Mutism or psychogenic silence ( Latin: mutitas " dumbness ", mutus "dumb") is a communication disorder , with no defects in the speech organs or hearing. Mutism occurs mostly in connection with a social phobia . In adolescence and adulthood, silence is often embedded in depression . A distinction is made in mutism between (s) elective mutism , total mutism and akinetic mutism .
Frequency and distribution
Mutism is a very rare and often unknown communication disorder that affects around two to five children in 10,000 preschool or school children. The information on the gender distribution (girls: boys) varies. They range from 1.6: 1 to 2.6: 1. These results are uncertain because they were obtained from small samples (100 or 50 people). It is noteworthy that selective mutism is the only language disorder that affects girls more than boys.
Kurth and Schweigert differentiate between early mutism , which occurs between the ages of 3 and 4, and late mutism . This form often shows up when starting school between the ages of 5 and 7. An alternative name is therefore school mutism .
Subdivision of Mutism
The term elective mutism was introduced by the Swiss child and adolescent psychiatrist Moritz Tramer (1934) and spread internationally. In the current discussion it is supplemented by the term “selective mutism”. In the WHO ICD-10, the term “elective mutism” can be found under F94.0. The terms "elective mutism" or "selective mutism" describe one and the same disorder. In Anglo-American literature, the term “selective mutism” is usually used. In the past, the term refusal to speak was often used, but this reduced the problem to the child alone and suggested that the child had the opportunity to speak if he wanted to.
Selective mutism is an anxiety disorder that occurs primarily in childhood and adolescence. The inability to articulate is only present in specific situations. In familiar surroundings, the sick person usually speaks an above-average amount, as if the neglected topic had to be made up for. In many cases, parents do not even notice their child's illness and are only made aware of it by the child's teachers and friends. There are no mental limitations with this type of mutism.
In contrast to selective mutism, total mutism is easier to recognize and define. The person concerned cannot verbally communicate with other people in any situation. Total mutism can be triggered by shock experiences. Sources are not known for the frequency of possible causes.
The akinetic mutism is a neurological syndrome , which by a heavy failure of the actuator is indicated. The person concerned is awake and has no paralysis . However, he does not move himself ( akinesia ), does not speak ( mutism ) and does not show any emotions, as there is no drive for this. Perception and memory are usually not impaired.
Symptoms and ailments
The mutistic patient does not speak at all ( total mutism ) or he is only silent towards certain people or in certain situations ( selective mutism , also: elective mutism ). In addition, forms of breaking contact take place at the level of non-verbal communication.
Mutism is usually conditioned by a disposition . So show z. In a study by Kristensen, for example, 72.2% of the examined mutists found markedly shy family members, in contrast to only 17.6% of the children in the control group. Trauma can play a role in total mutism. However, this most severe form of silence often occurs in combination with endogenous depression, psychosis or other psychiatric illnesses.
The disorder is often associated with social anxiety , withdrawal, or resistance. It can make sense to offer multifactorial therapy that ranges between speech therapy , psychotherapy , family therapy and psychiatry .
With regard to selective mutism, the following characteristics can frequently be found in the families of those affected: inhibition, communicative and social withdrawal, solitary behavior, fears and depression . In addition, there are psychological factors of maintenance such as increased attention , focus in the family , special roles and the release from duties, which can lead to those affected no longer escaping the vicious circle of silence on their own.
Most of the time, the selectively or electively mutistic children speak to their parents and siblings, but do not speak in other definable situations (with strangers, in kindergarten or school, etc.). Total mutism is extremely rare in children .
Consequences and complications
The entire development ( linguistic , cognitive , social and emotional ) can be affected by mutistic behavior . This can have consequences for personal development , self-identity and self-confidence . Affected people can suffer from social anxiety, emotional withdrawal or resistance to others or from a depressive mood. Difficulties in school, training or at work can arise.
Because children with mutism are easier to ignore than hyperactive or learning disabled children, it is seldom properly diagnosed or even noticed that a disorder is present. Parents often see children with mutism as shy or listless. In the environment of their parents, siblings and close friends, those affected speak normally and relaxed; However, as soon as there is a suspicion that someone is listening, or only a third party sees that the mouth is being moved, the person concerned can fall back into silence.
Since mutism is a communication disorder and occurs in interaction with other people, the communication partners also suffer from the silence. You cannot ask mutists to speak , because that “forces” them to become more and more quiet.
The treatment is speech therapy , psychotherapeutic and / or psychiatric . Mutistic adolescents and adults may receive additional pharmacological treatment with antidepressants (e.g. sertraline ) if an appropriate medical approach is adopted. Systemic Mutism Therapy (SYMUT) by Hartmann is a mutism- specific treatment concept . It combines speech therapy and behavior therapy measures. Another connection between psychology and communication therapy can be found in the approach of Katz-Bernstein. Other designs reinterpret silence as a positive ability of the child. The point here is rather that the child should make contact with other people on their own initiative, which, however, only rarely succeeds due to the present anxiety.
- Persistent inability to speak in certain situations (when it is expected to speak , e.g. at school ) while remaining normally able to speak in other situations.
- The disorder hinders academic or professional performance or social communication .
- The disruption lasts for at least a month and is not limited to the first month after starting school, training or working.
- The inability to speak is not due to a lack of knowledge of the spoken language , which is required in the social situation, or to the fact that the person concerned does not feel comfortable in this language.
- The disorder cannot be better explained by a communication disorder (e.g. stuttering ) and does not occur exclusively in the course of a profound developmental disorder (e.g. autism ), schizophrenia, or any other psychotic disorder.
Central organic damage ( head trauma , aphasia ), language development disorders and deafness must also be excluded. A special form that is associated with organic brain lesions and / or inhibition mechanisms is known as akinetic mutism . In addition, it is not a question of mutism if people remain silent out of defiance ( self-preservation ), out of grief (e.g. loss of a loved one or divorce ) or as a conscious avoidance behavior or defense mechanism (e.g. during lectures in front of a large audience ) .
The mental and non-organic speech disorders (as developmental disorders ) such as mutism are coded in the ICD-10 F80 category . ICD-10 F80.0 describes the articulation disorder, ICD-10 F80.1 and ICD-10 F80.2 the expressive or receptive language disorder . ICD-10 F80.3 is acquired aphasia with epilepsy ( Landau-Kleffner syndrome ).
- Hildegard Brand: Mutism - silent children and young people in conversation. Experiences with groups . Pabst Science Publishers, Lengerich / Berlin 2009, ISBN 978-3-89967-549-8 .
- Boris Hartmann, Michael Lange: Advisor: Mutism in Child, Adolescent and Adulthood . 6th edition. Schulz-Kirchner , Idstein-Wörsdorf 2013, ISBN 978-3-8248-0506-8 .
- Nitza Katz-Bernstein: Selective Mutism in Children. Appearances, diagnostics, therapy . 2nd Edition. Reinhardt Verlag, Munich / Basel 2007, ISBN 978-3-497-01754-6 .
- Boris Hartmann (Ed.): Faces of Silence. Systemic Mutism Therapy / SYMUT as a therapy alternative . 2nd Edition. Schulz-Kirchner Verlag, Idstein-Wörsdorf 2008, ISBN 978-3-8248-0336-1 .
- Otto Dobslaff: Mutism in School . Wissenschaftsverlag Spiess, Berlin 2005, ISBN 978-3-89776-008-0 .
- Boris Hartmann: Mutism. On the theory and casuistry of total and elective mutism . 5th edition. Wissenschaftsverlag Spiess, Berlin 2007, ISBN 978-3-89166-196-3 .
- Ornella Garbani Ballnik: Silent children. Forms of Mutism in Educational and Therapeutic Practice . Vandenhoeck & Ruprecht, Göttingen 2009, ISBN 978-3-525-40201-6 .
- Ornella Garbani Ballnik: Our child doesn't speak. Guide for parents of silent children . Vandenhoeck & Ruprecht, Göttingen 2012, ISBN 978-3-525-40215-3 .
- References from the Mutismus Selbsthilfe association
- Overview of the forms of mutism on the website of the Mutism Advisory Center
- Not a word. In: Jetzt.de , November 11, 2013, accessed on November 11, 2013
- Further specialist articles and information on the topic
- Sabine Laerum: Selective Mutism: The silent child. Psychologie Heute, August 2014, pp. 40–45 (PDF, 6 pages, 6.8 MB).
- Robert Goodman, Stephen Scott: Child Psychiatry . Blackwell Science, Oxford; Malden, MA, USA 1997, ISBN 978-0-632-03885-5 .
- Hans-Christoph Steinhausen , Claudia Juzi: Elective Mutism: An Analysis of 100 Cases . In: Journal of the American Academy of Child and Adolescent Psychiatry . Vol. 35, No. 5 , May 1996, pp. 606-614 .
- Dummit, Small, Tancer, ash, Martin, Fairbanks: Systematic Assessment of 50 Children With Selective Mutism . In: Journal of the American Academy of Child & Adolescent Psychiatry . Vol. 36, No. 5 , May 1997, pp. 653-660 .
- E. Kurth, K. Schweigert: Causes and developmental courses of mutism in children . In: Psychiatry, Neurology and Medical Psychology . tape 24 , 1972, ISSN 0033-2739 , pp. 741-749 .
- Thomas Müller: These are the new diseases in ICD-11. In: aerztezeitung.de. Doctors newspaper , May 23, 2019, accessed December 27, 2019 .
- Kristensen, H .: Selective mutism and comorbidity with developmental disorder / delay anxiety disorder, and elimination disorder . In: Journal of the American Academy of Child and Adolescent Psychiatry . tape 39 , no. 2 , 2000, pp. 249-256 .
- Hartmann, B: Treatment of a (s) electively mutis girl tables according to the concept of systemic therapy mutism / SYMUT - Part I . In: Forum Speech Therapy . tape 18 , no. 1 , 2004, p. 20-26 .
- Hartmann, B: The treatment of an electively mutistic girl according to the concept of systemic mutism therapy / SYMUT - Part II . In: Forum Speech Therapy . tape 18 , no. 2 , 2004, p. 30-35 .
- Nitza Katz-Bernstein (ed.): Finding courage to speak - therapeutic ways for selectively mutistic children . 1st edition. Reinhardt Verlag, 2007, ISBN 978-3-497-01894-9 .
- Reiner Bahr: When children are silent. Understand and deal with inhibitions to speak . 4th edition. Walter Verlag, 2007, ISBN 978-3-491-40135-8 .
- Cairns, H., RC Oldfield, JB Pennybacker, D. Whitteridge: Akinetic mutism with an epidermoid cyst of the 3rd ventricle . In: Brain . tape 64 , 1941, pp. 273-290 .