Mutism

Definition

Mutism is a rare childhood condition characterized by a consistent failure to speak in situations where talking is expected. The child has the ability to converse normally, and does so, for example, in the home, but consistently fails to speak in specific situations such as at school or with strangers. It is estimated that one in every 1,000 school-age children are affected.

Description

Experts believe that this problem is associated with anxiety and fear in social situations such as in school or in the company of adults. It is therefore often considered a type of social phobia. This is not a communication disorder because the affected children can converse normally in some situations. It is not a developmental disorder because their ability to talk, when they choose to do so, is appropriate for their age level. This problem has been linked to anxiety, and one of the major ways in which both children and adults attempt to cope with anxiety is by avoiding whatever provokes the anxiety.

Affected children are typically shy, and are especially so in the presence of strangers and unfamiliar surroundings or situations. However, the behaviors of children with this condition go beyond shyness.

Causes and symptoms

Mutism is believed to arise from anxiety experienced in social situations where the child may be called upon to speak. Refusing to speak, or speaking in a whisper, spares the child from the possible humiliation or embarrassment of "saying the wrong thing." When asked a direct question by teachers, for example, the affected child may act as if they are unable to answer. Some children may communicate via gestures, nodding, or very brief utterances. Additional features may include excessive shyness, oppositional behavior, and impaired learning at school.

Diagnosis

The diagnosis of mutism is fairly easy to make because the signs amd symptoms are clear-cut and easily observable. However, other social disorders effecting social speech, such as autism or schizophrenia, must be considered in the diagnosis.

Treatment

There are two recommended treatments for mutism: behavior modification therapy and antidepressant medication. Treatment is most effective when individualized to each patient. It has been suggested that speech pathologists may also be able to help these children.

Prognosis

The prognosis for mutism is good. Sometimes it disappears suddenly on its own. The negative impact on learning and school activities may, however, persist into adult life.

Prevention

Mutism cannot be prevented because the cause is not known. However, family conflict or problems at school contribute to the seriousness of the symptoms.

Resources

BOOKS

Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

KEY TERMS

Behavior modification— A form of therapy that uses rewards to reinforce desired behavior. An example would be to give a child a piece of chocolate for grooming themselves appropriately.

mutism (mewt-izm) n. inability or refusal to speak. Innate speechlessness most commonly occurs in those who have been totally deaf since birth (deaf m.). Mutism may also result from brain damage (see aphasia) or be caused by depression, anxiety, psychosis, or psychological trauma, in which case the patient may speak only in particular situations or to particular people (selective or elective m.).
—mute adj., n.