unless there is another problem contributing to the condition, children generally function well in other areas and do not need to be placed in special education classes.
Is selective mutism a mental disorder?
Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013. The use of the term "selective" was adopted in 1994, prior to which the disorder was known as "elective mutism.".
What is selective mutism?
Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings, such as school . These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.
What are the behavioral problems of selective mutism?
Behavioral: Children with Selective Mutism are often inflexible and stubborn, moody, bossy, assertive and domineering at home.
What are the developmental delays of autism?
Developmental Delays: A proportion of children with Selective Mutism have developmental delays. Some have multiple delays and have the diagnosis of an autistic spectrum disorder, such as Pervasive Developmental Disorder, Aspergers, or Autism. Delays include motor, communication and/or social development.
What are the characteristics of a child with selective mutism?
Children with Selective Mutism often have severely inhibited temperaments. Studies show that individuals with inhibited temperaments are more prone to anxiety than those without shy temperaments. Most, if not all, of the distinctive behavioral characteristics that children with Selective Mutism portray can be explained by the studied hypothesis that children with inhibited temperaments have a decreased threshold of excitability in the almond-shaped area of the brain called the amygdala. When confronted with a fearful scenario, the amygdala receives signals of potential danger (from the sympathetic nervous system) and begins to set off a series of reactions that will help individuals protect themselves. In the case of children with Selective Mutism, the fearful scenarios are social settings such as birthday parties, school, family gatherings, routine errands, etc.
How does selective mutism affect social relationships?
As social relationships are built, and a child develops one or a few friendships, he/she may interact and even whisper or speak to a few children in school or other settings but seem to be disinterested or ignore other classroom peers. Over time, these children learn to cope and participate in certain social settings. They usually perform nonverbally or by talking quietly to a select few. Social relationships become very difficult as children with Selective Mutism grow older. As peers begin dating and socializing more, children with Selective Mutism may remain more aloof, isolated, and alone.
Why is my child not upset about mutism?
Emotional: When the child is young, he/she may not seem upset about mutism since peers are more accepting. As children age, inner turmoil often develops and they may develop the negative ramifications of untreated anxiety (see below).
Why do children have oppositional behavior?
These children may develop oppositional behaviors out of a combination of frustration, their own inability to make sense of their mutism, and others pressuring them to speak.
What is selective mutism?
Selective mutism is in the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, or DSM-5. Doctors and others use the DSM-5 to help diagnose social and mental problems. In the DSM-5, a child with selective mutism may: Have an anxiety disorder. Be very shy.
How do you know if your child has selective mutism?
If your child has selective mutism, you may notice that: She will not speak at times when she should, like in school. This will happen all of the time in that situation. Your child will talk at other times and in other places. Not speaking gets in the way of school, work, or friendships.
Why isn't the first month of school included in selective mutism?
This does not include the first month of school because children may be shy and not talk right away. Your child can speak the language needed at that time. A child who does not know the language being used may not talk. This is not selective mutism.
Why do some children not talk?
Some children are shy and do not like to talk to people they don’t know. They usually start talking when they feel more comfortable. However, some children will not talk at certain times, no matter what. This is selective mutism. It is often frustrating for the child and others. Help is available.
Can a child talk to the SLP?
Some children will not talk to the SLP. If that happens, the SLP may ask if you have a video of your child talking.
What is selective mutism?
Selective mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. An individual's pattern of mutism can vary greatly.
How to help a child with selective mutism?
Consistency in the intervention and expectations, at home and at school, of everyone on the team involved is important when working with children with selective mutism. When providing predictability and control for the child with selective mutism, he/she will feel a decrease in anxiety and an improvement in self image based on mastery of skills in a variety of settings (Kotrba, 2015). The use of social stories and scripting can be helpful ways to reduce the child's anxiety and uncertainty in a variety of social situations (Dow et al., 1995; Kotrba, 2015).
What is the evaluation of selective mutism?
Evaluation and assessment of children with selective mutism is accomplished through a collaborative approach with an interdisciplinary team consisting of a pediatrician, psychologist or psychiatrist, SLP, teacher, school social worker or guidance counselor, and family/caregivers. During the evaluation, parents/caregivers may need to help elicit verbal output. The SLP can also involve parents/caregivers by requesting a video recording of the child's communicative behavior at home and then compare the child's behavior in a clinical or school setting. Video recordings may also be used for subsequent language sample analysis.
When is selective mutism diagnosed?
Screening for selective mutism is conducted whenever selective mutism is suspected or as part of a comprehensive speech and language evaluation for any child with communication concerns. If a parent or caregiver reports that a child is communicating successfully at home but not in one or more settings, the SLP may want to consider the diagnosis of selective mutism.
What are the characteristics of selective mutism?
If they are able to express themselves, they may rely on gesturing, nodding, pointing, or whispering. They may have fears of being ignored, ridiculed, or harshly evaluated if they speak.
What is the incidence of selective mutism?
The incidence of selective mutism refers to the number of new cases identified in a specified time period. Prevalence is the number of individuals who are living with selective mutism in a given time period.
Can a child with selective mutism speak?
Children with selective mutism typically do not speak at school, which interferes with academic, educational, and/or social performance. Children with this disorder sometimes communicate via nonspoken or nonvocal means (e.g., pointing, writing). Collaboration between the speech-language pathologist (SLP) and behavioral health professionals ...
What is selective mutism?
Selective mutism is a rare childhood disorder characterized by the persistent failure to speak in specific contexts where speech is typically expected, despite hearing and speaking in other contexts. It is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision(DSM-IV-TR), under the category of disorders first diagnosed in infancy, childhood, or adolescence.1The social contexts in which the persistent failure to speak occurs are at school and with playmates. In the home with parents and siblings, the child tends to engage in normal conversation.
What are the comorbid conditions associated with selective mutism?
Comorbid psychiatric conditions associated with selective mutism include depression, panic disorders, dissociative disorders, obsessive-compulsive behavior, and Asperger's disorder.5 Asperger's disorder is a mild form of autism that inhibits social interactions, peculiar speech, and nonverbal communication, such as excessive clumsiness.3A study in 1995 by Kopp and Gillberg12found that 7.4 percent of children with selective mutism also met criteria for Asperger's disorder. While this association has not been validated in further studies, the 7.4-percent rate is significantly higher than the rate of Asperger's disorder in the general population (0.3%). Clinicians are still urged to investigate Asperger's in children diagnosed with selective mutism.
How to evaluate mutism?
The evaluation of a patient with selective mutism consists of a comprehensive and multimodal approach.3Beyond information from parents and teachers, health professionals, such as audiologists, psychiatrists, psychologists, and speech/language pathologists, may be involved in the multidimensional assessment. Early on, a parent interview reviewing the child's comprehensive medical history, including in-depth review of prenatal and perinatal course, helps screen for neurological, speech, and language difficulties and assess trends in meeting developmental milestones. The clinician's direct observation of the child provides insight into the child's level of social interaction, communication needs, ability to establish friendships, participation in social activities, and the overall extent of inhibition. Details such as whether the child actually does attempt to communicate nonverbally are important to assess. Direct observation by the provider in the clinic and home environments sheds valuable information on the child's behavior in these various settings and enables comparison of the child's behavior and speaking habits. Direct observation also provides the clinician with a sense of the child's overall temperament. Observations recorded by teachers are undoubtedly helpful, although no standardized form for assessing teachers' observations is available at this time.
What are the comorbidities of selective mutism?
Selective mutism can present a variety of comorbidities including enuresis, encopresis, obsessive-compulsive disorder, depression, premorbid speech and language abnormalities, developmental delay, and Asperger's disorders. The specific manifestations and severity of these comorbidities vary based on the individual. Given the multidimensional manifestations of selective mutism, treatment options are similarly diverse. They include individual behavioral therapy, family therapy, and psychotherapy with antidepressants and anti-anxiety medications.
What percentage of people have social mutism?
The prevalence of social mutism ranges from 0.47 to 0.76 percent of the population based on pooled case studies from Western Europe, the United States, and Israel.4Previous prevalence has been reported much lower, at 0.03 to 0.2 percent reported across several epidemiological and cross cultural studies.3,5The wide range reflects the lack of uniformity in establishing the diagnosis from chart review and the infrequent use of standardized assessments.4Nonetheless, the onset of selective mutism typically occurs between ages three and six, and diagnosis occurs between ages five and eight, most often discovered after the child enters school.5It is slightly more common in girls than in boys, although the difference may be accounted for by research limitations, such as small sample populations and the rare nature of the disorder. The disorder can occur over a few months or persist for several years, although the majority of selectively mute children tend to outgrow the disorder spontaneously for unknown reasons.3,6However, despite apparent remission, talking behaviors over time remain lower than average, and residual social phobia and other anxiety disorders may persist.7
What is bedrock behavioral approach to selective mutism?
Another bedrock behavioral approach to selective mutism is contingency management, where the aim is to identify and specifically reward verbal behavior and not reinforce mute behavior .3Often, teachers and peers must be involved for the approach to succeed, and this is not always practical. Moreover, the efficacy of this strategy is equivocal.
How to help a child with selective mutism?
Family therapy. Family therapy is another treatment option that is especially relevant when family factors play a role in the potential development and perpetuation of selective mutism.16While the effectiveness of family therapy is unproven, incorporating the family in the therapeutic process can play a vital role in the child's recovery. Cooperation and understanding from parents and siblings helps the child overcome anxiety and avoidance. Collaborating with school staff is another vital component of healing given that the diagnosis is usually made as children become school age. Education about selective mutism should be clearly communicated to teachers and guidance counselors, as teachers can play an invaluable role in breaking cycles of negative reinforcement.6
What is selective mutism?
General Discussion. Selective mutism is a rare psychiatric condition primarily occurring during childhood. It is characterized by the failure to speak in certain social situations. The ability to speak and understand spoken language is not impaired, and may be exhibited in more familiar environments. Symptoms include excessive shyness and social ...
What percent of children are affected by selective mutism?
Selective mutism is recorded to affect less than one percent of children in the United States. This disorder appears slightly more common in females than in males. The percent of affected population is unknown due to undiagnosis and misdiagnosis.
How long does selective mutism last?
Individuals with selective mutism may be excessively shy, socially isolated, and withdrawn. In some cases, selective mutism lasts only a few weeks or months. However, some cases have been reported to continue for several years. Symptoms of selective mutism usually become noticeable between the ages of two and four years.
How do people with selective mutism communicate?
Affected individuals may communicate by gesturing, nodding their heads, uttering sounds or one-syllable words, or whispering. However, individuals with selective mutism usually talk normally at home and appear to have typical ...
What are the treatments for selective mutism?
The therapies that may be effective in treating selective mutism are counter-conditioning, modeling, shaping (successive approximations), and contingency management. Counter-conditioning involves developing new behaviors that are not compatible with the undesirable behaviors.
Does selective mutism affect language?
However, individuals with selective mutism usually talk normally at home and appear to have typical language skills – although they may have subtle language difficulties in areas such as grammar when compared to other children their age. Symptoms may also include fear of social embarrassment, clinginess and anxiety.
Is fluoxetine a selective mutism drug?
Use of the drug fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) is being studied for the treatment of selective mutism. More studies are needed to determine the long-term effectiveness of drugs for the treatment of selective mutism. Early evidence is promising and suggests that SSRIs are most effective when paired with behaviour management therapies.
What is mutism in psychiatry?
Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output , is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.
What is the disorder of speech called?
Aphasia: This is a disorder of the content of speech, seen generally in organic conditions and occasionally as gargon aphasia in schizophrenia
What Is Selective Mutism?
Symptoms
- If you believe that your child may be struggling with selective mutism, look for the following symptoms: 1. Expression of a desire to speak that is held back by anxiousness, fear, or embarrassment 2. Fidgeting, eye contact avoidance, lack of movement or lack of expression when in feared situations 3. Inability to speak in school and other specific social situations 4. Use of nonverbal communication to express needs (e.g., nodding head, pointin…
Diagnosis
- Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)published in 2013. The use of the term "selective" was adopted in 1994, prior to which the disorder was known as "elective mutism." The change was made to emphasize that children with selective mutism are not choosing to be silent, but rather are …
Causes
- Because the condition tends to be quite rare, risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval. Research now suggests that the disorder is related to extreme social anxiety and that genetic predisposition is likely.2 Like all mental disorders, it is unlikely that there is one single cause. Kids who develop the condition: 1. Tend to be very shy 2. M…
Treatment
- Selective mutism is most receptive to treatment when it is caught early. If your child has been silent at school for two months or longer, it is important that treatment begin promptly. Treatment for selective mutism may include psychotherapy, medication, or a combination of the two.
Coping
- In addition to seeking appropriate professional treatment, there are things that you can do to help your child manage their condition. 1. Inform teachers and others who work with your child. Teachers can sometimes become frustrated or angry with children who don't speak. You can help by making sure that your child's teacher knows that the behavior is not intentional. Together you need to encourage your childand offer praise and rewar…
Overview
- Selective Mutism is a complex childhood anxiety disorder characterized by a childs inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.
Symptoms
- More than 90% of children with Selective Mutism also have social phobia or social anxiety. This disorder is quite debilitating and painful to the child. Children and adolescents with Selective Mutism have an actual FEAR of speaking and of social interactions where there is an expectation to speak and communicate. Many children with Selective Mutism have great difficulty responding or initiating communication in a nonverbal manner; therefore, …
Characteristics
- When compared to the typically shy and timid child, most children with Selective Mutism are at the extreme end of the spectrum for timidity and shyness.
Causes
- Research at the Selective Mutism Anxiety Research and Treatment Center (SMart Center) indicates that there is a proportion of children with Selective Mutism who come from bilingual/multilingual families, have spent time in a foreign country, and/or have been exposed to another language during their formative language development (ages 2-4 years old). These children are usually temperamentally inhibited by nature, but the additional stress of …
Themes
- Children who suffer from Selective Mutism speak in at least one setting and are rarely mute in all settings. Most have inhibited temperaments and manifest social anxiety. For children with Selective Mutism, their mutism is a means of avoiding the anxious feelings elicited by expectations and social encounters.
Treatment
- It is important for parents and teachers to understand that the physical and behavioral symptoms are due to anxiety and treatment needs to focus on helping the child learn the coping skills to combat anxious feelings.
Risks
- Others are less avoidant and do not seem as uncomfortable. They may play with one or a few children and be very participatory in groups. These children will still be mute or barely communicate with most classmates and teachers.
Diagnosis
- If mutism persists for more than a month, a parent should bring this to the attention of their childs physician.
Prognosis
- As a result of the scarcity and often inaccuracy of information in the published literature, children with Selective Mutism may be misdiagnosed and mismanaged. In many circumstances, parents will wait and hope their child outgrows their mutism (and may even by advised to do so by well-meaning, but uninformed professionals). However, without proper recognition and treatment, most of these children do NOT outgrow Selective Mutism an…
Epidemiology
- Anxiety disorders are the most common mental illnesses among children and adolescents. Our main objective is to diagnose children early, so they can receive proper treatment at an early age, develop proper coping skills, and overcome their anxiety. According to the US Surgeon General, our country is in a state of emergency as far as childrens mental health is concerned. 10% of children suffer from mental disorders, but less than 5% of these chi…
Results
- Do your homework! You will have a much better idea what to look for if you understand Selective Mutism. Educate yourself as much as possible before seeing any professional. Parents should read as much information as they can about Selective Mutism. The Selective Mutism Association website has countless pages of information and it is updated on a regular basis.
Management
- *Children do not progress communicatively without learning coping skills. Simply lowering anxiety is NOT enough to enable the child to begin engaging socially, learn to progress to verbal communication and feel comfortable in an environment. Skills must be taught.
Contraindications
- Caution: When speaking to potential treating professionals, please be cautious of those who see Selective Mutism as a controlling/manipulative behavior. Treatment approaches based on discipline and forcing a child to speak are inappropriate and will only heighten anxiety and negatively reinforce mute behavior.
Research
- Social Communication Anxiety Treatment® or S-CAT® is an evidenced-based program created by Dr. Elisa Shipon-Blum and implemented at the Selective Mutism Anxiety Research and Treatment Center (SMart Center). Presently, the SMart Center is the ONLY Center in the world that implements S-CAT®.