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Psychiatria Polska 1996This paper presents contemporary opinions about selective mutism in children, including epidemiology, etiology, clinical features and therapy. This is the first... (Review)
Review
This paper presents contemporary opinions about selective mutism in children, including epidemiology, etiology, clinical features and therapy. This is the first extensive review on this topic in Polish literature. The essential feature of selective mutism is persistent failure to speak in social situations, where speaking is expected (e.g., in school), despite speaking in other situations (e.g., at home). The authors present the diagnostic criteria according do DSM-IV and suggested by other authors. Clinical characteristics of this disorder were also presented, including personality traits and behaviour of mutistic children (different at home and in unfamiliar environment) and comorbidity of selective mutism. Etiology of this disorder seems to be multifactorial. The important etiological factors are: minimal brain dysfunction, somatic or psychological trauma, particularly during the speech development and a family structure, especially the mother-child relation. The authors emphasize that mutism in children is a heterogeneous symptom and present several models of mutism. The paper describes also different methods of treatment (e.g., behavioral, psychodynamic, family therapy and some case reports on pharmacotherapy); and long-term prognosis.
Topics: Age of Onset; Behavior Therapy; Child, Preschool; Female; Humans; Male; Mutism; Psychiatric Status Rating Scales; Speech Disorders
PubMed: 8650285
DOI: No ID Found -
Clinical Psychology Review Feb 2009Selective mutism (SM) is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected. A comprehensive and... (Review)
Review
Selective mutism (SM) is a rare childhood disorder characterized by a lack of speech in one or more settings in which speaking is socially expected. A comprehensive and uniform theory about the etiology, assessment, and treatment of SM does not exist. Historically, varying definitions and criteria have been applied to children with SM, therefore making comparisons between studies somewhat difficult. Accumulating findings on the phenomenology of SM point to a complex and multidetermined etiology. Developmental psychopathology represents a useful heuristic for conceptualization of SM and serves as an integrative framework for organizing the sometimes disparate findings that permeate the SM literature. The purpose of this review is to summarize the literature on SM, including phenomenology, assessment, and treatment, with the main goals of clarifying its clinical presentation, offering a theoretical understanding of SM from a developmental psychopathology perspective, and highlighting both research and practice gaps that may exist. Recommendations for future research are made with the goal of expanding the current knowledge base on the etiology of SM.
Topics: Child; Cognition; Cognitive Behavioral Therapy; Developmental Disabilities; Drug Therapy; Humans; Multilingualism; Mutism
PubMed: 18986742
DOI: 10.1016/j.cpr.2008.09.009 -
Nordic Journal of Psychiatry May 2018Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to... (Review)
Review
BACKGROUND
Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature.
AIM
To test whether there is evidence on treatment based on CBT, medication or a combination of these.
METHODS
Systematic and critical review of the literature on CBT and/or pharmacological treatments of SM. Literature was sought on PubMed, Embase and Psycinfo in March 2017.
RESULTS
Of the included studies, six examined CBT, seven pharmacologic treatment and two a combination of these. Using CBT 53/60 children improved symptomatically whilst respectively 55/67 and 6/7 improved using pharmacologic- and combination-treatment.
CONCLUSION
Pharmacologic treatment and especially CBT showed promising results supported by some degree of evidence, which combination treatment lacks. Yet small numbers, few RCTs, heterogeneous study designs, lack of consistent measures, short treatment and follow-up periods, generally limits the evidence. This needs focus in future research.
Topics: Antidepressive Agents; Anxiety Disorders; Child; Cognitive Behavioral Therapy; Combined Modality Therapy; Humans; Mutism; Outcome Assessment, Health Care
PubMed: 29447060
DOI: 10.1080/08039488.2018.1439530 -
European Child & Adolescent Psychiatry Jun 2016Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM)... (Review)
Review
Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.
Topics: Child; Humans; Monoamine Oxidase Inhibitors; Mutism; Selective Serotonin Reuptake Inhibitors
PubMed: 26560144
DOI: 10.1007/s00787-015-0794-1 -
Child's Nervous System : ChNS :... Jun 2020The supplementary motor area (SMA) syndrome affects adults after tumour resection in SMA neighbouring motor cortex. Cerebellar mutism syndrome (CMS) affects children... (Review)
Review
PURPOSE
The supplementary motor area (SMA) syndrome affects adults after tumour resection in SMA neighbouring motor cortex. Cerebellar mutism syndrome (CMS) affects children after tumour resection in the posterior fossa. Both syndromes include disturbances in speech and motor function. The causes of the syndromes are unknown; however, surgical damage to the dentato-thalamo-cortical pathway (DTCP) has been associated with CMS. Thus, an anatomical link between the areas associated with the syndromes is possible. We discuss the syndromes and their possible relationship through the DTCP.
METHODS
We identified 61 articles (cohort studies, case reports and reviews) in MEDLINE and Embase searching for CMS, SMA syndrome or DTCP or synonyms and reviewed for evidence linking CMS and SMA.
RESULTS
We found that SMA syndrome and CMS are similar regarding (1) surgical causation; (2) symptoms including speech impairment, disturbance in motor function and facial dysfunction; (3) delayed onset; (4) the courses of the syndromes are transient; and (5) long-term sequelae are seen in both. Relevant differences include age predominance of adults in SMA syndrome versus children in CMS.
CONCLUSIONS
The similarities of the two syndromes could be traced back to their mutual connection through the DTCP and their membership to a cerebro-cerebellar circuit. The connectivity network could explain the emotional changes and speech reduction in CMS. The difference in time of post-surgical onset may be related to the anatomical distance between the surgical damage to the cerebellum and the SMA, respectively, and the effector neural loop underpinning symptoms.
Topics: Adult; Cerebellar Diseases; Cerebellar Neoplasms; Child; Humans; Motor Cortex; Mutism; Postoperative Complications; Syndrome
PubMed: 31127340
DOI: 10.1007/s00381-019-04202-3 -
Acta Neurochirurgica. Supplement 2023Cerebellar mutism syndrome (CMS) is a morbid complication of posterior fossa surgery in children. This review focuses on the current understanding of pathophysiology in... (Review)
Review
AIM
Cerebellar mutism syndrome (CMS) is a morbid complication of posterior fossa surgery in children. This review focuses on the current understanding of pathophysiology in the white matter tracts (WMT) using diffusion tensor imaging (DTI).
MATERIAL AND METHODS
A series of 38 patients operated on for posterior fossa tumors in our institute between December 2019 till May 2021 were evaluated neurologically along with characteristics of mutism and DTI imaging (fractional anisotropy) in preoperative and postoperative periods. We also noted tumor size, location, volume, brainstem compression, cerebellar peduncle involvement, extent of resection, surgical approach, and histopathology.
RESULT
Cerebellar mutism developed in five patients. The mean age, male sex, tumor size >5 cm, superior cerebellar peduncle involvement, and vermian incision were found to have positive correlation with the development of CMS. They showed reduction in fractional anisotropy in superior cerebellar peduncle (SCP) following resection; however, others' WMT did not show any significant change in fractional anisotropy values pre- or post-surgery.
CONCLUSION
Our study suggests that functional disruption of WMT, i.e., superior cerebellar peduncle and dentato-thalamo-cortical tract (DTC) is the underlying pathophysiological component of CMS. Taking this into consideration, we need to deploy techniques to limit the damage to the superior cerebellar peduncle and DTC using neurophysiological monitoring.
Topics: Child; Humans; Male; Diffusion Tensor Imaging; Mutism; Brain Neoplasms; Infratentorial Neoplasms; Prognosis; Syndrome
PubMed: 38153449
DOI: 10.1007/978-3-031-36084-8_10 -
Developmental Cognitive Neuroscience Apr 2015Selective mutism (SM) is a relatively rare psychiatric disorder of childhood characterized by consistent inability to speak in specific social situations despite the... (Review)
Review
Selective mutism (SM) is a relatively rare psychiatric disorder of childhood characterized by consistent inability to speak in specific social situations despite the ability to speak normally in others. SM typically involves severe impairments in social and academic functioning. Common complications include school failure, social difficulties in the peer group, and aggravated intra-familial relationships. Although SM has been described in the medical and psychological literatures for many years, the potential underlying neural basis of the disorder has only recently been explored. Here we explore the potential role of specific auditory neural mechanisms in the psychopathology of SM and discuss possible implications for treatment.
Topics: Auditory Pathways; Cerebral Cortex; Efferent Pathways; Family; Hearing; Humans; Interpersonal Relations; Learning; Mutism; Peer Group; Social Behavior
PubMed: 25625220
DOI: 10.1016/j.dcn.2015.01.002 -
Neuro-oncology Sep 2021
Topics: Cerebellar Neoplasms; Humans; Mutism; Syndrome
PubMed: 34139019
DOI: 10.1093/neuonc/noab147 -
CNS Drugs 2002Selective mutism is a multidimensional childhood disorder in which, according to the most recent studies, biologically mediated temperament and anxiety components seem... (Review)
Review
Selective mutism is a multidimensional childhood disorder in which, according to the most recent studies, biologically mediated temperament and anxiety components seem to play a major role. Several psychotherapy methods have been reported in case studies to be useful, but the disorder is commonly seen to be resistant to change, particularly in cases of long duration. Currently, behaviour modification and other cognitive methods, together with cooperation with the family and the school personnel, are recommended in the treatment of selective mutism. Selective serotonin reuptake inhibitors and selective monoamine oxidase inhibitors have also been reported to be helpful when treating children with selective mutism. At the moment, pharmacotherapy cannot be recommended as the treatment of first choice but if other methods of treatment are not helpful, medication can be included in the treatment scheme. Comprehensive evaluation and treatment of possible primary and comorbid problems that require treatment are also essential.
Topics: Anti-Anxiety Agents; Antidepressive Agents; Child; Humans; Mutism; Psychotherapy
PubMed: 11888338
DOI: 10.2165/00023210-200216030-00004 -
Child's Nervous System : ChNS :... Sep 2021Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that... (Review)
Review
BACKGROUND
Paediatric postoperative cerebellar mutism syndrome (ppCMS) is a common complication following the resection of a cerebellar tumour in children. It is hypothesized that loss of integrity of the cerebellar output tracts results in a cerebello-cerebral "diaschisis" and reduced function of supratentorial areas of the brain.
METHODS
We performed a systematic review of the literature according to the PRISMA guidelines, in order to evaluate the evidence for hypoperfusion or hypofunction in the cerebral hemispheres in patients with ppCMS. Articles were selected based on the predefined eligibility criteria and quality assessment.
RESULTS
Five studies were included, consisting of three prospective cohort studies, one retrospective cohort study and one retrospective case control study. Arterial spin labelling (ASL) perfusion MRI, dynamic susceptibility contrast (DSC) perfusion MRI and single photon emission computed tomography (SPECT) were used to measure the cerebral and cerebellar tissue perfusion or metabolic activity. Reduced cerebral perfusion was predominantly demonstrated in the frontal lobe.
CONCLUSIONS
This systematic review shows that, after posterior fossa tumour resection, cerebral perfusion is reduced in ppCMS patients compared to patients without ppCMS. Well-powered prospective studies, including preoperative imaging, are needed to ascertain the cause and role of hypoperfusion in the pathophysiology of the syndrome.
Topics: Case-Control Studies; Cerebellar Diseases; Cerebellum; Cerebrovascular Circulation; Child; Humans; Mutism; Perfusion; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 34155533
DOI: 10.1007/s00381-021-05225-5