Selective Mutism: Association with AS and Speech Delays

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blondeambition
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25 Sep 2011, 4:16 pm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861522/

I found the above scholarly article about selective mutism, a psychiatric condition where a person--usually a child--can speak in some situations and not others. In daycare, school, or church, for instance, the child could be unable to talk due to extreme anxiety. However, the child can talk at home with family.

According to the article, Asperger's Syndrome, anxiety disorders, speech delays, and developmental delays can co-occur with selective mutism. Or the child could be able to speech perfectly well at home and have no other delays--just the selective mutism.

I have a history of selective mutism with no known delays. My older son with classic autism also has it and is successfully treated with fluoxetine (Prozac) for this and other anxiety issues.


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Willard
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25 Sep 2011, 5:03 pm

Redacted.



Last edited by Willard on 01 Oct 2011, 9:11 pm, edited 1 time in total.

Apera
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25 Sep 2011, 5:17 pm

I know the author of the DIlbert comics had something like this, but it was caused by a vocal chord spasm.


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Apple_in_my_Eye
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25 Sep 2011, 5:39 pm

It's hard to tell if the authors consider it a purely emotional (anxiety) based thing (which it usually is, I hear). I bet if definitive brain scans of ASD ever happen they'll show there's more than just anxiety going on with speech/language difficulties.

Anxiety could also be there, of course.

Huh, I just noticed an odd thing -- PDD's are specifically excluded in "Selective Mutism" in the DSM?

Quote:
The DSM-IV-TR criteria for selective mutism also specifies that the persistent failure to speak in specific contexts should not be explained by the following:

1) An organic inability rooted in language ability (comprehension and comfort speaking the language)
2) Another communication disorder, such as stuttering
3) Concurrent diagnosis of pervasive development disorder, schizophrenia, or other psychotic disorder1



aspie48
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25 Sep 2011, 5:42 pm

thats kind of a stupid dx. like doesn't everybody choose who and when to talk? like i only talk to friends most of the time and so do most people. so i guess i am selectively mute.



Apple_in_my_Eye
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25 Sep 2011, 5:48 pm

Apera wrote:
I know the author of the DIlbert comics had something like this, but it was caused by a vocal chord spasm.


Sounds like "spasmodic dysphonia." I used to know someone (ASD someone) who had that.



blondeambition
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25 Sep 2011, 5:50 pm

Apple_in_my_Eye wrote:
It's hard to tell if the authors consider it a purely emotional (anxiety) based thing (which it usually is, I hear). I bet if definitive brain scans of ASD ever happen they'll show there's more than just anxiety going on with speech/language difficulties.

Anxiety could also be there, of course.

Huh, I just noticed an odd thing -- PDD's are specifically excluded in "Selective Mutism" in the DSM?

Quote:
The DSM-IV-TR criteria for selective mutism also specifies that the persistent failure to speak in specific contexts should not be explained by the following:

1) An organic inability rooted in language ability (comprehension and comfort speaking the language)
2) Another communication disorder, such as stuttering
3) Concurrent diagnosis of pervasive development disorder, schizophrenia, or other psychotic disorder1


I know that PDD is excluded as a comorbid disorder. I think that they exlcuded it because they did not want it confused with mutism caused by PDD. Selectively mute people can talk with close friends or family at home. Selective mutism is basically a type of severe social anxiety disorder which may or may not co-occur with speech issues.


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Apple_in_my_Eye
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25 Sep 2011, 6:01 pm

Yeah, but Asperger's syndrome is a PDD, and they list it later in the paper as a possible co-morbid of SM. I guess maybe they're implying that a PDD shouldn't rule out SM.



Willard
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25 Sep 2011, 6:35 pm

Redacted.



Last edited by Willard on 01 Oct 2011, 9:10 pm, edited 1 time in total.

SuperTrouper
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25 Sep 2011, 9:12 pm

aspie48 wrote:
thats kind of a stupid dx. like doesn't everybody choose who and when to talk? like i only talk to friends most of the time and so do most people. so i guess i am selectively mute.


This is like someone says that AS is a "stupid diagnosis" because most people with AS are "smart enough" to "act normal." In other words, just not cool to point fingers. Please think before you say things are stupid. You're liable to upset someone.



aann
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26 Sep 2011, 6:16 am

My son was selectively mute in preschool. The county paid psychologist came to his school and then came to my home. The diff was night and day. We couldn't get him to shut up at home and he didn't speek at all at school. What helped was speeking to a lady who had a selectively mute child who was in 4th grade at the time. I feel really bad for her. She helped me tremendously, telling me what she did wrong when her child was the age of my child. I implemented her suggestions and my son got over it. Her daughter remains w/ a serious problem. And, God bless them, this mother died last year.



azurecrayon
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26 Sep 2011, 7:04 am

i find it odd that they point out asperger's specifically as a co-morbid and not the entire autism spectrum. especially considering they are trying to correlate the mutism with speech disorders, and there are inherently more speech disorders in classic autism than in asperger's.

both my SO and our 5 yo autie have selective mutism. ive never seen it as a co-morbid really, as its not a stand alone diagnosis for them but rather a result of the extreme social anxiety from autism. perhaps i will have to look into that further as i always assumed the anxiety was from autism, but i dont see how it would be possible to separate out anxiety by autism from just regular old social anxiety. our autie was also electively mute from the first words he spoke until he was about 4. he could talk, he just chose not to most of the time, even at home. he would regularly tell us no when asked to say something or prompted to ask for something verbally. now with us, whether at home or out, he is a complete chatterbox, but with other people, whether at home or out, he still doesnt talk.

very interesting article, thank you, blondeambition!


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blondeambition
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27 Sep 2011, 2:36 pm

azurecrayon wrote:
i find it odd that they point out asperger's specifically as a co-morbid and not the entire autism spectrum. especially considering they are trying to correlate the mutism with speech disorders, and there are inherently more speech disorders in classic autism than in asperger's.


I think that it is actually a problem with kids across the spectrum. I think that it is just underdiagnosed in kids with classic autism.

I also think that, with many kids, you could either label it as a separate condition or as a symptom.


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Alien_Papa
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01 Oct 2011, 11:54 pm

I think my daughter has this. She hasn't spoken to her mom in eighteen months. She once went two months without speaking to me. I was recently contacted by her high school guidance counselor because she's not answering simple teacher questions like: how do you pronounce your name. Yet, when she's confident, at the right time and place, she comes across as mature and capable.



blondeambition
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02 Oct 2011, 6:17 am

Alien_Papa wrote:
I think my daughter has this. She hasn't spoken to her mom in eighteen months. She once went two months without speaking to me. I was recently contacted by her high school guidance counselor because she's not answering simple teacher questions like: how do you pronounce your name. Yet, when she's confident, at the right time and place, she comes across as mature and capable.


If she has the disorder, you could consider seeing a child/adolescent psychiatrist or pediatric neurologist and asking about fluoxetine (Prozac). It has a 76% effectiveness rate in studies and is commonly used for this condition here in the U.S. It worked for my older son with classic autism. It is an antidepressant/antianxiety SSRI and, if it is the right drug, it will make your child happier and less anxious.

Some kids become hyperactive when first placed on the drug or if the dose it too high for their body weight. Also, it should not be used in kids with bipolar disorder, as it can produce mania in a bipolar individual. However, most have very little in the way of noticeable side effects.


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