Mutism and selective mutism explained
This article covers the difference between the anxiety disorder, selective mutism, along with motor functioning impairments or speech disorders which result in an inability to speak — known simply as ‘mutism’.
Key points:
- Selective mutism is an anxiety disorder, which limits who a person is able to speak to
- Permanent mutism can occur in people losing their prior ability to sleep (aphasia) and occur through injury to the brain or a stroke
- Damage to the larynx or an inability to speak through motor function impairments (apraxia or dysarthria)
Shy, autism, anxiety or mutism? The lines are often blurred between where a trait becomes a disability or whether that disability can actually be treated. This article covers the difference between the anxiety disorder, selective mutism, along with motor functioning impairments or speech disorders which result in an inability to speak — known simply as ‘mutism’.
In this edition of Disability Support Guide, mutism and selective mutism, along with causes and treatments will be addressed, comparing and contrasting how mutism presents in people with the condition.
What is mutism and what is selective mutism?
Mutism presents as an inability to talk in people with the condition, but for people with selective mutism, they may be able to talk with people that they share a close sense of trust with.
People with mutism may be able to communicate with others through gestures, facial expressions or devices or understand what others are communicating to them through speech, gestures and visual cues.
Despite this, people with selective mutism have an increased likelihood of comorbid diagnoses of autism spectrum disorders (ASD), which can limit their overall ability to interpret facial expressions or fluent social communication. Despite the likelihood of ASD and the shy symptoms of people with autism, the distinction is that people with selective mutism are unlikely to fluently communicate with strangers to a severe degree.
However, adults who were previously able to speak without impairment, but have since lost the ability to speak, may come as a result of neurological problems resulting from brain injury or stroke, which impacts the Broca’s area of the frontal lobe.
Additionally disabilities which relate to motor function, such as apraxia (muscle problems preventing speech) or anarthia, which is the inability for the body to coordinate speaking and breathing correctly can result in mutism.
Injury to the vocal chords (larynx) can occur from strangulation or intense pressure which can be fatal, but potentially lead to temporary or permanent mutism depending on the level of associated trauma.
Can selective mutism be overcome by adulthood?
Through consultation with a psychologist or psychiatrist, a plan for treating selective mutism can be developed to gauge the level of stress that a situation can cause and help them manage the condition.
It is highly advised that parents of a child with selective mutism do not emphasise the need to speak or comment on the symptoms of someone with the condition, as it can put more undue stress on the person and their relationship with communicating.
Sydney’s Selective Mutism Clinic has a wide range of resources and support options, including webinars and assessment choices in order to help put someone with the condition on the right path to overcoming their difficulties in speaking.
Parents often experience difficulties in dealing with symptoms of selective mutism and may feel that their child speaks to them on a manipulative or self-serving basis, but it is important to note that people with the condition only speak when they are comfortable enough and to certain people under certain conditions. Taking a negative tone or attitude towards mutism may prompt them to communicate less or feel unable to communicate with you on a similar basis.
Selective mutism may resolve itself spontaneously upon starting school, but early intervention is vital, as by the second year of waiting for a resolution, the person may have a harder time developing speaking skills and abilities, furthering their fear of using their voice at school.
For students with selective mutism, this can be incredibly difficult for many aspects of life, including informing their teacher about bullying, asking to use school facilities or during tasks which involve confidence or vocal expression (ie. a class presentation).
By very subtly complimenting your child on instances where they overcome their impairment in some way, such as speaking up in school or during a family event, rather than prompting them to, the positive indicator can serve as a supportive and effective way to overcome the disability.
Medication for the treatment of selective mutism is typically not necessary, due to the high success rate of effective cognitive behavioural therapy (CBT), however, in some instances, a selective serotonin reuptake inhibitors medicine (SSRI — commonly used to treat depression and anxiety) may be prescribed by a psychiatrist of paediatrician to overcome the associated phobia.
Although selective mutism in children and cases of adult trauma leading to the onset of selective mutism or through a lack of treatment in childhood are a disability which can be temporary, as opposed to mutism through neurological damage or motor functioning disability, which can severely limit the quality of life. Many with selective mutism wish to overcome their inability to talk freely, but are otherwise able to participate in routine social activities with relative ease.
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