In human development, muteness or mutism (from Latin mutus 'silent') is defined as an absence of speech, with or without an 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 pathologists . It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma , developmental disorders , or neurological disorders . A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech ( aphasia ) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.
19-513: Muteness is a speech disorder in which a person lacks the ability to speak. Mute or the Mute may also refer to: Muteness 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. Biological causes of mutism may stem from several different sources. One cause of muteness may be problems with
38-681: A neurodevelopmental disorder in the DSM-5 , often demonstrate language delays. 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 ) and other specified and unspecified communication disorders. For example, speech and language services may focus on
57-616: 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 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. Pivotal response treatment Pivotal response treatment ( PRT ), also referred to as pivotal response training ,
76-400: Is child-directed : the child makes choices that direct the therapy. Emphasis is also placed upon the role of parents as primary intervention agents. A 2020 meta analysis which included 5 RCTs concluded there was a statistically significant positive effect of PRT on expressive language skills, social interaction, and reducing repetitive behaviour. However it also notes the quality of evidence
95-436: 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
114-425: Is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that invented by Robert Koegel and Lynn Kern Koegel . PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. It's an alternative approach to ABA from
133-755: 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 , physical therapy , and/or speech therapy . 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 involves
152-518: Is rare as a cause for adults. Absence or paucity of speech in adults may also be associated with specific psychiatric disorders. Absence of speech in children may involve communication disorders 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 often have impaired language and speech. Children with autism , categorized as
171-460: Is used to teach language, decrease disruptive/ self-stimulatory behaviors , and increase social, communication, and academic skills. The two primary pivotal areas of pivotal response therapy are motivation and self-initiated activities. Three others are self-management, empathy , and the ability to respond to multiple signals, or cues. Play environments are used to teach pivotal skills, such as turn-taking , communication, and language. This training
190-403: The natural language procedures to develop verbal communication in children with autism. They theorized that, if effort was focused on certain pivotal responses, intervention would be more successful and efficient. As they saw it, developing these pivotal behaviors would result in widespread improvement in other areas. Pivotal response treatment is a naturalistic intervention model derived from
209-448: The age of five. Not all children express the same symptoms. Selective mutism may occur in conjunction with autism spectrum disorder or other diagnoses. Differential diagnosis 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
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#1732779890985228-403: 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 tumor surgery. When children do not speak, psychological problems or emotional stress , such as anxiety , may be involved. Children may not speak due to selective mutism . Selective mutism
247-431: The coordination of movements of the mouth and tongue or the conscious coordination of the lungs are damaged. Neurological damage due to stroke may cause loss or impairment of speech, termed aphasia . Neurological damage or problems with development of the area of the brain involved in speech production, Broca's area , may cause muteness. Trauma or injury to Broca's area, located in the left inferior frontal cortex of
266-402: The more common form, sometimes called discrete trial training (DTT). Initial attempts to treat autism were mostly unsuccessful and in the 1960s researchers began to focus on behavioral intervention therapies . Though effective, limitations included significant time investment, considerable expense, and limited generalization to new environments. Lynn and Robert Koegel incorporated ideas from
285-407: The physiology involved in speech, for example, the mouth or tongue. Mutism may be due to apraxia , 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 . Anarthria is a severe form of dysarthria , in which
304-655: The principles of applied behavior analysis . Rather than target individual behaviors one at a time, PRT targets pivotal areas of a child's development such as motivation, responsiveness to multiple cues, self-management, and social initiations. By targeting these critical areas, PRT ideally results in collateral improvements in other social, communicative, and behavioral areas that are not specifically targeted. The underlying motivational strategies of PRT are incorporated throughout intervention as often as possible, and they include child choice, task variation, interspersing maintenance tasks, rewarding attempts, mand training, and
323-442: The production of speech sounds for children with phonological challenges. Intervention services and treatment programs have been specifically developed for autistic children with language delays. For example, pivotal response treatment 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
342-425: 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,
361-456: The use of direct and natural reinforcers. The child plays a crucial role in determining the activities and objects that will be used in the PRT exchange. Intentful attempts at the target behavior are rewarded with a natural reinforcer (e.g., if a child attempts to request for a stuffed animal, the child receives the animal, not a piece of candy or other unrelated reinforcer). Pivotal response treatment
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