Mutism is a speech disorder that usually has no physical causes, such as hearing defects or vocal cord problems. This speech disorder is something completely different than that of deaf-mutes. The cause is a mental disorder or damage to the brain. Mutism distinguishes between (s) elective mutism, total mutism, and akinetic mutism.

What is mutism?

The word mutism was derived from the Latin word mutus, meaning mute. This term is, strictly speaking, not correct, because affected people are not dumb in the classical sense, but can speak quite physically.

People who suffer from selective and total mutism are basically physically capable of speaking normally. They have no physical limitations that do not allow language, such as vocal cords or hearing problems. Due to a mental illness sufferers but suffer from such a strong fear that they stop speaking. This can be continuous or only in certain situations.

The akinetic mutism is caused by damage to the frontal brain or by brain tumors. Creutzfeldt-Jakob disease may also be responsible for akinetic mutism.


Mutism is strongly favored by the genetic disposition. People who have often shown extreme anxiety reactions in childhood are most likely to be affected by mutism.

These anxiety reactions include, for example, extreme separation anxiety, drowsiness or wine attacks. Researchers have come to the conclusion that in these people, the anxiety center in the brain reacts much more violently than it would actually be necessary. Small dangerous situations can trigger extreme reactions to activate the self-protection. In a healthy person, such a situation would not activate the anxiety center so much.

In selective mutism, the anxiety response is triggered by certain events. If the child speaks completely normal at home, it can persistently remain silent in kindergarten. The child feels in danger at the kindergarten for an incomprehensible reason in danger and speaks therefore in this environment no more. In total mutism, however, those affected remain silent. Responsible for this is also a mental disorder, the exact causes are not known.

Symptoms, complaints & signs

The absence of any kind of communication is the key symptom of mutism. The affected children and adolescents do not speak, keep eye contact, are shy and withdrawn. Other signs include fear of being in the center of attention and doing something sporty, such as being afraid of swimming or learning to ride a bicycle.

In addition, an increased speech volume home is possible, which is immediately stopped when strangers come to it. In selective mutism, these behaviors always come into play only in certain situations, in relation to particular persons or in specific places, such as in kindergarten. The appearance is exactly predictable and always the same.

Through increased facial expressions and gestures is partially compensated that is not spoken. In the familiar environment, however, is spoken and it shows a normal behavior. In total mutism, verbal and nonverbal communication is always completely avoided. Body sounds, such as laughter, coughing and sneezing are forcibly suppressed. A remote posture is as much a symptom as appearance in any situation, against all persons and in all places. There is also a solidification of the body. This does not make it possible for the person concerned to interact.

Diagnosis & History

Mutism can be diagnosed by doctors or psychologists. However, as this disease has not yet been conclusively researched and is relatively unknown, the diagnosis is not always easy.

In the case of children, the parents can provide decisive information that guides the doctor in the right direction. Even a speech therapist can be the right contact person. Speech therapists are often more familiar with mutism than doctors and psychologists.

For further development, treatment with psychotherapy is enormously important. Especially affected children suffer very much from the situation, they quickly become outsiders and there can be problems at school. In addition, depression can develop, which can often trigger thoughts of suicide. Social phobias are also often a consequence of mutism.


Total mutism can complicate the treatment, as the affected person can not communicate to a therapist or psychiatrist. However, empathic practitioners can facilitate communication using appropriate conversational techniques. The same applies to selective mutism. In both cases, a good relationship of trust with the therapist or doctor is particularly important.

Children with selective mutism often experience other mental illnesses or complaints. Many mutants suffer from anxiety disorder or clinical depression. It should be noted that mutism should actually be diagnosed only if the anxiety disorder or depression can not fully explain the psychogenic silence.

Without adequate therapy, there is a risk that mutism will persist. As a rule, treatment should begin as soon as possible. The longer the mutism persists, the more likely complications become. Personality development can be impaired.

Enkopresis and enuresis are also common complications in mutant children. In the process, they either ate or ooze, even though they have already learned to control their excretions. Adults' mutants are often professionally and socially restricted due to their mental illness.

Mutism often encounters incomprehension or helplessness in other people. If the mutism is triggered by trauma, unfavorable reactions from relatives increase the likelihood of developing post-traumatic stress disorder.

When should you go to the doctor?

Disturbances of the communication are always to be presented to a doctor. If there is any impairment of the vocalization, the child learns despite multiple efforts no language or if there is a sudden silencing, a doctor must be consulted. If the person concerned can not express himself sufficiently through body language, react appropriately to a social interaction, or if the symptoms occur according to the situation, the observations should be discussed with a doctor.

In many cases, a normal exchange of the person concerned with persons in his immediate environment takes place under almost all circumstances. However, if the symptoms cease under certain very selective conditions, a doctor should be consulted. It is characteristic that in a different environment a very active communication is maintained by the person concerned or a traumatic experience was experienced.

For various behavioral problems, personality disorders or general development, a doctor's visit is recommended. If, compared to peers, there are delays in learnable progress or severe learning difficulties, a doctor should be consulted. In case of memory problems, orientation problems or a concentration deficit, medical examinations are necessary to clarify the cause. An averted posture and supposed disinterest should be presented to a doctor. If the affected person replaces the lute with noises such as coughing, laughing or humming, there is an irregularity that should be clarified.

Treatment & Therapy

Mutism is treated both language therapy as well as psychiatric and psychological. Whether individual treatments are sufficient, or a combination of the different treatment areas is necessary, must be made dependent on the extent of the disease. But the actual cause also determines the form of the treatment.

In addition, Mutimus can also be treated by the drug, using antidepressants. These provide for a more balanced mental state and thus also reduce anxiety. The affected person can experience their everyday life more relaxed and is less often affected by the speech impediment.

In any case, it is important to start treatment once mutism has been diagnosed. The sooner the therapy starts, the greater the chances of success. If the anxiety behavior has stabilized over many years, a therapy is much more difficult and will not lead to success so quickly. There are now a few forms of therapy specifically designed for mutism. Which is the right form of therapy can be different. A panacea does not exist.

A therapy of mutism is always a very lengthy affair and not completed within a few weeks. Depending on how strongly the mental disorder has already manifested, months or even years of regular therapy may be necessary to achieve a lasting improvement.

Outlook & Forecast

Selective mutism, which often occurs when entering kindergarten or other foreign situations, often disappears after a few weeks or months. If he stays longer than six months, the prognosis for a recovery is bad. The children are usually relatively silent until adolescence and can only learn through years of practice to speak in unfamiliar situations. Often a social phobia develops in adulthood. The sooner the disease is treated, the better the chance of recovery.

However, the cause of the child's mutism and character as well as its environment play a role. Children who suffer from mutism need support from several caregivers who encourage them early on during the illness and thus make them talk. Total mutism can be treated much more difficult. The child does not speak with friends or with the parents, which usually means that no medical or therapeutic treatment is possible.

The prospect of a healthy development is only given if the child decides to speak again. Selective mutism often develops in adolescence. The children maintain a normal speech behavior later in life. Further information can the association Mutismus self-help Germany e. V. give.


A direct prevention for mutism does not exist. Parents who observe a tremendous increase in their anxiety behavior with their children, but should strengthen their child accordingly to reduce the fears. If necessary, the advice of a child psychologist may already be appropriate, so that the self-confidence of the child strengthened and exaggerated fears are contained.


The aftercare is above all a topic for cancer patients. Doctors promise to recognize the recurrence of a tumor at an early stage by a close follow-up. Mutism, on the other hand, exists or has been successfully treated by appropriate therapies. Also, as with a malignant carcinoma, a shortening of the lifetime is not expected.

Therefore, aftercare is not primarily about preventing a recurrence. Rather, patients with a condition in their everyday life should receive support. A permanent treatment is arranged. The extent of aftercare depends greatly on the severity of mutism and age. Especially in children, a frequent follow-up is recommended, because the mutism can cause serious developmental delays. These are difficult to fix in late years.

The follow-up includes regular presentations, whereby usually the relatives and parents are of great importance. They experience their child in everyday life and can therefore best inform about changes and progress. If the mutism is accompanied by depression, temporary hospitalization may be appropriate. Outpatient measures include speech and psychotherapy.

You can do that yourself

Mutism requires speech therapy combined with a psychologist. Parents who find signs of mutism in their child should consult a specialist in good time.

If it is selective mutism, the conversation with the educators in the kindergarten or the teachers in the school of the child must be sought. Perhaps the refusal to speak is based on exclusion or bullying. If the cause can not be determined, further investigation is required. In many cases, children begin to talk as soon as they become affectionate over a longer period of time. Parents of affected children must therefore show much patience and understanding.

Accompanying this, further therapeutic measures can be taken to make it easier for the child to deal with the illness. Thus, the child can often be moved to speak by an early intervention. Attending a special remedial school for children with language disorders can relieve the child's anxiety and provide appropriate therapy options. What measures can be taken in detail, must answer a doctor or psychologist. He will first conduct a comprehensive examination and also speak with his parents. The actual therapy can then be specifically supported by the parents.

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