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Mutism - Mutism Symptom, Cause, Treatment
Mutism s a mental disorder which is decribed as inability or unwillingness to speak. A person who is mute cannot or does not care to talk. Someone who was mute was said to be dumb, not in the sense of being stupid, but in the sense of being devoid of the power of speech. 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.
Symptoms of Mutism
The term "mutism" is specifically applied to people who, due to profound congenital (or early) deafness , are unable to use articulate language and so are affected by deaf-mutism. The word "mutism' comes from the Latin "mutus" meaning unable to speak. Posterior fossa surgery for tumor- Overwhelmingly mutism of cerebellar origin has been reported with surgical intervention in the posterior fossa for tumor. However, there are other etiologies reported in the literature including posterior fossa trauma., cerebellitis (inflammation of the cerebellum), cerebellar hemorrhage, embolic events, and AVM's.
- Children - Most cases involve children. Although there have been reports of mutism in patients in there eighth decade of life.
- Midline tumor location
- Cerebellar vermal incision
- Large or very large tumor size - A size greater than 5cm with medulloblastomas appears to increase the risk.
- Medulloblastoma - This tumor type appears to be increasingly associated with mutism although it has also been reported to occur with ependymomas, choroid plexus tumors, astrocytomas and rhabdoid tumors.
Causes of Mutism
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. Children with cerebellar mutism are usually seen by a speech-language pathologist whose job may include-
- Assisting in devising a form of nonverbal communication
- Explaining the usual course of cerebellar mutism and what to expect in the recovery. For example, asking a child to speak when they do not have the motor ability just leads to frustration for both the parents and children.
- Practicing tongue and lip movements before speech returns
- Practicing and suggesting volitional blowing tasks (Harmonicas, recorders, party favors, blowing bubbles are some of the most common. Straw games such as blowing the paper off a straw, blowing bubbles into liquid, and blowing cottonballs off a table are favorites among many kids)
- Assessing speech and language skills
Treatment of Mutism
It has been suggested that speech pathologists may also be able to help these children. There are two recommended treatments for mutism: behavior modification therapy and antidepressant medication. Posterior fossa surgery for tumor- Overwhelmingly mutism of cerebellar origin has been reported with surgical intervention in the posterior fossa for tumor. However, there are other etiologies reported in the literature including posterior fossa trauma., cerebellitis (inflammation of the cerebellum), cerebellar hemorrhage, embolic events, and AVM's. Treatment is most effective when individualized to each patient. The essential element of selective mutism is that the child has the ability to both comprehend and speak, but fails to speak in certain settings or environments. This syndrome differs from mutism. Children with mutism never speak.
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