What is selective autism?

I don’t know if it’s selective mutism.

If yes, the information is as follows:

Overview

Selective Mutism is a mental disorder (Selective Mutism, SM) in which children with certain A clinical syndrome characterized by persistent "refusal" to speak in situations that require verbal communication (such as school, environments with strangers or crowded people, etc.), while speaking normally in other situations. Children with the disease can often speak normally and actively at home, but "refuse" to speak to teachers or classmates at school. Chinese people have a relatively introverted personality. Children do not speak when they start kindergarten or primary school. They are often ignored due to reasons such as introversion and shyness, resulting in children with the disease not being discovered and treated in time. It usually begins between the ages of 3 and 5, and is more common in girls. Patients are afraid to speak even if they are able to speak because of anxiety or extreme shyness in certain situations. As social pressure increases, social conflicts increase, social mobility increases, family problems and family conflicts increase, factors that cause SM increase. Domestic children with SM not only exist, but are also increasing.

[Edit this paragraph] English translation

Abstract: 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. Debate surrounds the origins and causes of this disorder. This paper is a brief review of the literature on the etiology, prevalence, assessment and treatment perspectives from several theoretical orientations, including behavioral, family systems, and psychopharmacological1.

Key words: selective mutism, mutism, anxiety disorders, speech and language disorders

[Edit this paragraph ]Proposition of the concept of SM

In 1877, Kussmaul first described a clinical dysfunction characterized by children with the ability to speak, but in some cases unable to speak, named Voluntaria, emphasizing that patients spontaneously did not Speech. In 1934, Tramer called similar cases Elective Mutism, emphasizing that children choose not to speak on certain occasions. The American DSM-IV changed to Selective Mutism, which is intended to indicate that children refuse to speak on "carefully selected" occasions or situations. , emphasizing that psychological factors may be the main cause of SM. The World Health Organization Classification of Diseases-10 (ICD-10) defines SM as children with normal or near-normal speech or language ability. In some specific situations, the loss of speech ability is obviously due to emotional factors, emphasizing that emotional disorders are an important cause of SM. The basis of etiology.

[Edit this paragraph] Epidemiology

SM is a rare disease. In 1994, the American Psychological Association estimated that clinical SM children accounted for less than 1% of the total number of children. Kopp, Kamulainen , Bergman et al. conducted an epidemiological survey on SM and found that its incidence rate is between 0.2% and 2.0%. The vast majority of children suffer from SM for more than one year. Some studies show that girls have slightly more SM patients than boys, with a ratio of 2: 1. There are only sporadic case reports or mentions in review literature in the Chinese literature, and there is no epidemiological study. Due to the large population base in my country, although SM is relatively rare, the absolute number of children with it is also very large.

[Edit this paragraph] Causes and manifestations of selective mutism

Selective mutism refers to the speech organ without organic disease, normal intelligence, and has acquired language Functional children, under the influence of certain mental factors, show stubborn silence. This disease is considered to be a special form of childhood neurosis and usually begins between the ages of 3 and 5 years old. Neuropsychiatric diseases such as childhood hysteria, schizophrenia, childhood autism, and mental retardation may also be accompanied by silent symptoms, but they do not fall into this category.

[Edit this paragraph] The cause of SM is not yet clear, but there are etiological theories

·SM is a psychological disorder:

Early SM case studies will The problem is attributed to family factors or difficult-to-resolve inner conflicts, such as overprotective parents. Recent research suggests that SM is closely related to anxiety disorder. Some experts even believe that SM is a type of anxiety disorder. SM should be called children's social phobia. Children with SM have many characteristics in common with adult patients with social phobia. Another strong piece of evidence linking SM and anxiety disorders is that anti-anxiety medications are effective in treating SM.

·SM is a behavioral disorder:

Behaviorists believe that SM is a behavioral problem caused by a series of reinforced negative learning patterns, and is a "refuse to speak" as a habitual response to clever responses to external circumstances.” In other words, the mute state is a behavioral manifestation of the interrelationship between the child's processing and the environment. Behavioral experts believe that children's silent behavior is functional, and advocate that the adverse external environment is the maintenance factor for the persistence of this state. Therefore, this mute state of children is an adaptive behavior rather than a pathological behavior.

·SM is related to intellectual development disorders:

Kristensen et al. believe that SM is related to intellectual development disorders, pregnancy or childbirth disorders, and is often combined with chewing and swallowing disorders, movement coordination disorders and sleep disorders. obstacle. Anxiety symptoms may be caused by cognitive difficulties, such as working memory impairments. When completing cognitive tasks that exceed cognitive abilities, the children's individual working memory resources are scarce, and their anxiety increases, so they adopt a compromising approach (passive, not talking) to complete the task. However, children with SM usually do not have low cognitive abilities. The study by Katharina et al. showed that there was no significant difference in cognitive function between children with SM and children in the control group.

·SM is related to speech or language disorders:

Some studies have found that children with SM have speech or language disorders. Kolvin and Fundudis [Study confirmed that children with SM started to speak significantly later. Compared with normal children, 50% of children with SM have immature speech, while only 9% of children in the control group have immature speech. Wilkins studied 24 children with SM. Although only 8% had speech problems at the time of evaluation, 25% had speech delays and 21% had unclear speech. In a large-scale study of 100 children with SM in Europe, at least 38% had speech or language expression difficulties. The high incidence of SM among immigrant children also confirms that language barriers are related to SM. Frequent moving or changing schools can induce SM, so SM should not be just a language problem.

[Edit this paragraph] Clinical diagnosis of selective mutism

Currently SM is generally considered to be an independent disease, but some scholars believe that SM is a family hereditary social anxiety SM is closely related to anxiety disorder. It may be a symptom of anxiety disorder, a variant of social phobia, or one of the symptoms of other mental illnesses. It is not an independent disease. The accurate diagnosis of SM is quite difficult and requires a comprehensive examination and evaluation, including neurological examination, psychiatric examination, hearing examination, social communication ability examination, learning ability examination, language and speech examination, and various related objective examinations (such as EEG images, cranial imaging, event response potential), etc., and related examinations are necessary [3].

SM is classified under "Other Disorders of Children and Adolescents" in the US DSM-IV. There are 5 clinical characteristics of SM, which can be used as the basis for diagnosis:

1) "Cannot" speak in situations that require verbal communication, but speak normally in other environments;

2 ) lasting more than one month;

3) No speech disorder, no speech problems caused by speaking a foreign language (or different dialect);

4) Due to enrollment or change of school, Relocation or social interactions affect the children's lives.

5) Not suffering from developmental or psychological diseases such as autism, schizophrenia, mental retardation or other developmental disabilities.

[Edit this paragraph] Treatment plan

The prognosis of selective mutism is good. After treatment, most children can recover within months to years. A small number of children develop chronic partial mutism. The child still exhibits excessive shyness and social anxiety in adolescence and adulthood, and still has difficulty speaking fluently and expressing his/her ideas in certain social situations.

[Edit this paragraph] 6 types of treatment methods

· Psychotherapy: It is the earliest treatment method used in SM and is still widely used in the treatment of SM. Psychologists believe that SM is a psychological disease and a manifestation of social phobia. Physical or mental trauma is the root cause of SM. They advocate psychoanalysis and psychotherapy. Psychotherapy is mainly aimed at alleviating children's inner conflicts and emphasizes individualized treatment. Specific methods include psychological suggestion, psychological counseling, psychoanalysis, cognitive therapy, etc. Psychiatrists believe that psychotherapy is effective based on case studies and experience. However, psychotherapy is a long-term process. Case studies cannot get rid of the interference of SM's natural recovery factors and cannot confirm whether psychotherapy is really effective.

·Behavioral therapy: Behavioral therapy is a special form of psychotherapy.

SM is a behavioral disorder that often occurs in children who have social anxiety and are very shy, so their behavior needs to be corrected. Research has confirmed that behavioral therapy has significant effects. New research shows that behavioral therapy can help children regulate their emotions, overcome impatience and anxiety, and correct their behavior patterns in dealing with problems. Commonly used methods include positive reinforcement, negative reinforcement, desensitization, video self-modeling, etc.

·Family therapy: including family education and family games. The purpose of family education is to improve unhealthy family environment and family relationships, strengthen parents' understanding of SM, create a suitable family environment for children with SM, improve family relationships, reduce rough scolding, and increase well-intentioned encouragement, such as children taking the initiative to interact with guests. Provide appropriate encouragement when communicating (eyes, gestures, body postures, words, etc.), and do not force the child to speak; for family games, invite the child's friends, classmates and teachers to the home, play games with the child, and let The children communicate with them in a familiar environment. Children are not encouraged to use other methods of communication, but they cannot be opposed to increase the child's anxiety and induce and encourage the child to talk. The visitors range from familiar to unfamiliar, from few to many. In the end, the people the children come into contact with at school are all people they are familiar with, ignoring that school is a strange environment.

·Participation and support from the school and social environment: Create a good environment for the children, encourage the children to speak, do not make fun of their speech disorders, do not intimidate or tease them, etc. Form a help group at school, mainly composed of teachers and some classmates, and tell them the importance of cooperating with the doctor's treatment, understand the children's condition and treatment characteristics, communicate more with the children, do not force the children to respond verbally, and encourage the children to use various forms of treatment. response. In the classroom: Children are initially encouraged to participate in collective answers, and the number of answers gradually decreases; children are encouraged to communicate with the teacher individually and prepare to answer questions in advance, and then the children answer alone in a small group, and the teacher or classmates use verbal guidance, prompts, and Cooperate with the children to answer questions and gradually expand the scope.

·Drug treatment: In the past ten years, antidepressant drugs have been studied in the treatment of SM, and drug treatment is believed to be effective. Golwyn et al. believed that monooxygenase inhibitors are effective in the treatment of social phobia. Their inhibition of dopamine degradation in the synaptic cleft can promote central excitability and improve social functions. They are suitable for the treatment of SM, so they used phenylishydrazine to treat 4 patients. Example of SM, one of the children was switched to fluoxetine after treatment failed, and the effect was remarkable. SSRI drugs are effective in treating SM in individual cases and small case groups. Black et al. designed a small case group, a double-blind controlled study, with 6 cases treated with fluoxetine. The results of the condition assessment and the evaluation results of the parents of the children were that the fluoxetine treatment group was better than the control group, but professional doctors The results of the teacher's evaluation showed that there was no significant difference between the two groups. Dummit et al. reported a study on the treatment of 21 children with SM by the SSRI drug fluoxetine. There was no control. After 9 weeks of treatment, 16 of the children's anxiety was reduced, their symptoms were improved, and the children gradually spoke more in public. , the degree of improvement is inversely proportional to age, and the efficacy is better than psychological or behavioral treatment. Drug therapy is generally not used as the first treatment method, but if other methods are not effective, drug therapy can be added to the treatment plan.

·Comprehensive treatment: Since the cause of SM is not yet clear, it may be caused by multiple factors. Various methods have different curative effects, so currently SM treatment mostly adopts comprehensive treatment plans, including psychotherapy, behavioral therapy, family therapy, school social support and possible psychotropic drug treatment.

[Edit this paragraph] Selective mutism in children

Selective mutism refers to a disease that occurs in children who have acquired language ability due to the influence of mental factors. The phenomenon of remaining silent on some occasions is essentially a social dysfunction rather than a language barrier.

This disease usually begins at the age of 3 to 5 years old, and is more common in girls. Children with normal intellectual development are mainly silent, or even silent for a long time. This phenomenon of silence is selective, that is, you can speak in certain situations, such as speaking to familiar people (father, mother, grandma, and some friends). The occasions for refusing to speak generally refer to school or in front of strangers. A small number of children do the opposite, talking at school but not at home. When silent, you can express your opinions with gestures, nodding, and shaking your head, or just using words such as "yes", "no", "want", etc., and occasionally express your opinions in writing. ?

Three manifestations of selective mutism in children

1. This disease mostly begins between the ages of 3 and 5, and is more common in girls. The main manifestations are silence and even long-lasting mutism. Time said nothing. But this kind of silence is selective, that is, speaking in certain situations, such as at home or to familiar people, but not speaking in other situations, such as in kindergarten or to strangers.

2. A small number of children with the disease are just the opposite. They do not speak at home but speak in kindergarten. When interacting with others when silent, you can use gestures, nodding, shaking your head and other actions to express your opinions, or answer questions with the simplest words such as "yes", "no", "want", "no", etc. After you learn to write, you can occasionally use writing to express your opinions.

3. This type of children are not easily discovered by their parents before going to school. The children are unwilling to talk to unfamiliar people, which is often considered by their parents to be timid and shy.

It was not discovered until after entering elementary school that he was unwilling to answer any questions, talk to other students, and not participate in group activities. The children can participate in studies as usual, but their academic performance varies, and some children refuse to go to school.

Three major causes of selective mutism in children

This disease generally has no organic cause in the brain. It is currently believed that it is caused by mental factors acting on children with certain personality characteristics, which may be related to the following reasons -

1. Having personality characteristics before the disease

Children often have personality traits such as sensitivity, timidity, shyness, withdrawal, vulnerability, dependence, etc. before the disease. The parents of children often have personality abnormalities and mental disorders.

2. Delayed development and maturity

Although children with this disease have acquired language functions, their start of speaking is significantly delayed compared to normal children, and they are often accompanied by other language problems. It is also often accompanied by other developmental disorders such as functional enuresis and functional enuresis, and the electroencephalogram of some children shows immature electroencephalogram and other abnormal changes.

3. Psychosocial factors

Children often experience emotional trauma in their early years, such as family conflicts, parental discord, parental separation and divorce, parental child abuse, and sudden changes in the family environment. Etc., some children develop the disease after a change in the family environment or an obvious mental stimulation.

About the diagnosis of selective mutism in children

The accurate diagnosis of selective mutism in children is very difficult and requires a comprehensive examination and evaluation, including neurological examination, psychiatric examination, Hearing examination, social communication ability examination, learning ability examination, language and speech examination and various related objective examinations. At present, relevant experts in the United States believe that there are 5 clinical characteristics that can be used as the basis for diagnosis-

1. "Unable" to speak in situations that require verbal communication, but speaking normally in other environments.

2. The duration exceeds 1 month.

3. No speech impediment, no speech problems caused by speaking a foreign language (or different dialect).

4. It is due to the impact on the child's life due to enrollment or change of school, relocation or social interaction.

5. Do not suffer from developmental or psychological diseases such as autism, schizophrenia, mental retardation or other developmental disabilities.

Differential diagnosis of selective mutism in children

Because selective mutism in children, hysteria in children, catatonia in children, paranoia in children, depression in children, etc. all have mutism, so Identification is particularly important -

1. Selective mutism in children

The high degree of selectivity of "silence" is a characteristic of this disease. The children have normal intellectual development, and the Wechsler Children's Intelligence Test IQ People aged 70 or above are mostly sensitive and shy. The neurological examination was unremarkable and there were no other mental or physical disorders.

2. Hysterical mutism in children

Hysterical mutism often lasts from weeks to months. There is often obvious emotional conflict before the disease, but the mutism is non-selective. Moreover, mutism, like other clinical symptoms, has the characteristics of sudden onset, recovery, and ease of accepting suggestions.

3. Catatonic mutism in children

Children are silent or have fragmented speech, accompanied by rejection, disobedience, stupor, waxy buckling, and impulsivity and other symptoms. Although the child has clear consciousness and no mental retardation, he lacks insight.

4. Delusional mutism in children

In addition to the symptoms of mutism, it is also accompanied by other obvious mental symptoms, such as poor contact with the outside world and lack of affection for anyone. Stupefied expression and strange behavior.

5. Depressive mutism in children

It is characterized by stupor or mumbling, a sad face, sometimes accompanied by paroxysmal anxiety, absolute silence when the condition is severe, and electroshock It can return to normal after treatment.

Children's mutism is a psychological disorder, and psychotherapy should be the main treatment. ?

(1) Avoid mental stimulation. Children who are in the language development period should try to avoid all kinds of mental stimulation. Cultivate children's broad interests and cheerful and open-minded character. ?

(2) Eliminate psychological stress factors, appropriately arrange and improve the living and learning environment, and encourage them to actively participate in various group activities. ?

(3) Transfer method: Don’t pay too much attention to the child’s silence, and avoid forcing the child to speak, which may cause further emotional tension or even resistance. Diversion methods can be adopted, such as parents playing games with their children or going out to play, to disperse their nervousness. ?

(4) Behavior modification is most effective with positive reinforcement. On the basis of emotional relaxation, reward and encourage the child as soon as he opens his mouth to speak; you can also use what the child needs and likes most as a reward condition to let the child speak. ?

(5) Drug treatment: For some children with severe symptoms, if they are excessively anxious, nervous, or fearful, they can take a small amount of anti-anxiety drugs under the guidance of a doctor. ?

With treatment, most children can be cured. Untreated children may remain silent until early adulthood. Some can affect language expression and interpersonal communication skills.

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