Mutism

Mutism is defined as absence of speech while maintaining the ability to hear the speech of others. It is usually related to a mental disorder such as depression, avoidance disorders in childhood or adolescence, negativism, or social phobia.

There are different types of mutism:

Total mutism consists of a total progressive disappearance of language and is not very frequent.

Akinetic mutism which is also described as greater apathy, and it is a subjective lack of thought, in which the person is not able to initiate any movement or even speech.

Selective mutism which is defined as a decrease and disappearance of speech ability in certain circumstances or to certain people. This lack of speech only occurs in certain circumstances or situations, and in other contexts or with relatives in which the person feels safe, the person communicates normally. There is no lack of communication skills or are damaged by some cause. According to the DSM-5, selective mutism falls within the category of anxiety disorders.

The diagnostic criteria for selective mutism include:
• The consistent failure of a child to speak in specific social situations (school), despite speaking in other situations
• Interference caused by this speech disturbance, for at least one month
• The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
• The disturbance is not better explained by a communication disorder (e.g., child-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Guidelines for communication with people diagnosed with mutism:
• Acquire a good relationship with the individual.
• Do not force the user to talk, let him know he will be able to speak when he is ready.
• Educate staff about selective mutism.
• Know the situations in which the user feels comfortable and in which he feels uncomfortable talking.
• Have a structured routine.
• Designate a safe place.
• Teach strategies
• Do not allow others to speak for the user.
• Perform activities and talk games
Assessment of Mutism involves the answers to fear, and anxiety motor responses. Examples of assessment tools concerning breathing and relaxation are Jacobson's progressive relaxation technique and Progressive Muscle Relaxation for kids and adults.