View source for Medicine:Muteness

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}}'''Muteness''' or '''mutism''' ({{ety|la|mutus|silent}}) is defined as an absence of speech while conserving or maintaining the ability to hear the speech of others.<ref>{{Cite journal|last1=Grippo|first1=J.|last2=Vergel|first2=M. F.|last3=Comar|first3=H.|last4=Grippo|first4=T.|date=2001|title=[Mutism in children]|journal=Revista de Neurología|volume=32|issue=3|pages=244–246|doi=10.33588/rn.3203.2000376|issn=0210-0010|pmid=11310279}}</ref> Mutism is typically understood as an inability to speak on the part of a child or an adult due to an observed lack of speech from the point of view of others who know them. Such observers commonly include a mute person's family members, caregivers, teachers, and health professionals like doctors or speech and language pathologists.  Muteness may not be a permanent condition, depending upon [[Philosophy:Etiology|etiology]] (cause).  In general, someone who is mute may be mute for one of several different reasons: organic, psychological, developmental/neurological [[Medicine:Psychological trauma|trauma]].<ref>{{Cite journal|last1=Grippo|first1=J.|last2=Vergel|first2=M. F.|last3=Comar|first3=H.|last4=Grippo|first4=T.|date=2001|title=[Mutism in children]|journal=Revista de Neurología|volume=32|issue=3|pages=244–246|doi=10.33588/rn.3203.2000376|issn=0210-0010|pmid=11310279}}</ref> For children, a lack of speech may be developmental, neurological, psychological, or due to a [[Medicine:Physical disability|physical disability]] or a [[Medicine:Communication disorder|communication disorder]]. For adults who previously had speech and then became unable to speak, loss of speech may be due to injury, disease, termed [[Medicine:Aphasia|aphasia]], or surgery affecting areas of the brain needed for speech. Loss of speech in adults may occur rarely for psychological reasons.

Treatment or management of muteness depends on what has caused the absence of speech. When there is an absence of speech, a speech assessment is strongly recommended to determine cause and treatment.<ref>{{Cite web|url=https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html|title=Language and Speech Disorders in Children {{!}} CDC|last=CDC|date=2019-01-30|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-10}}</ref> Treatment of absence of speech is possible in a variety of cases. If the absence of speech is determined to be a permanent condition, a range of assistive and augmentative communication devices are available to aid communication.

== Organic causes ==
Organic 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.<ref>{{Cite web|url=http://www.personal.rdg.ac.uk/~llsroach/phon2/artic-basics.htm|title=2 The production of speech sounds|website=www.personal.rdg.ac.uk|access-date=2020-04-11}}</ref>  Mutism may be due to [[Engineering:Apraxia|apraxia]], that is, problems with coordination of muscles involved in speech.<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045|title=Childhood apraxia of speech - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2020-04-13}}</ref>  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 [[Medicine:Larynx|larynx]].<ref>{{Cite web|url=https://www.enthealth.org/conditions/vocal-cord-fold-paralysis/|title=Vocal Cord (Fold) Paralysis|website=ENT Health|language=en-US|access-date=2020-04-19}}</ref>   Anarthria is a severe form of [[Medicine:Dysarthria|dysarthria]]. The coordination of movements of the mouth and tongue or the conscious coordination of the lungs are damaged.<ref name="mozgi">{{cite web|url=http://www.sulinovadatbank.hu/letoltes.php?d_id=467|title=Ajánlások mozgáskorlátozott gyermekek, tanulók kompetencia alapú fejlesztéséhez|date=2006|website=Dombainé Esztergomi Anna|publisher=suliNova Közoktatás-fejlesztési és Pedagógus-továbbképzési Kht.|location=Budapest|language=hu|archive-url=https://web.archive.org/web/20140219224104/http://www.sulinovadatbank.hu/letoltes.php?d_id=467|archive-date=19 February 2014|access-date=1 May 2017}}</ref>

Neurological damage due to [[Medicine:Stroke|stroke]] may cause loss or impairment of speech, termed [[Medicine:Aphasia|aphasia]]. Neurological damage or problems with development of the area of the brain involved in speech production, [[Biology:Broca's area|Broca's area]], may cause muteness.<ref>{{Cite web|url=https://www.britannica.com/science/Broca-area|title=Broca area {{!}} Definition, Function, & Facts|website=Encyclopedia Britannica|language=en|access-date=2020-04-11}}</ref> Trauma or injury to Broca's area, located in the left inferior frontal cortex of the brain, can cause muteness.<ref>{{Citation|title=Aphasia|url=https://medical-dictionary.thefreedictionary.com/Aphasia|work=The Free Dictionary|access-date=2020-04-11}}</ref> Muteness may follow brain surgery. For example, there is a spectrum of possible neurobehavioural deficits in the posterior fossa syndrome in children following [[Biology:Cerebellum|cerebellar]] tumor surgery.<ref>{{Cite journal|last1=Catsman-Berrevoets|first1=Coriene E.|last2=Aarsen|first2=Femke K.|date=2010|title=The spectrum of neurobehavioural deficits in the Posterior Fossa Syndrome in children after cerebellar tumour surgery|journal=Cortex; A Journal Devoted to the Study of the Nervous System and Behavior|volume=46|issue=7|pages=933–946|doi=10.1016/j.cortex.2009.10.007|issn=1973-8102|pmid=20116053|s2cid=206983595}}</ref>

== Psychological causes ==
When children do not speak, psychological problems or emotional stress, such as [[Medicine:Anxiety|anxiety]], may be involved. Children may not speak due to suffering from [[Medicine:Selective mutism|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.<ref>{{Cite web|url=https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942812&section=Signs_and_Symptoms|title=Selective Mutism: Signs and Symptoms|website=American Speech-Language-Hearing Association|language=en|access-date=2020-04-13}}</ref> Assessment is needed to rule out possible illness or other conditions and to determine treatment.<ref>{{Cite journal|last=Manassis|first=Katharina|date=2009|title=Silent suffering: understanding and treating children with selective mutism|journal=Expert Review of Neurotherapeutics|volume=9|issue=2|pages=235–243|doi=10.1586/14737175.9.2.235|issn=1744-8360|pmid=19210197|s2cid=25263166}}</ref> Prevalence is low, but not as rare as once thought.<ref>{{Cite journal|last1=Bergman|first1=R. Lindsey|last2=Piacentini|first2=John|last3=McCracken|first3=James T.|date=August 2002|title=Prevalence and description of selective mutism in a school-based sample|journal=Journal of the American Academy of Child and Adolescent Psychiatry|volume=41|issue=8|pages=938–946|doi=10.1097/00004583-200208000-00012|issn=0890-8567|pmid=12162629}}</ref>  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.

Selective mutism may occur in conjunction with autism spectrum disorder or other diagnoses.<ref>{{Cite journal|last1=Steffenburg|first1=Hanna|last2=Steffenburg|first2=Suzanne|last3=Gillberg|first3=Christopher|last4=Billstedt|first4=Eva|date=2018-05-07|title=Children with autism spectrum disorders and selective mutism|journal=Neuropsychiatric Disease and Treatment|volume=14|pages=1163–1169|doi=10.2147/NDT.S154966|issn=1176-6328|pmc=5944454|pmid=29765220}}</ref> [[Medicine:Differential diagnosis|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.<ref>{{Cite journal|last1=Koźmin-Burzyńska|first1=Agnieszka|last2=Bratek|first2=Agnieszka|last3=Zawada|first3=Karolina|last4=Krysta|first4=Krzysztof|last5=Krupka-Matuszczyk|first5=Irena|date=2015|title=Psychogenic speech disorder--a case report|journal=Psychiatria Danubina|volume=27 Suppl 1|pages=S411–414|issn=0353-5053|pmid=26417806}}</ref> Absence or paucity of speech in adults may also be associated with specific psychiatric disorders.<ref>{{Cite journal|last1=Cohen|first1=Alex S.|last2=McGovern|first2=Jessica E.|last3=Dinzeo|first3=Thomas J.|last4=Covington|first4=Michael A.|date=December 2014|title=Speech Deficits in Serious mental Illness: A Cognitive Resource Issue?|journal=Schizophrenia Research|volume=160|issue=1–3|pages=173–179|doi=10.1016/j.schres.2014.10.032|issn=0920-9964|pmc=4310829|pmid=25464920}}</ref>

== 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.<ref>{{Cite web|url=https://www.cdc.gov/ncbddd/childdevelopment/language-disorders.html|title=Language and Speech Disorders in Children {{!}} CDC|last=CDC|date=2019-01-30|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-19}}</ref><ref>{{Cite web|url=https://medlineplus.gov/speechandcommunicationdisorders.html|title=Speech and Communication Disorders|website=medlineplus.gov|access-date=2020-04-20}}</ref>

Language delays may be associated with other developmental delays.<ref>{{Cite journal|last1=Marrus|first1=Natasha|last2=Hall|first2=Lacey|date=2017|title=Intellectual Disability and Language Disorder|journal=Child and Adolescent Psychiatric Clinics of North America|volume=26|issue=3|pages=539–554|doi=10.1016/j.chc.2017.03.001|issn=1056-4993|pmc=5801738|pmid=28577608}}</ref> For example, children with [[Medicine:Down syndrome|Down syndrome]] often have impaired language and speech.<ref>{{Cite journal|last1=Martin|first1=Gary E.|last2=Klusek|first2=Jessica|last3=Estigarribia|first3=Bruno|last4=Roberts|first4=Joanne E.|date=2009|title=Language Characteristics of Individuals with Down Syndrome|journal=Topics in Language Disorders|volume=29|issue=2|pages=112–132|doi=10.1097/tld.0b013e3181a71fe1|issn=0271-8294|pmc=2860304|pmid=20428477}}</ref><ref>{{Cite web|url=https://www.ndsccenter.org/programs-resources/speech-and-language/|title=Speech and Language Resources {{!}} National Down Syndrome Congress|language=en-US|access-date=2020-04-19}}</ref>

Children with [[Medicine:Autism|autism]], categorized as a neurodevelopmental disorder in the DSM-V, often demonstrate language delays.<ref>{{Cite journal|last=Volkers|first=Nancy|date=2018|title=Untangling the Language Challenges of Autism|journal=The ASHA Leader|language=EN|volume=22|issue=4|pages=54–59|doi=10.1044/leader.FTR2.22042017.54}}</ref><ref>{{Cite web|url=https://www.nidcd.nih.gov/health/autism-spectrum-disorder-communication-problems-children|title=Autism Spectrum Disorder: Communication Problems in Children|date=2015-08-18|website=NIDCD|language=en|access-date=2020-04-19}}</ref> Recent studies have found that autistic children with language delays are often more able to benefit from treatment services to help build language than was previously believed.<ref>{{Cite journal|last1=Wodka|first1=Ericka L.|last2=Mathy|first2=Pamela|last3=Kalb|first3=Luther|date=2013-04-01|title=Predictors of Phrase and Fluent Speech in Children With Autism and Severe Language Delay|url=https://pediatrics.aappublications.org/content/131/4/e1128|journal=Pediatrics|language=en|volume=131|issue=4|pages=e1128–e1134|doi=10.1542/peds.2012-2221|issn=0031-4005|pmid=23460690|s2cid=2846260}}</ref>

==Treatment==
For language delays or communication disorders in children, early assessment is strongly recommended.<ref name=":0">{{Cite journal| url= https://www.aafp.org/afp/2011/0515/p1183.html|title=Speech and Language delay in children| publisher= American Association of Family Physicians|date=May 2011| journal= American Family Physician| volume=83|issue=10|pages=1183–1188|pmid=21568252|last1=McLaughlin|first1=M. R.}}</ref> Language delays may impact expressive language, receptive language, or both. Communication disorders may impact articulation, fluency ([[Medicine:Stuttering|stuttering]]) and other specified and unspecified communication disorders. Treatment focuses on the diagnosed condition. For example, speech and language services may focus on the production of speech sounds for children with phonological challenges.<ref name=":3">{{Cite web| url=http://www.oralmotorinstitute.org/mons/v2n2_marshalla.html|title=Oral Motor Institute |website= oralmotorinstitute.org |access-date= 2020-04-13}}</ref> Overall, early intervention for young children with language or other developmental delays is strongly recommended.<ref name=":1">{{Cite web |url= https://www.cdc.gov/ncbddd/actearly/whyActEarly.html|title=Why Act Early if You're Concerned about Development?| date=2019-12-09| publisher= Centers for Disease Control and Prevention| website= CDC.gov |language=en-us|access-date=2020-04-17}}</ref><ref>{{Cite journal| last1= Roberts |first1= Megan| last2= Kaiser |first2= Ann| date= 2015-03-02 |title= Early Intervention for Toddlers With Language Delays: A Randomized Controlled Trial | journal= Pediatrics |volume= 135 |issue=4|pages=686–693| doi= 10.1542/peds.2014-2134|pmid=25733749|pmc=4379460}}</ref>

For toddlers with language delay who may also be autistic, early intervention services focusing on speech production is strongly recommended. When absence of speech is observed in children who may also be autistic, assessment is also strongly recommended.<ref name=":2">{{Cite web|url=https://www.autismspeaks.org/science-news/children-nonverbal-autism-overcome-severe-language-delays |title= Study shows that many nonverbal autistic children overcome severe language delays| website= Autism Speaks |language= en |access-date= 2020-04-17}}</ref> Intervention services and treatment programs have been specifically developed for autistic children with language delays. For example, [[Medicine:Pivotal response treatment|pivotal response treatment]] is a well-established and researched intervention that includes family participation.<ref>{{Cite journal| last1= Lei |first1= Jiedi |last2= Ventola|first2=Pamela|date=2017-06-20|title=Pivotal response treatment for autism spectrum disorder: current perspectives| journal= Neuropsychiatric Disease and Treatment|volume=13|pages=1613–1626|doi=10.2147/NDT.S120710|issn=1176-6328|pmc=5488784|pmid=28790824}}</ref>  Mark Sundberg's verbal behavior framework is another well-established assessment and treatment modality that is incorporated into many [[Philosophy:Applied behavior analysis|applied behavior analysis (ABA)]] early intervention treatment programs for young children with autism and communication challenges.<ref>{{Cite web|url=https://www.autismspeaks.org/verbal-behavior-therapy|title=Verbal Behavior Therapy|website=Autism Speaks| language=en|access-date=2020-04-20}}</ref>

Treatment for absence of speech due to apraxia, involves assessment, and, based on the assessment, [[Medicine:Occupational therapy|occupational therapy]], [[Medicine:Physical therapy|physical therapy]], and/or speech therapy.<ref>{{cite web|url=https://www.apraxia-kids.org/wp-content/uploads/2013/01/BHSM-Fact-Sheet-2.pdf| title=Treatment Approaches for Children with Childhood Apraxia of Speech (CAS)| first= Sue| last= Caspari|year=2018| website= apraxia-kids.org}}</ref><ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045| title= Childhood apraxia of speech - Symptoms and causes|website= mayoclinic.org| publisher= Mayo Clinic|language=en|access-date=2020-04-13}}</ref><ref>{{Cite web| url= https://kidshealth.org/en/parents/speech-therapy.html|title=Speech-Language Therapy (for Parents) | publisher= Nemours KidsHealth|website=kidshealth.org|access-date= 2020-04-20}}</ref> Treatment for selective mutism involves assessment, counseling, and positive supports.<ref>{{Cite web|url=https://www.nhs.uk/conditions/selective-mutism/| title= Selective mutism| date= 2017-10-19| website= nhs.uk |language=en|access-date=2020-04-20}}</ref> 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.<ref>{{Cite journal |last1= Lincoln |first1=Tania M.| last2= Riehle| first2= Marcel| last3= Pillny |first3= Matthias |last4= Helbig-Lang| first4= Sylvia| last5= Fladung |first5= Anne-Katharina| last6= Hartmann-Riemer |first6= Matthias |last7= Kaiser|first7=Stefan|date=2017-12-05| title= Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms |journal= Frontiers in Psychology |volume= 8| pages= 2108| doi= 10.3389/fpsyg.2017.02108| issn= 1664-1078 |pmc= 5723417|pmid=29259567|doi-access=free}}</ref><ref>{{Cite encyclopedia| url= https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&ContentID=22953-1|title=Learning to Speak Again After Laryngeal Surgery |encyclopedia= Health Encyclopedia | publisher= University of Rochester Medical Center| via= urmc.rochester.edu| access-date=2020-04-20}}</ref>

==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.<ref>{{Cite web|url=https://www.spectrumnews.org/opinion/viewpoint/families-need-guidance-buying-communication-app-autism/|title=Families need guidance before buying a communication app for autism|date=2019-04-23|website=Spectrum {{!}} Autism Research News|language=en-US|access-date=2020-04-14}}</ref>

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.<ref>{{Cite web|url=https://www.livingmadeeasy.org.uk/communication/augmentative-and-alternative-communication-(aac)-3552/|title=Communication aids for disabled children - Living made easy|website=www.livingmadeeasy.org.uk|access-date=2020-04-14}}</ref>

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.<ref>{{Cite web|url=http://www.childrenshospital.org/Centers-and-Services/Programs/A-_-E/als-augmentative-communication-program/protocol-of-assessment-considerations/speech-generating-devices|title=ALS Augmentative Communication Program {{!}} Speech-Generating Devices {{!}} Boston Children's Hospital|website=www.childrenshospital.org|access-date=2020-04-20}}</ref>

==See also==
*[[Medicine:Aphasia|Aphasia]]
*[[Medicine:Aphonia|Aphonia]]
*Augmentative and alternative communication
*[[Medicine:Autism|Autism]]
*[[Medicine:Deafness|Deafness]]
*[[Social:Developmental disability|Developmental disability]]
*[[Medicine:Dysarthria|Dysarthria]]
*Dyslalia
*Speech delay
*Vocal cord paresis

==References==
{{Reflist|30em}}


[[Category:Communication disorders]]

{{Sourceattribution|Muteness|1}}