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PubMed1995

Case study: fluoxetine in the multimodal treatment of a preschool child with selective mutism.

Selective mutism is a rare disorder with poor treatment outcome. The current study describes the successful treatment of selective mutism in a preschool-age girl, using a comprehensive multifaceted therapeutic approach. The components of this intervention reflect a conceptualization of selective mutism that emphasizes anxiety as a core feature but also focuses on associated factors such as oppositional behaviors.

Anxiety Disorders↗
PubMed1995

Case study: is selective mutism a manifestation of dissociative identity disorder?

Selective mutism is a rare psychiatric disorder that usually has its onset in early childhood. This case study describes a patient in whom selective mutism developed in adolescence. It was later discovered that he had dissociative identity disorder. The study documents his history, which included violence, abuse, and threats to keep silent. The study suggests that in cases presenting with significant trauma or abuse, selective mutism may be a manifestation of dissociative identity disorder.

Adolescent↗
PubMed1995

Itard's 1828 mémoire on "Mutism caused by a lesion of the intellectual functions": a historical analysis.

OBJECTIVE: To demonstrate that Itard was one of the first clinicians to describe autism (which Itard named "intellectual mutism") and effectively separate these cases from mental retardation. Known for his attempts at rehabilitation of the Wild Boy of Aveyron, Itard wrote a largely unacknowledged paper in 1828 on the different causes of "intellectual mutism," the result of 28 years of observations at the Institut des Sourd-Muets in Paris. METHOD: Itard emphasized a complete examination of the child's faculties including attention, memory, and imitative capacity. He also described the behavior of these children as unsocialized, with poor peer relationships, superficial contact with adults in order to satisfy their own needs, and difficulties in language, especially with pronouns. RESULTS: He then described his various diagnostic and treatment approaches to determine whether the child can regain language and is educable. His description of the key features of intellectual mutism is compared to Kanner's classic description of autism. CONCLUSION: Itard rejected the overly inclusive diagnosis of "idiocy" and offered a way to distinguish children with mental retardation from those with pervasive developmental disorders, described key clinical features, and offered an assessment and treatment of these cases, all before 1830. His contribution should be recognized in textbooks of child psychiatry and developmental disorders.

Autistic Disorder↗
PubMed1996

Fluoxetine treatment of children with selective mutism: an open trial.

OBJECTIVE: A pilot study was designed to evaluate the safety and efficacy of fluoxetine treatment for children with selective mutism (elective mutism in DSM-III-R). METHOD: Twenty-one children (mean age 8.2 years, range 5 through 14) participated in a 9-week open trial of fluoxetine in graduated doses (mean end dose 28.1 mg, range 10 to 60 mg) with systematic baseline and outcome evaluations and weekly clinical assessment. RESULTS: All 21 children met DSM-III-R and DSM-IV criteria for anxiety disorders. After fluoxetine treatment, 76% were improved, with diminished anxiety and increased speech in public settings, including school. Improvement at week 9 was inversely correlated with age. CONCLUSIONS: Persistent selective mutism presenting with comorbid anxiety disorders may respond to fluoxetine treatment.

Adolescent↗
PubMed1998

Case study: audio feedforward treatment of selective mutism.

Selective mutism is a relatively rare and difficult-to-treat disorder. Audio feedforward is a potential intervention that involves having the individual with selective mutism listen to audiotapes edited to depict him or her speaking in situations in which he or she is not currently speaking. The successful use of this intervention for three children with selective mutism is reported. The intervention was used in both school and community settings. This intervention has not always proved successful, sometimes because children refused to make the audiotapes.

Behavior Therapy↗
PubMed1997

Complex orofacial movements and the disappearance of cerebellar mutism: report of five cases.

A syndrome of mutism and subsequent dysarthria occurs frequently in children after resection of a cerebellar tumour. The role of orofacial and speech motor control in this syndrome has not been studied systematically. We examined simple and complex orofacial movements during the mute phase and shortly after the resumption of speech in five children with mutism and subsequent dysarthria. The recovery of complex orofacial movements coincided with the disappearance of the mutism.

Adolescent↗
PubMed1999

Right parietal infarction with concomitant mutism.

Right brain damage results in a variety of cognitive and behavioural dysfunctions. Mutism however, has been described only with left or bihemispheric lesions involving the parietal lobe. We report an elderly man who had left faciobrachial monoparesis and concomitant mutism. His auditory-verbal comprehension was intact. MRI revealed a right parietal infarct involving the cortical and subcortical regions. Recovery from mutism during the course of treatment was abrupt and complete with no residual dysarthria. A possibility of diaschisis or impaired modulation of left hemispheric function due to right cerebral infarct, presenting as conversion reaction, is proposed for this rare association.

Cerebral Infarction↗
PubMedDate not supplied

Diffusion-weighted MRI in acute mutism.

Mutism defined as a complete loss of speech may be related to psychiatric or neurologic disorders. The ischemic stroke origins of mutism are often difficult to assess at the acute stage. Accordingly, the search for the underlying mechanism as the localization of the damages may be difficult by conventional radiological techniques. Diffusion-weighted (DWI) MRI may accurately identify patients with acute ischemic stroke and distinguish them from those who mimic acute stroke better than clinical and conventional neuroradiological methods. This report aims to demonstrate the utility of DWI-MRI in the diagnosis of acute mutism.

Acute Disease↗
PubMedDate not supplied

Cerebellar mutism after posterior fossa surgery.

A large midline posterior fossa medulluloblastoma and a cerebellar arteriovenous malformation with associated clot were moved with postoperative mutism. Mutism was immediate and resolved into an ataxic dysarthria with residual mild dysarthria at 3 months. The literature is reviewed, and the clinicopathological and neurophysiological data of cerebellar function in speech are discussed. Acute injury to the midportion of the cerebellum with or without dentate nuclear involvement can cause a spectrum of speech disturbances. The more widespread the injury to the midportion of the cerebellum with dentate nuclei involvement the greater the risk of developing postoperative mutism.

Adolescent↗
PubMed1992

Controlled investigation of the amobarbital interview for catatonic mutism.

OBJECTIVE: Clinical reports over the last 60 years suggest that the amobarbital interview is effective in relieving catatonic symptoms. This has never been substantiated with methodologically sound trials. The authors postulated that a randomized blind comparison of intravenous amobarbital and saline would demonstrate the superiority of amobarbital in relieving catatonic mutism. METHOD: The subjects were 20 inpatients with catatonic mutism. They were randomly assigned to either saline (N = 10) or a 5% amobarbital solution (N = 10), and the infusions were administered intravenously at a rate of 1 cc/min or less over 10 minutes by a blinded physician. A second blinded physician administered a semistructured interview during the infusion to control for the effect of suggestion. A third blinded physician rated patient responsiveness, reactivity, and arousal. Any patient who was unresponsive to the initial infusion was crossed over to the other infusion. Interviews were videotaped for determination of interrater reliability. RESULTS: In the initial infusions, six of 10 patients responded to amobarbital and zero of 10 responded to saline. Four of the saline nonresponders responded when given amobarbital. Response was evident by the 4th minute of the amobarbital infusion. Interrater reliability was high. The responders and nonresponders differed significantly in the variance of the weight-adjusted amobarbital dose, and the responders tended to be older and female. CONCLUSIONS: Intravenous amobarbital is superior to saline in relieving catatonic mutism, although only 50% of these patients responded. The nonresponders were distinguished from the responders by a greater variance in the weight-adjusted dose of amobarbital.

Adult↗
PubMed1995

Prolonged akinetic mutism due to multiple sclerosis.

A 25-year-old woman with multiple sclerosis and an affective disorder probably secondary to MS presented with multiple neurological signs and symptoms suggestive of active MS, most prominently akinetic mutism. Spinal fluid analysis and MRI supported a diagnosis of active MS. SPECT and EEG were nonspecifically abnormal. After 6 weeks of severe akinetic mutism refractory to one ECT treatment and trials of steroids and stimulants, the patient recovered spontaneously over a 2-month period. An acute brainstem lesion seen on MRI may explain this patient's akinetic mutism.

Adult↗
PubMed1994

The syndrome of 'cerebellar' mutism and subsequent dysarthria.

"Cerebellar" mutism refers to a specific childhood disorder in which a complete but transient loss of speech, followed by dysarthria, occurs after removal of a cerebellar tumor. We present a consecutive series of 15 children with this disorder, which we prefer to designate "mutism and subsequent dysarthria." The conditions in which it develops suggest also an extracerebellar component of cerebellar mutism. Hydrocephalus at presentation, localization of tumor adjacent to the fourth ventricle, and postsurgical edema of the pontine tegmentum are involved in its development.

Astrocytoma↗
PubMed1999

Selective mutism--the child who doesn't speak at school.

Selective mutism is a syndrome in which there is a consistent failure to speak in social situations where speech is expected, despite speaking in other situations. The problem is most common in the child who speaks actively and well at home but who refuses to speak in school. This paper describes 2 young children from the author's practice who refuse to speak at school and a short summary of recent changes in the thinking about the cause and therapy of selective mutism. This is the first article on selective mutism to appear in an American pediatric journal.

Child, Preschool↗
PubMed2002

Phenomenology and treatment of selective mutism.

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.

Anti-Anxiety Agents↗
PubMed1987

Unilateral third nerve palsy and somnolent mutism.

A 64-year-old man developed unilateral third nerve palsy and somnolent mutism. Computed tomography (CT) revealed a small unilateral midbrain infarct. Previous reports of somnolent mutism placed the lesion in both sides of the midbrain tegmentum, usually extending into the thalamus. The unilateral third nerve palsy, and high-resolution 4-mm contiguous tomographic sections of the brainstem, helped localize the lesion. To our knowledge, this is the first CT clinical report of somnolent mutism induced by unilateral midbrain infarct.

Cerebral Infarction↗
PubMedDate not supplied

Unexpected recovery of functional communication following a prolonged period of mutism post-head injury.

A case is presented of a seven-year-old female who showed an unexpected recovery of functional communication skills following a prolonged period of traumatic mutism subsequent to a severe closed head injury. The patient initially presented as comatose. A period of mutism subsequent to the coma extended for ten months. Following this protracted period of mutism the child demonstrated rapid and unexpected recovery of functional communication skills, despite the persistence of higher level language deficits. The findings of a neurological assessment, neuroradiological assessment and battery of speech/language tests are described. The present case is discussed in light of the existing literature on recovery from paediatric head trauma.

Brain Damage, Chronic↗
PubMed2001

Selective mutism: how a successful speech and language assessment really is possible.

A speech and language assessment of children with selective mutism is often difficult because these children are silent in most situations. In Australia, a study was designed to assess the children in their homes, the place where they usually speak. Five children who met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria for selective mutism participated in the study. Assessment included audio-taping extracts of the children's conversations with members of their family and the administration of a number of standardised speech and language tests. The study found that four of the five children had a communication disorder. This paper outlines these communication disorders and describes how a successful speech and language assessment of children with selective mutism is possible.

Child↗
PubMed1995

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children.

Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Adolescent↗