Muteness

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Muteness
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Jan Jansz. de Stomme, a deaf-mute 17th century Dutch Golden Age portrait painter.
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In human development, muteness or mutism [1] is defined as an absence of speech, with or without an ability to hear the speech of others. [2] Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. [3] A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

Contents

Treatment or management also varies by cause and this can often determined after a speech assessment. [4] Treatment can sometimes restore speech. If not, a range of assistive and augmentative communication devices are available.

Biological causes

Biological causes of mutism may stem from several different sources. One cause of muteness may be problems with the physiology involved in speech, for example, the mouth or tongue. [5] Mutism may be due to apraxia, that is, problems with coordination of muscles involved in speech. [6] Another cause may be a medical condition impacting the physical structures involved in speech, for example, loss of voice due to the injury, paralysis, or illness of the larynx. [7] Anarthria is a severe form of dysarthria, in which the coordination of movements of the mouth and tongue or the conscious coordination of the lungs are damaged. [8]

Neurological damage due to stroke may cause loss or impairment of speech, termed aphasia. Neurological damage or problems with development of the area of the brain involved in speech production, Broca's area, may cause muteness. [9] Trauma or injury to Broca's area, located in the left inferior frontal cortex of the brain, can cause muteness. [10] Muteness may follow brain surgery. For example, there is a spectrum of possible neurobehavioural deficits in the posterior fossa syndrome in children following cerebellar tumor surgery. [11]

Psychological causes

When children do not speak, psychological problems or emotional stress, such as anxiety, may be involved. Children may not speak due to selective mutism. Selective mutism is a condition in which the child speaks only in certain situations or with certain people, such as close family members. [12] Assessment is needed to rule out possible illness or other conditions and to determine treatment. [13] Prevalence is low, but not as rare as once thought. [14] Selective mutism should not be confused with a child who does not speak and cannot speak due to physical disabilities. It is common for symptoms to occur before the age of five. Not all children express the same symptoms.[ citation needed ]

Selective mutism may occur in conjunction with autism spectrum disorder or other diagnoses. [15] Differential diagnosis between selective mutism and language delay associated with autism or other disorders is needed to determine appropriate treatment.

Adults who previously had speech and subsequently ceased talking may not speak for psychological or emotional reasons, though this is rare as a cause for adults. [16] Absence or paucity of speech in adults may also be associated with specific psychiatric disorders. [17]

Developmental and neurological causes

Absence of speech in children may involve communication disorders or language delays. Communication disorders or developmental language delays may occur for several different reasons. [18] [19]

Language delays may be associated with other developmental delays. [20] For example, children with Down syndrome often have impaired language and speech. [21] [22]

Children with autism, categorized as a neurodevelopmental disorder in the DSM-5, often demonstrate language delays. [23] [24]

Treatment

Evaluation of children with language delays is necessary to determine whether the language delay was caused by another condition. [25] Examples of such conditions are autism spectrum disorder, hearing loss and apraxia. The manner of treatment depends on the diagnosed condition. Language delays may impact expressive language, receptive language, or both. Communication disorders may impact articulation, fluency (stuttering) and other specified and unspecified communication disorders. For example, speech and language services may focus on the production of speech sounds for children with phonological challenges. [26] [27] [28]

Intervention services and treatment programs have been specifically developed for autistic children with language delays. For example, pivotal response treatment is a well-established and researched intervention that includes family participation. [29] Mark Sundberg's verbal behavior framework is another well-established assessment and treatment modality that is incorporated into many applied behavior analysis (ABA) early intervention treatment programs for young children with autism and communication challenges. [30] [ unreliable source? ]


Treatment for absence of speech due to apraxia, involves assessment, and, based on the assessment, occupational therapy, physical therapy, and/or speech therapy. [31] [32] [33] Treatment for selective mutism involves assessment, counseling, and positive supports. [34] Treatment for absence of speech in adults who previously had speech involves assessment to determine cause, including medical and surgery related causes, followed by appropriate treatment or management. Treatment may involve counseling, or rehabilitation services, depending upon cause of loss of speech. [35] [36]

Management

Management involves the use of appropriate assistive devices, called alternative and augmentative communications. Suitability and appropriateness of modality will depend on users' physical abilities and cognitive functioning. [37]

Augmentative and alternative communication technology ranges from elaborated software for tablets to enable complex communication with an auditory component to less technologically involved strategies. For example, a common method involves the use of pictures that can be attached to velcro strips to create an accessible communication modality that does not require the cognitive or fine motor skills needed to manipulate a tablet. [38]

Speech-generating devices can help people with speech deficiencies associated with medical conditions that affect speech, communication disorders that impair speech, or surgeries that have impacted speech. Speech-generating devices continue to improve in ease of use. [39]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized subtype of autism

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, was a diagnosis used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.

Speech disorders, impairments, or impediments, are a type of communication disorder in which normal speech is disrupted. This can mean fluency disorders like stuttering, cluttering or lisps. Someone who is unable to speak due to a speech disorder is considered mute. Speech skills are vital to social relationships and learning, and delays or disorders that relate to developing these skills can impact individuals function. For many children and adolescents, this can present as issues with academics. Speech disorders affect roughly 11.5% of the US population, and 5% of the primary school population. Speech is a complex process that requires precise timing, nerve and muscle control, and as a result is susceptible to impairments. A person who has a stroke, an accident or birth defect may have speech and language problems.

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serve as triggers. This is caused by the freeze response. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. The term is often applied to autistic people who are fluently verbal and of at least average intelligence. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.

Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language.

Pressure of speech is a speech fast and frenetic, including some irregularities in loudness and rhythm or some degrees of circumstantiality; it is hard to interpret and expresses a feeling/affect of emergency. It is mainly a neuropsychological symptom of specific mental disorders, such as bipolar disorders, thought disorders, and stress-related disorders among others.

The floortime or Developmental, Individual-differences, Relationship-based (DIR) model is a developmental model for assessing and understanding any child's strengths and weaknesses. This model was developed by Stanley Greenspan and first outlined in 1979 in his book Intelligence and Adaptation.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Speech and language impairment are basic categories that might be drawn in issues of communication involve hearing, speech, language, and fluency.

Global developmental delay is an umbrella term used when children are significantly delayed in two or more areas of development. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, cognitive skills, and social and emotional development. There is usually a specific condition which causes this delay, such as Cerebral Palsy, Fragile X syndrome or other chromosomal abnormalities. However, it is sometimes difficult to identify this underlying condition.

Autism, or autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as deficits in social interaction and social communication. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the underlying spectrum. For example, some are nonverbal, while others have proficient spoken language.

Developmental regression is when a child who has reached a certain developmental stage begins to lose previously acquired milestones. It differs from global developmental delay in that a child experiencing developmental delay is either not reaching developmental milestones or not progressing to new developmental milestones, while a child experiencing developmental regression will lose milestones and skills after acquiring them. Developmental regression is associated with diagnoses of autism spectrum disorder, childhood disintegrative disorder, Rett syndrome, Landau-Kleffner syndrome, and neuro-degenerative diseases. The loss of motor, language, and social skills can be treated with occupational therapy, physical therapy, and speech therapy.

A late talker is a toddler experiencing late language emergence (LLE), which can also be an early or secondary sign of an autism spectrum disorder, or other developmental disorders, such as fetal alcohol spectrum disorder, attention deficit hyperactivity disorder, intellectual disability, learning disability, social communication disorder, or specific language impairment. Lack of language development, comprehension skills, and challenges with literacy skills are potential risks as late talkers age. Outlook for late talkers with or without intervention is generally favorable. Toddlers have a high probability of catching up to typical toddlers if early language interventions are put in place. Language interventions include general language stimulation, focused language stimulation and milieu teaching.

Developmental Language Disorder (DLD) is identified when a child has problems with language development that continue into school age and beyond. The language problems have a significant impact on everyday social interactions or educational progress, and occur in the absence of autism spectrum disorder, intellectual disability or a known biomedical condition. The most obvious problems are difficulties in using words and sentences to express meanings, but for many children, understanding of language is also a challenge. This may not be evident unless the child is given a formal assessment.

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals who are defined by the acronym "SPCD" struggle to effectively indulge in social interactions, interpret social cues, and may struggle to use words appropriately in social contexts.

The Early Start Denver Model (ESDM) is a form of intervention directed at young children that display early signs of being on the autism spectrum proposed by American psychiatrists Sally J. Rogers and Geraldine Dawson. It is intended to help children improve development traits as early as possible so as to narrow or close the gaps in capabilities between the individual and their peers.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

References

  1. ↑ (from Latin mutus 'silent')
  2. ↑ Grippo, J.; Vergel, M. F.; Comar, H.; Grippo, T. (2001). "[Mutism in children]". Revista de Neurología. 32 (3): 244–246. doi:10.33588/rn.3203.2000376. ISSN   0210-0010. PMID   11310279.
  3. ↑ Grippo, J.; Vergel, M. F.; Comar, H.; Grippo, T. (2001). "[Mutism in children]". Revista de Neurología. 32 (3): 244–246. doi:10.33588/rn.3203.2000376. ISSN   0210-0010. PMID   11310279.
  4. ↑ CDC (2019-01-30). "Language and Speech Disorders in Children | CDC". Centers for Disease Control and Prevention. Retrieved 2020-04-10.
  5. ↑ "2 The production of speech sounds". www.personal.rdg.ac.uk. Retrieved 2020-04-11.
  6. ↑ "Childhood apraxia of speech - Symptoms and causes". Mayo Clinic. Retrieved 2020-04-13.
  7. ↑ "Vocal Cord (Fold) Paralysis". ENT Health. Retrieved 2020-04-19.
  8. ↑ "Ajánlások mozgáskorlátozott gyermekek, tanulók kompetencia alapú fejlesztéséhez". Dombainé Esztergomi Anna (in Hungarian). Budapest: suliNova Közoktatás-fejlesztési és Pedagógus-továbbképzési Kht. 2006. Archived from the original on 19 February 2014. Retrieved 1 May 2017.
  9. ↑ "Broca area | Definition, Function, & Facts". Encyclopedia Britannica. Retrieved 2020-04-11.
  10. ↑ "Aphasia", The Free Dictionary, retrieved 2020-04-11
  11. ↑ Catsman-Berrevoets, Coriene E.; Aarsen, Feke K. (2010). "The spectrum of neurobehavioural deficits in the Posterior Fossa Syndrome in children after cerebellar tumour surgery". Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 46 (7): 933–946. doi:10.1016/j.cortex.2009.10.007. ISSN   1973-8102. PMID   20116053. S2CID   206983595.
  12. ↑ "Selective Mutism: Signs and Symptoms". American Speech-Language-Hearing Association. Retrieved 2020-04-13.
  13. ↑ Manassis, Katharina (2009). "Silent suffering: understanding and treating children with selective mutism". Expert Review of Neurotherapeutics. 9 (2): 235–243. doi:10.1586/14737175.9.2.235. ISSN   1744-8360. PMID   19210197. S2CID   25263166.
  14. ↑ Bergman, R. Lindsey; Piacentini, John; McCracken, James T. (August 2002). "Prevalence and description of selective mutism in a school-based sample". Journal of the American Academy of Child and Adolescent Psychiatry. 41 (8): 938–946. doi:10.1097/00004583-200208000-00012. ISSN   0890-8567. PMID   12162629. S2CID   20947226.
  15. ↑ Steffenburg, Hanna; Steffenburg, Suzanne; Gillberg, Christopher; Billstedt, Eva (2018-05-07). "Children with autism spectrum disorders and selective mutism". Neuropsychiatric Disease and Treatment. 14: 1163–1169. doi: 10.2147/NDT.S154966 . ISSN   1176-6328. PMC   5944454 . PMID   29765220.
  16. ↑ Koźmin-Burzyńska, Agnieszka; Bratek, Agnieszka; Zawada, Karolina; Krysta, Krzysztof; Krupka-Matuszczyk, Irena (2015). "Psychogenic speech disorder--a case report". Psychiatria Danubina. 27 (Suppl 1): S411–414. ISSN   0353-5053. PMID   26417806.
  17. ↑ Cohen, Alex S.; McGovern, Jessica E.; Dinzeo, Thomas J.; Covington, Michael A. (December 2014). "Speech Deficits in Serious mental Illness: A Cognitive Resource Issue?". Schizophrenia Research. 160 (1–3): 173–179. doi:10.1016/j.schres.2014.10.032. ISSN   0920-9964. PMC   4310829 . PMID   25464920.
  18. ↑ CDC (2019-01-30). "Language and Speech Disorders in Children | CDC". Centers for Disease Control and Prevention. Retrieved 2020-04-19.
  19. ↑ "Speech and Communication Disorders". medlineplus.gov. Retrieved 2020-04-20.
  20. ↑ Marrus, Natasha; Hall, Lacey (2017). "Intellectual Disability and Language Disorder". Child and Adolescent Psychiatric Clinics of North America. 26 (3): 539–554. doi:10.1016/j.chc.2017.03.001. ISSN   1056-4993. PMC   5801738 . PMID   28577608.
  21. ↑ Martin, Gary E.; Klusek, Jessica; Estigarribia, Bruno; Roberts, Joanne E. (2009). "Language Characteristics of Individuals with Down Syndrome". Topics in Language Disorders. 29 (2): 112–132. doi:10.1097/tld.0b013e3181a71fe1. ISSN   0271-8294. PMC   2860304 . PMID   20428477.
  22. ↑ "Speech and Language Resources | National Down Syndrome Congress" . Retrieved 2020-04-19.
  23. ↑ Volkers, Nancy (2018). "Untangling the Language Challenges of Autism". The ASHA Leader. 22 (4): 54–59. doi:10.1044/leader.FTR2.22042017.54.
  24. ↑ "Autism Spectrum Disorder: Communication Problems in Children". NIDCD. 2015-08-18. Retrieved 2020-04-19.
  25. ↑ McLaughlin, M. R. (May 2011). "Speech and Language delay in children". American Family Physician. 83 (10). American Association of Family Physicians: 1183–1188. PMID   21568252.
  26. ↑ "Oral Motor Institute". oralmotorinstitute.org. Retrieved 2020-04-13.
  27. ↑ "Why Act Early if You're Concerned about Development?". CDC.gov. Centers for Disease Control and Prevention. 2019-12-09. Retrieved 2020-04-17.
  28. ↑ Roberts, Megan; Kaiser, Ann (2015-03-02). "Early Intervention for Toddlers With Language Delays: A Randomized Controlled Trial". Pediatrics . 135 (4): 686–693. doi:10.1542/peds.2014-2134. PMC   4379460 . PMID   25733749.
  29. ↑ Lei, Jiedi; Ventola, Pamela (2017-06-20). "Pivotal response treatment for autism spectrum disorder: current perspectives". Neuropsychiatric Disease and Treatment. 13: 1613–1626. doi: 10.2147/NDT.S120710 . ISSN   1176-6328. PMC   5488784 . PMID   28790824.
  30. ↑ "Verbal Behavior Therapy". Autism Speaks. Retrieved 2020-04-20.
  31. ↑ Caspari, Sue (2018). "Treatment Approaches for Children with Childhood Apraxia of Speech (CAS)" (PDF). apraxia-kids.org.
  32. ↑ "Childhood apraxia of speech - Symptoms and causes". mayoclinic.org. Mayo Clinic. Retrieved 2020-04-13.
  33. ↑ "Speech-Language Therapy (for Parents)". kidshealth.org. Nemours KidsHealth. Retrieved 2020-04-20.
  34. ↑ "Selective mutism". nhs.uk. 2017-10-19. Retrieved 2020-04-20.
  35. ↑ Lincoln, Tania M.; Riehle, Marcel; Pillny, Matthias; Helbig-Lang, Sylvia; Fladung, Anne-Katharina; Hartmann-Riemer, Matthias; Kaiser, Stefan (2017-12-05). "Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms". Frontiers in Psychology. 8: 2108. doi: 10.3389/fpsyg.2017.02108 . ISSN   1664-1078. PMC   5723417 . PMID   29259567.
  36. ↑ "Learning to Speak Again After Laryngeal Surgery". Health Encyclopedia. University of Rochester Medical Center . Retrieved 2020-04-20– via urmc.rochester.edu.
  37. ↑ "Families need guidance before buying a communication app for autism". Spectrum | Autism Research News. 2019-04-23. Retrieved 2020-04-14.
  38. ↑ "Communication aids for disabled children - Living made easy". www.livingmadeeasy.org.uk. Retrieved 2020-04-14.
  39. ↑ "ALS Augmentative Communication Program | Speech-Generating Devices | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2020-04-20.
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