Selective mutism

Classification according to ICD-10
F94.0	Elective mutism
ICD-10 online (WHO version 2019)

Selective mutism (also: Elektiver Mutismus ; English selective : “selectively, punctually”, elective : “optionally”, Latin mutus : “dumb”) describes an emotionally conditioned psychological disorder in child and adolescent psychiatry , in which linguistic communication is severely impaired is. Selective mutism is characterized by speaking selectively with certain people or in defined situations. In contrast to total mutism , silence is not complete.

The articulation , language understanding and expression of those affected, on the other hand, are usually within the normal range, at best they are slightly delayed in development.

As far as we know today, the term “selective mutism” appears to be a more appropriate description, since silence is by no means freely chosen and is therefore not “elective” in the literal sense of the word.

description

Selective mutism is not a language disorder in the conventional sense, but a temporary, fear-related breakdown in speech in certain social situations or in the presence of unconsciously selected people. This can lead to the fact that affected children only speak to certain people, mostly from close family circles.

Since the child is no longer able to communicate using spoken language, despite intact language skills, mutism is counted among the "secondary language disorders".

Mutual effects

The silence means a great burden for all concerned and contact persons. The children and adolescents affected are quickly sidelined and can become outsiders .

Since the person concerned is not generally speechless, communication partners who encounter the selective silence often feel provoked and helpless, and react disappointed or angry.

In the context of the school, a contradiction quickly arises for teachers between desired pedagogical attitudes such as acceptance and patience and the institutionally justified demands such as timely teaching of subjects and performance evaluation. Misjudgments of real school performance are common.

Occurrence and course

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

Selective mutism is a relatively persistent disorder, the duration of which often extends into late school age, sometimes even into adulthood. Although the silence can obviously also be overcome without therapy, the risk of damage to the self-concept and feelings of linguistic incompetence increases without therapy.

Approximately 30 to 50% of the mutistic children and adolescents show normal speaking behavior and a comparatively good psychosocial adjustment in a catamnesis interval of 5 to 10 years. The other affected persons show a clearly improved, but further disturbed speaking behavior, which is characterized by speaking aversion, tendency to withdraw and fear of social contact.

diagnosis

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

ICD-10

In the ICD-10 of the World Health Organization , selective mutism is described as a clearly emotionally conditioned selectivity of speaking in which the child speaks in certain situations and again not in other, well-defined situations. Certain personality traits such as social anxiety , withdrawal, special sensitivity or resistance can usually be found in the child .

Key symptoms according to ICD-10 :

• Speech selectivity: in some social situations the child speaks fluently, but in other social situations the child remains silent or almost silent
• Consistency in the social situations in which people speak and do not speak
• Frequent use of non-verbal communication (facial expressions, gestures, written notes) by the child
• Duration of the disturbance for at least one month
• Age-appropriate competence in the linguistic expression of the situation-dependent language

DSM-IV

Key symptoms according to DSM-IV :

• Persistent inability to speak in certain situations while having normal ability to speak in other situations
• The disorder hinders academic or professional performance or social communication
• The disruption lasts at least a month (and is not limited to the first month after school starts)
• The inability to speak is not due to a lack of knowledge of the spoken language or to the person not feeling comfortable in that language

For these symptoms, the DSM-IV further describes features and disorders that often exist in addition to selective mutism. Symptoms such as anxiety, compulsive behavior, controlling and oppositional behavior, but also intellectual disability , hospitalization and extreme psychosocial stress factors are mentioned here.

Differential diagnosis

When diagnosing selective mutism, it must be differentiated from other clinical pictures, which have a certain similarity in their phenomenology of permanent silence.

In this way, the fearful silence in certain audience situations can be made conscious and promised as a consciously implemented avoidance strategy, at least in retrospect. Mutism, on the other hand, is not a conscious, willful act; Even a self-reflective thinking about the meaningfulness of this behavior is not possible with selective mutism.

Selective mutism does not include hesitant speaking of shy children towards strangers, falling silent out of defiance or as a grief reaction, remaining silent due to poor language skills, silent autistic children or being silent in the case of profound personality disorders and silence as a result of organically caused speech and language disorders. The disorder must also not be better explained by a communication disorder and must not occur exclusively in the course of a profound developmental disorder , schizophrenia or another psychotic disorder .

Comorbidity

A particularly common concomitant disease is social phobia . This anxiety disorder or avoidance behavior is found in 97% of the cases .

Other comorbidities are:

• Disorder of social behavior with oppositional behavior (F91.3; here a passive-aggressive basic attitude may require a different therapeutic approach)
• Phobic disorders (F40)
• Other anxiety disorders (F41)
• Reactions to severe stress and adjustment disorders (F43)
• Depressive symptoms (F3)
• Disorders of the regulation of sleep, eating and excretory function

therapy

Today, a multi-dimensional therapeutic approach is unanimously recommended, ie it should include various treatment elements. In addition to the individual treatment, the environment should also be included. Psychoanalytically oriented forms of therapy and behavioral therapeutic concepts are in the foreground in the treatment of mutism, since in most cases a neurotic cause is assumed or the mutism has led to learned behavioral patterns over time.

In terms of behavioral therapy , successes can be achieved relatively quickly compared to the psychoanalytic approach. The aim is to create a fear-free situation without being forced to speak in order to then build up verbal communication in small steps. In psychotherapeutic treatment , among other things, it is pushed to reduce the causal factors, to further promote personality development and to try to reduce communication disorders. The spoke 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 medical-psychiatric treatment , attempts are often made to influence the symptoms positively with the help of drug therapy .

literature

• Reiner Bahr: Understanding silent children - communication and coping with selective mutism. Heidelberg 2006, ISBN 978-3-8253-8331-2 .
• Otto Dobslaff: Mutism in School. Appearance and Therapy. Spiess, Berlin 2005. ISBN 3-89776-008-8 .
• Ornella Garbani Ballnik: Silent children. Forms of Mutism in Educational and Therapeutic Practice. Göttingen 2009, ISBN 978-3-525-40201-6 .
• Ornella Garbani Ballnik: Our child doesn't speak. Guide for parents of silent children. Göttingen 2012, ISBN 978-3-525-40215-3 .
• Ingrid Gregor: Silence - a foreign language? Thinking about the mutistic withdrawal. In: The Speech Therapist. Volume 30/4, 1998.
• Maggie Johnson & Alison Wintgens: The Selective Mutism Resource Manual: 2nd Edition. Routledge 2016. ISBN 978-1909301337 .
• Boris Hartmann: Mutism. On the theory and casuistry of total and elective mutism. Berlin 2007, ISBN 978-3-89166-196-3 .
• Katja Subellok & Anja Starke: Selective Mutism. In: S. Niebuhr-Siebert & U. Wiecha (Hrsg.): Parent counseling for children with speech, speech, voice and swallowing disorders. Munich 2012, pp. 212-237, ISBN 978-3437444029 .

Web links

• Further specialist articles and information on the topic
• List of specialist articles on the subject of mutism
• Sabine Laerum: Selective Mutism: The silent child. Psychologie Heute, August 2014, pp. 40–45 (PDF, 6 pages, 6.8 MB).

Individual evidence

1. ↑ ^{a b} Guidelines of the German Society for Child and Adolescent Psychiatry and Psychotherapy: Elective Mutism (F94.0) ( Memento from May 11, 2012 in the Internet Archive )
2. ↑ R. Bahr: (S) elective mutism: A systemic perspective for therapy and counseling. In: Speech healing work. Volume 43, 1998, pp. 28-36.
3. ↑ ^{a b} Resch et al .: Development Psychopathology of Childhood and Adolescence - A textbook. PVU, Weinheim 1999
4. ↑ Sabine Laerum: Selective Mutism: The silent child. Psychologie Heute, August 2014, pp. 40–45 (PDF, 6 pages, 6.8 MB).
5. ↑ ^{a b c d} U. Schoor: Silent children in kindergarten and school. In: Speech healing work. October 2002, pp. 219-225.
6. ↑ ^{a b} H. Remschmidt: Child and Adolescent Psychiatry. A practical introduction. Stuttgart 2000.
7. ^ O. Braun: Language disorders in children and adolescents. Stuttgart 1999.
8. ^ U. Schoor: Silent children in school. The appearance of selective mutism. In: Elementary School. Volume 5, 2001, pp. 24-26.
9. ^ E. Heinemann, H. Hopf: Mental disorders in childhood and adolescence. Kohlhammer, Stuttgart 2004.
10. ↑ Horst Dilling, Werner Mombour, Martin H. Schmidt : International Classification of Mental Disorders. ICD-10 Chapter V (F). Clinical diagnostic guidelines (edition: 5). Huber, Bern 2002.
11. ^ University of Munich: Disorder teaching seminar in clinical psychology ( Memento from June 9, 2008 in the Internet Archive )

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !