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Muteness or mutism () is defined as an absence of speech while conserving or maintaining the ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or
speech and language pathologist Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
s. It may not be a permanent condition, depending on the cause, which might be physical, medical, organic,
psychological Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries between t ...
,
developmental Development of the human body is the process of growth to maturity. The process begins with fertilization, where an egg released from the ovary of a female is penetrated by a sperm cell from a male. The resulting zygote develops through mitosi ...
,
neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
or traumatic. A specific
physical disability A physical disability is a limitation on a person's physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living, such as respiratory disorders, blindness, epilep ...
or
communication disorder A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. The delays and disorders can range from simple sound substitution to t ...
can be diagnosed. Loss of previously normal speech (
aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in th ...
) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons. Treatment or management also varies by cause, determined after a speech assessment. Treatment can sometimes restore speech. If not, a range of assistive and augmentative communication devices are available.


Organic causes

Organic causes of mutism may stem from several different sources. One cause of muteness may be problems with the physiology involved in speech, for example, the mouth or tongue. Mutism may be due to
apraxia Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex or corpus callosum), which causes difficulty with motor planning to perform tasks or movements. The nature of the damage determines the disorder ...
, that is, problems with coordination of muscles involved in speech. Another cause may be a medical condition impacting the physical structures involved in speech, for example, loss of voice due to the injury, paralysis, or illness of the
larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
. Anarthria is a severe form of
dysarthria Dysarthria is a speech sound disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes. In other words, it is a condition in which problems effectively ...
. The coordination of movements of the mouth and tongue or the conscious coordination of the lungs are damaged. Neurological damage due to
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop funct ...
may cause loss or impairment of speech, termed
aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in th ...
. Neurological damage or problems with development of the area of the brain involved in speech production,
Broca's area Broca's area, or the Broca area (, also , ), is a region in the frontal lobe of the dominant hemisphere, usually the left, of the brain with functions linked to speech production. Language processing has been linked to Broca's area since Pierre ...
, may cause muteness. Trauma or injury to Broca's area, located in the left inferior
frontal cortex The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere (in front of the parietal lobe and the temporal lobe). It is parted from the parietal lobe by a groove betw ...
of the brain, can cause muteness. Muteness may follow brain surgery. For example, there is a spectrum of possible neurobehavioural deficits in the posterior fossa syndrome in children following
cerebellar The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...
tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
surgery.


Psychological causes

When children do not speak, psychological problems or
emotional stress In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excess ...
, such as
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, may be involved. Children may not speak due to
selective mutism Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serving as triggers. ...
. Selective mutism is a condition in which the child speaks only in certain situations or with certain people, such as close family members. Assessment is needed to rule out possible illness or other conditions and to determine treatment. Prevalence is low, but not as rare as once thought. Selective mutism should not be confused with a child who does not speak and cannot speak due to physical disabilities. It is common for symptoms to occur before the age of five. Not all children express the same symptoms. Selective mutism may occur in conjunction with
autism spectrum disorder The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
or other diagnoses.
Differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...
between selective mutism and language delay associated with autism or other disorders is needed to determine appropriate treatment. Adults who previously had speech and subsequently ceased talking may not speak for psychological or emotional reasons, though this is rare as a cause for adults. Absence or paucity of speech in adults may also be associated with specific psychiatric disorders.


Developmental and neurological causes

Absence of speech in children may involve
communication disorders A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. The delays and disorders can range from simple sound substitution to t ...
or language delays. Communication disorders or developmental language delays may occur for several different reasons. Language delays may be associated with other developmental delays. For example, children with
Down syndrome Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual di ...
often have impaired language and speech. Children with
autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
, categorized as a neurodevelopmental disorder in the DSM-V, often demonstrate language delays.


Treatment

Evaluation of children with language delays is necessary to determine whether the language delay was caused by another condition. Examples of such conditions are autism spectrum disorder, hearing loss and apraxia. The manner of treatment depends on the diagnosed condition. Language delays may impact expressive language, receptive language, or both. Communication disorders may impact articulation, fluency (
stuttering Stuttering, also known as stammering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the ...
) and other specified and unspecified communication disorders. For example, speech and language services may focus on the production of speech sounds for children with
phonological Phonology is the branch of linguistics that studies how languages or dialects systematically organize their sounds or, for sign languages, their constituent parts of signs. The term can also refer specifically to the sound or sign system of a ...
challenges. Intervention services and treatment programs have been specifically developed for autistic children with language delays. For example,
pivotal response treatment Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that was pioneered by Robert and Lynn Koegel. PRT advocates c ...
is a well-established and researched intervention that includes family participation. Mark Sundberg's verbal behavior framework is another well-established assessment and treatment modality that is incorporated into many applied behavior analysis (ABA) early intervention treatment programs for young children with autism and communication challenges. Treatment for absence of speech due to apraxia, involves assessment, and, based on the assessment,
occupational therapy Occupational therapy (OT) is a global healthcare profession. It involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or ''occupations'', of individuals, groups, or communities. The field of ...
,
physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...
, and/or
speech therapy Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
. Treatment for selective mutism involves assessment, counseling, and positive supports. Treatment for absence of speech in adults who previously had speech involves assessment to determine cause, including medical and surgery related causes, followed by appropriate treatment or management. Treatment may involve counseling, or rehabilitation services, depending upon cause of loss of speech.


Management

Management involves the use of appropriate assistive devices, called alternative and augmentative communications. Suitability and appropriateness of modality will depend on users' physical abilities and cognitive functioning. Augmentative and alternative communication technology ranges from elaborated software for tablets to enable complex communication with an auditory component to less technologically involved strategies. For example, a common method involves the use of pictures that can be attached to velcro strips to create an accessible communication modality that does not require the cognitive or fine motor skills needed to manipulate a tablet.
Speech-generating devices Speech-generating devices (SGDs), also known as voice output communication aids, are electronic augmentative and alternative communication (AAC) systems used to supplement or replace speech or writing for individuals with severe speech impairme ...
can help people with speech deficiencies associated with medical conditions that affect speech, communication disorders that impair speech, or surgeries that have impacted speech. Speech-generating devices continue to improve in ease of use.


See also

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Aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in th ...
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Aphonia Aphonia is defined as the inability to produce voiced sound. Damage to the nerve may be the result of surgery (e.g., thyroidectomy) or a tumor. Aphonia means "no sound". In other words, a person with this disorder has lost their voice. Causes ...
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Augmentative and alternative communication Augmentative and alternative communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. AAC is used by t ...
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Autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
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Deafness Deafness has varying definitions in cultural and medical contexts. In medical contexts, the meaning of deafness is hearing loss that precludes a person from understanding spoken language, an audiological condition. In this context it is written ...
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Developmental disability Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, espe ...
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Dysarthria Dysarthria is a speech sound disorder resulting from neurological injury of the motor component of the motor–speech system and is characterized by poor articulation of phonemes. In other words, it is a condition in which problems effectively ...
*
Dyslalia Dyslalia means difficulties in talking due to structural defects in speech organs, such as sigmatism (defective pronunciation of sibilant sounds, for example "S" pronounced as "TH") and rhotacism, in which the letter "R" pronounced as "I or Y". It ...
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Speech delay Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, ...
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Speech disorder Speech disorders or speech impairments are a type of communication disorder in which normal speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute. Speech skills a ...
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Vocal cord paresis Vocal cord paresis, also known as recurrent laryngeal nerve paralysis or vocal fold paralysis, is an injury to one or both recurrent laryngeal nerves (RLNs), which control all intrinsic muscles of the larynx except for the cricothyroid muscle. Th ...


References

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