Treatment of selective mutism in children and adults with schizophrenia

How does mutism manifest?

Mutism is one of the most serious changes in speech ; when it occurs, a person remains completely silent, which leads to the inability to enter into verbal contact with other people. Total mutism is diagnosed if a person remains unable to make verbal contact under any circumstances. Partial mutism in adults and children is a condition in which a person is unable to carry on a conversation with certain people or in a specific situation that is traumatic for him. At the same time, in a different environment or with other people, he is able to talk. Selective mutism is a condition in which the patient experiences silence occasionally. For example, selective mutism in children can appear at school, when communicating with a certain circle of peers.

If a person has hysterical mutism , then the patient cannot pronounce words even in a whisper, although his tongue and lips can make the movements necessary to reproduce speech. A person with mutism understands both oral and written speech. In order to contact people, such patients use facial expressions and gestures. Typically, people suffering from hysterical mutism do not appear depressed or upset by the condition. Manifestations of hysterical mutism are often combined with other neurotic disorders. This may be enuresis , encopresis , amaurosis . As a rule, people with increased emotionality and lability of nervous processes are prone to manifestations of hysterical mutism. This type of mutism is more common in women.

A special form of mutism is determined, which in medicine is called surdomutism . In this case we are talking about deaf-muteness, which can be either congenital or acquired. However, in this case, the patient does not have organic defects of the speech departments and the hearing aid.

Prevention

In order to prevent the development of such a disease as childhood selective mutism, you must follow a few simple rules. Parents should know the basic methods of prevention:

carefully ensure that stress and nervous shock are present as little as possible in the child’s life;
when communicating with children, be sure to regularly play in the fresh air, offering various life situations;
maintain a healthy psychological microclimate in the family;
daily routine rules and regular walks in the fresh air are required;
balanced diet.

When the first symptoms of speech disorders appear in a child, you should definitely consult a doctor. Under no circumstances should you try to get rid of the problem yourself. Timely treatment is the key to the full development, health and activity of the baby.

Why does mutism occur?

Mutism in children and adults in most cases manifests itself as a result of mental trauma, which is a significant irritant for brain cells. As a rule, initially a person experiences an acute form of mutism, which is expressed by symptoms of hysterical neurosis. That is, the basis of such a disease is the hysterical mechanism.

Mutism develops against the background of mental disorders. It can be functional and organic . Its type is determined depending on the cause of the development of this symptom. Organic is akinetic mutism , in which the patient has no speech movements due to damage to the activating parts of the brain.

Selective mutism manifests itself as a peculiar reaction of the human psyche to a certain stimulus. Consequently, a factor that is a trigger for the development of the disease can be a serious conflict, strong resentment, or fear. Mutism in this case is directly related to neurosis . Very often, mutism is diagnosed in children with a high level of sensitivity, severe sensitivity, and physical weakness. In some cases, the child may remain silent for many months or even years. In this case, parents should not try to cope with the situation on their own, trying to persuade or captivate the child. Treatment of mutism in a child should be carried out by a doctor, taking into account all the characteristics of the patient’s condition.

When making a diagnosis, specialists always take into account the fact that childhood mutism can have a wide variety of psychological causes. Therefore, each such fact must be studied individually and very carefully. Sometimes mutism in children is a certain form of protest, an expression of silent aggression.

Surdomutism , that is, temporary deafness and muteness, can appear in a child as a result of injury or a reaction to stress. There are no organic reasons for this lesion.

Mutism in adults is often observed in the context of aphasia .

Selective mutism in children

When answering the question of what a disease such as selective mutism is, doctors emphasize that this is a disease in which the main symptom of the pathological condition is muteness of a psychological nature.
The pathogenesis of selective mutism is based on passive aggression, associated with the fact that the child seeks through his silence to express a protest against factors such as increased guardianship or parental control, social conditions.

In many situations, the causes of the disease are associated with psychological trauma. The child does not have the opportunity to express his dissatisfaction in any other way; he withdraws into himself and does not want to talk with others. The baby feels misunderstood and useless and completely refuses to establish verbal contact.

Hysterical mutism is considered a reversible condition, meaning the muteness is temporary. Most often, pathology develops in early childhood – from 3 to 8 years.

With this disorder, the baby fully, actively talks at home, with close and well-known people, but completely refuses to communicate under other circumstances. Much less common are forms of the disease when children prefer to remain silent and at home.

The help of a qualified specialist will help normalize the child’s psychological state and eliminate speech disorders.

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.

Selective mutism in simple schizophrenia

The reason for the appearance of this pathology may be not only an increased level of intellectual capabilities and the desire to manipulate adults in their own interests. When diagnosing this type of pathology, doctors first check the patient for the presence of schizophrenia. Such a manifestation may be a sign of the onset of one of the most complex types of catatonic schizophrenia. In the absence of proper therapy, a patient with this form of severe mental disorder is able to completely withdraw from the world, retreating into his own shell.

Classification

Types of mutism and its main symptoms

According to the International Classification of Diseases, 10th revision, mutism is assigned its own identifier - F94.0. In particular, we are talking about selective mutism, which mainly affects children. According to statistics, approximately 1 in 150 children are diagnosed with this condition. Interestingly, girls are most often susceptible to developing mutism. Selective mutism is also called selective mutism. With this condition, a child may be active and talkative in his usual environment, that is, in the family, but become completely silent in kindergarten and school, or lose the ability to speak in the presence of certain people. Often, adults perceive this behavior of a child as a social protest and try to solve the problem using radical educational methods. But this is fundamentally wrong, because timely identification and treatment of mutism will avoid problems with the psychological state of the child as he grows up.

The most common among children and adults is considered to be psychogenic mutism - a condition in which a person loses the ability to speak after severe mental trauma. There are several forms of psychogenic mutism:

Hysterical mutism occurs after a person has experienced a strong shock. The duration of this state can vary, and range from a couple of seconds to several weeks, or even months.
The logophobic form, as its name suggests, is silence caused by the fear of hearing one’s own voice. Most often, this condition develops in school-age children.

Causes

Selective mutism develops based on a person’s psychological characteristics, and the trigger is environmental influences.
Risk factors:

mental disorders - mental retardation, speech defects, schizophrenia at the initial stage;
neurological disorders - unstable nervous system, hysterical neurosis, traumatic brain injury, tumors, neuroinfections and other organic brain lesions;
emotional component of character - vulnerability, natural silence, indifference, shyness, impressionability, love of solitude, anxiety, habit of suppressing aggression;
peculiarities of upbringing: uncomfortable climate in the family - complete control of the child’s life, overprotection, lack of attention, aggression, violence;
heredity – insecure parents with depressive disorders and high levels of anxiety;
stressful psychotraumatic situation - parental divorce, death of a loved one, violence, accident, family moving to another, unfamiliar country.

There is a misconception that psychogenic muteness is associated with autism. In fact, these are completely different pathologies. Moreover, both of them can develop in the same child.

Diagnostics

To establish a diagnosis of “selective mutism,” an examination by a psychiatrist is necessary. The young patient is being monitored and parents are being interviewed. To confirm the disorder, you need to find out the following:

whether the child understands speech as such. This is determined by whether he can nod his head to express denial/agreement and carry out a command/request;
whether the patient ever uses oral speech, whether it is sufficient for communication, whether he is able to express his thoughts clearly.

The doctor needs to rule out other diseases:

childhood schizophrenia with its inherent set of symptoms (hallucinations, delusions, etc.);
early autism, in which speech is initially impaired and the psyche develops in a special way;
states of shock - they are accompanied by panic, acute onset, short duration, motor retardation;
neurological diseases - confirmed by brain studies;
hysterical muteness, characterized by high self-esteem, a tendency to fantasize, and a need for attention. A patient suffering from psychogenic mutism, on the contrary, tries to be invisible and is timid.

Therefore, the psychologist involves a psychologist, audiologist, neurologist, otolaryngologist, ophthalmologist, and instrumental studies are used.

Features of personal development

Children with selective mutism are usually children with a high level of intelligence, who, according to psychologists, are not mature enough to communicate with people. At the same time, while they are aware of the need to maintain verbal contact with all the people around them, their character is capable of undergoing some significant distortions.

Inside the little mutist, claims towards others and dissatisfaction with oneself accumulate, which can be expressed in the form of demonstrative antics. Such children usually try to join the company of hooligans and poor students. They feel satisfaction from defiant behavior, sometimes it seems that they are literally fascinated by vices. If the behavior of such children is corrected in time, then such unpleasant moments can be avoided.

In the absence of specialized help, an adult mutist may experience serious difficulties in his personal life. This pathology literally chains the patient to his mother.

The mother constantly tries to help, taking care of the child in all situations, which leaves an imprint on relationships with the opposite sex in the future.

Children manipulate their peculiarity, using their parents as the only link connecting them with society. Parents are also influenced by this pathology of their children: they protect this emotional contact, every word has a special meaning for them. A certain symbiosis arises that distorts the personal development of children.

Boys grow up to be dependent, immature and at the same time overly domineering. In childhood, such children turn into family “tyrants”. Girls see their mother as a potential rival, which can lead to early marriage or promiscuity. This behavior is a kind of revenge for the feeling of lack of freedom, although the child himself did not let his mother go. In this regard, you should not wait until these deviations develop, but begin timely treatment, which will restore normal speech and prevent personal problems from developing.