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Current Opinion in Pediatrics Feb 2016Selective mutism is a disorder in which an individual fails to speak in certain social situations though speaks normally in other settings. Most commonly, this disorder... (Review)
Review
PURPOSE OF REVIEW
Selective mutism is a disorder in which an individual fails to speak in certain social situations though speaks normally in other settings. Most commonly, this disorder initially manifests when children fail to speak in school. Selective mutism results in significant social and academic impairment in those affected by it. This review will summarize the current understanding of selective mutism with regard to diagnosis, epidemiology, cause, prognosis, and treatment.
RECENT FINDINGS
Studies over the past 20 years have consistently demonstrated a strong relationship between selective mutism and anxiety, most notably social phobia. These findings have led to the recent reclassification of selective mutism as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. In addition to anxiety, several other factors have been implicated in the development of selective mutism, including communication delays and immigration/bilingualism, adding to the complexity of the disorder. In the past few years, several randomized studies have supported the efficacy of psychosocial interventions based on a graduated exposure to situations requiring verbal communication. Less data are available regarding the use of pharmacologic treatment, though there are some studies that suggest a potential benefit.
SUMMARY
Selective mutism is a disorder that typically emerges in early childhood and is currently conceptualized as an anxiety disorder. The development of selective mutism appears to result from the interplay of a variety of genetic, temperamental, environmental, and developmental factors. Although little has been published about selective mutism in the general pediatric literature, pediatric clinicians are in a position to play an important role in the early diagnosis and treatment of this debilitating condition.
Topics: Anxiety Disorders; Child; Humans; Mutism; Prognosis; Risk Factors
PubMed: 26709680
DOI: 10.1097/MOP.0000000000000300 -
Psychiatria Polska Apr 2020The inability to speak in certain situations, as one may briefly characterize selective mutism (SM), according to the most recent classifications (DSM-5, ICD-11) belongs... (Review)
Review
The inability to speak in certain situations, as one may briefly characterize selective mutism (SM), according to the most recent classifications (DSM-5, ICD-11) belongs to the anxiety disorder spectrum. The onset of mutism in early childhood may impair further development and adversely affect educational achievements. It is essential that psychiatrists, as well as other physicians, speech therapists, nurses and teachers are familiar with this disorder, since the early start of treatment is associated with better prognosis. This literature review aims to present the contemporary view of this relatively rare psychopathological syndrome. In light of most recent studies on the etiology of SM, the sole symptom of mutism appears to represent an underlying heterogenic group of disorders. Based on the developmental psychopathology, the interrelations between overlapping abnormalities favor SM manifestation in some crucial moment in an individual's life. The etiologic complexity strongly suggests multimodal approach in the diagnostic and treatment process, which has been postulated by many authors.
Topics: Behavior Therapy; Child; Child Behavior Disorders; Child Development; Humans; Mutism
PubMed: 32772064
DOI: 10.12740/PP/OnlineFirst/108503 -
Clinical Child and Family Psychology... Jun 2021In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety,... (Review)
Review
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
Topics: Anxiety; Anxiety Disorders; Autism Spectrum Disorder; Child; Child Behavior Disorders; Humans; Mutism; Phobia, Social
PubMed: 33462750
DOI: 10.1007/s10567-020-00342-0 -
Child's Nervous System : ChNS :... Oct 2015Cerebellar mutism (CM) is defined as a peculiar form of mutism that may complicate the surgical excision of posterior cranial fossa tumor. The incidence is variable in... (Review)
Review
INTRODUCTION
Cerebellar mutism (CM) is defined as a peculiar form of mutism that may complicate the surgical excision of posterior cranial fossa tumor. The incidence is variable in the literature, occurring in up to one third of cases in some series. Commonly occurring peculiar features of CM are delayed onset following surgery, limited duration, and spontaneous recovery usually associated with dysarthria.
METHODS
A review has been performed concerning anatomical substrates and circuits actually considered to be involved in the development of cerebellar mutism, as well as risk factors for its development that have been documented in the literature. Attention has also been given to the long-term prognosis and the possibilities of rehabilitation that can be considered in these children, which has been compared with the authors' institutional experience.
RESULTS AND CONCLUSIONS
Tumor infiltration of the brainstem seems to represent the most relevant feature related to the development of CM, along with the histological diagnosis of medulloblastoma. On the other hand, hydrocephalus does not represent an independent risk factor. The higher rate of CM in children seems to be related to the higher incidence in children of tumors with malignant histology and brain stem involvement. Surgical technique does not seem to have a definite role; in particular, the use of a telovelar approach as compared to vermian split to reach the fourth ventricle extension of the tumor has not been demonstrated to prevent the development of cerebellar mutism. Concerning long-term prognosis, around one third of the children who develop cerebellar mutism after surgery have a persistent dysarthria, the remaining ones showing a residual phonological impairment. Long-term dysarthric features tend to be more severe and less prone to recovery in children presenting at diagnosis with associated combined procedural memory and defective neurocognitive functions.
Topics: Cerebellum; Humans; Infratentorial Neoplasms; Mutism; Neurosurgical Procedures; Postoperative Complications
PubMed: 26351234
DOI: 10.1007/s00381-015-2803-6 -
Brain and Language Dec 2013Cerebellar mutism occurs in about 25% of children following posterior fossa tumor surgery. It is usually accompanied by other neurological and behavioral disturbances.... (Review)
Review
Cerebellar mutism occurs in about 25% of children following posterior fossa tumor surgery. It is usually accompanied by other neurological and behavioral disturbances. Mutism is transient in nature lasting several days to months and is frequently followed by dysarthria. In addition, impairment of language and other neuropsychological functions can be found after long term follow up in the majority of patients. The pathophysiological background of mutism may be higher speech dysfunction mediated by crossed cerebello-cerebral diaschisis which is frequently found during the mute period. Foremost injury to the bilateral dentatothalamocortical tract appears to be critical for the development of cerebello-cerebral diaschisis and subsequent mutism. Direct cerebellar injury is the likely reason for persisting deficits after the mute period. Minimization of injury to the dentatothalamocortical tract during surgery may be promising in the prevention of mutism. While there is no established treatment of mutism, early speech and rehabilitation therapy is recommended.
Topics: Cerebellum; Child; Female; Humans; Infratentorial Neoplasms; Male; Mutism; Postoperative Complications
PubMed: 23398780
DOI: 10.1016/j.bandl.2013.01.001 -
Journal of Neurosurgery. Pediatrics Dec 2013Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on... (Review)
Review
Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation.
Topics: Cerebellar Diseases; Cerebellum; History, 20th Century; Humans; Infratentorial Neoplasms; Medulloblastoma; Mutism; Neurosurgical Procedures; Risk Factors; Speech; Wounds, Gunshot
PubMed: 24073751
DOI: 10.3171/2013.8.PEDS13168 -
L'Encephale Oct 2011Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose,... (Review)
Review
BACKGROUND
Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known.
METHOD
A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria.
RESULTS
The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches.
CONCLUSION
Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.
Topics: Aphonia; Conversion Disorder; Cross-Sectional Studies; Diagnosis, Differential; Female; Humans; Hysteria; Life Change Events; Male; Mutism; Recurrence; Sex Factors
PubMed: 22032276
DOI: 10.1016/j.encep.2010.12.006 -
Frontiers of Neurology and Neuroscience 2012Dysarthria is a speech disorder associated with impairments of intelligibility, smoothness, loudness, and clarity of articulations. Dysarthria involves disability of... (Review)
Review
Dysarthria is a speech disorder associated with impairments of intelligibility, smoothness, loudness, and clarity of articulations. Dysarthria involves disability of reproducing various physical, tonal, and sound features of speech sounds in oral speech; unintelligible and slurred articulation with swallowing of sounds is characteristic. Articulatory movements and speech are slow, patients complain to the sensations of a 'thick' tongue and 'porridge' in the mouth. Patients'phrases are constructed correctly, vocabulary is not affected, and the grammatical structure of words is preserved. Reading, writing, internal speech, and understanding of speech are unaffected. Several types of dysarthria have been described on the basis of the lesion locations. Dysarthria can be associated with lacunar syndromes as well. Mutism represents a condition when patient cannot speak and answer the questions, but remains conscious and is able to produce written speech.
Topics: Dysarthria; Humans; Mutism; Stroke
PubMed: 22377870
DOI: 10.1159/000333422 -
Duodecim; Laaketieteellinen... 2013Selective mutism is a disorder closely linked to anxiety disorders in particular social phobia. Heightened sensitivity to emotional stress factors and coping with social... (Review)
Review
Selective mutism is a disorder closely linked to anxiety disorders in particular social phobia. Heightened sensitivity to emotional stress factors and coping with social anxiety may be part of the causes leading to the failure to speak. Follow-up studies confirm the fact that selective mutism is a very persistent disorder with a general tendency of poor outcome in particular if not intensively treated. Current treatment combines different modalities of cognitive-behavioural therapies which are aimed to reduce anxiety symptoms and to improve verbal communication. Enhancing of parent-child interaction is often needed to improve the child's emotion regulation skills. SSRI medication, especially fluoxetine, may improve outcome when combined with therapy.
Topics: Adaptation, Psychological; Cognitive Behavioral Therapy; Humans; Mutism; Parent-Child Relations; Phobic Disorders; Selective Serotonin Reuptake Inhibitors; Stress, Psychological
PubMed: 24471207
DOI: No ID Found -
Current Opinion in Neurology Apr 2017Mutism of cerebellar origin may occur in the context of various causes but is most frequent in children after resection of a large midline cerebellar tumour. In this... (Review)
Review
PURPOSE OF REVIEW
Mutism of cerebellar origin may occur in the context of various causes but is most frequent in children after resection of a large midline cerebellar tumour. In this review, the endeavour to reach a consensus on name and definition of postoperative mutism of cerebellar origin and associated symptoms is highlighted. In addition, progress in understanding of cause and risk factors for the syndrome is discussed as well as the rehabilitation issues.
RECENT FINDINGS
Consensus on the term cerebellar mutism syndrome (CMS) has been reached. The exact pathogenesis of CMS remains unclear. Recently, attention was drawn to the hypothesis that thermal injury might be an important mechanism in the pathogenesis of CMS. Diffusion tensor imaging tractography was found to visualize the damage to relevant pathways that are associated with persistent impairments after recovery of CMS. There is still no established treatment for CMS to date.
SUMMARY
By reaching a consensus on terminology and description of CMS, a firm basis has been created for future research. The pathogenesis of CMS seems multifactorial and important risk factors have been found. However, CMS cannot be effectively prevented yet and no established or specific treatment is available, apart from very general rehabilitation and cognitive interventions.
Topics: Cerebellar Diseases; Cerebellar Neoplasms; Diffusion Tensor Imaging; Humans; Mutism; Risk Factors
PubMed: 28118304
DOI: 10.1097/WCO.0000000000000426