Speechlessness causes and therapy

Speechlessness and speech loss
Aphasia means "loss of language". Those affected can no longer really speak, but also hardly write, read or understand spoken language. The cause is always a damage in the brain, for example, as a result of a tumor, a stroke or a cerebral hemorrhage.

contents

• Speechlessness: aphasia
• treatment
• mutism
• symptoms
• An anxiety disorder
• causes
• diagnosis
• hazards
• Mutism therapy
• Recognize mutism
• Mutism and autism
• Notes for teachers
• Help for the families
• Speechlessness and trauma
• Depression and suicide
• suicide risk

Mutism, on the other hand, denotes speechlessness, which has psychological causes. Those affected are inhibited in their language development, they have massive cognitive problems and developmental disorders. Doctors suspect social anxiety and conflict as the source of this disorder.

If sudden speech is impossible, the cause can be organic but also psychological problems. Picture: kieferpix - fotolia

Speechlessness also occurs with different mental disorders - especially as a result of trauma. Traumatized people are often unable to talk about trauma-related events - we then talk about emotional speechlessness. But they also go through phases in which they do not speak and stare into the void.

Also, clinical depression, dissociative disorders, or the borderline syndrome associated with periods in which those affected silent.

The pathological loss of language differs from being silent in social relationships. Partners and families who do not talk about conflicts then sit together at the table and keep silent. Here, however, there is no speechlessness in the organic sense, but a disruption of communication. The many forms of speechlessness require different therapies.

Speechlessness: aphasia

Aphasia usually occurs after a stroke. But also arterioslerosis and diabetes mellitus can change the vessels so that the brain is no longer adequately supplied with blood. Children usually experience aphasia after a traumatic brain injury.

There are several forms of aphasia. In the global form, those affected can barely communicate in words. They only eject fragments of single words and hardly understand the words of others. Often they can only form one syllable, for example pa or ma.

Patients still speak in Broca's aphasia, but their speech falters. Forming words is difficult for them, predicates or subjects are missing in their sentences, and they string together short sentences. But they know what they want to express.

Wernicke aphasia expresses itself completely differently. The affected are in their flow of words hardly to stop. In doing so, they are constantly confusing words, turning letters back and forth, inventing words that are meaningless to outsiders, and making unintelligible sounds. They themselves do not realize that their language is disturbed.

Amnestic aphasia is associated with memory loss. Those affected will have no trouble reading, writing and understanding the words of other people. But they are missing, usually triggered by a brain-skull trauma, many terms. Although they know what they want to express, they have forgotten the right words. That's why they pause to speak, search for the right word, and rewrite what they want to say as someone who learns a foreign language. It does not have to be complicated technical terms - they also forget everyday words such as dog or sofa.

treatment

Aphasia occurs in a variety of forms and therapies to heal it are just as varied. The victims should be able to communicate again. In the first month, almost all therapies are about stimulating the language of patients.

Above all, speech therapists and speech scientists are in demand. In addition, music and painting therapy bring good results. Many sufferers can reactivate their language skills by singing songs. For melodies store the brain above all in the "old centers", that is, in associative thinking, while the content of spoken and written sentences deals with analytical thinking.

Even those who are severely speech impaired can form words when singing if their right brain is intact. You can even learn new texts through rhythm and melody.

A painting therapy opens a creative outlet to alleviate the social consequences of global aphasia. Language is the motor of communication for people. Who can not speak, participates in the social life only very limited. When patients paint, they find an alternative to express their thoughts and feelings. They use a non-verbal language.

Speech therapy leads again to obtaining syllables. Picture: photowahn - fotolia

A study by the University of Rome Tor Vergata showed that after a stroke, patients recover much better when they are involved in art, painting or theater. The treatment of speechlessness includes ergo-therapy, physiotherapy and physiotherapy.

The first treatments start in the acute hospital. The doctors clarify here which basic disease is present and the speech and ergotherapy begins.

The rehabilitation clinics then offer a comprehensive program. These include massage and baths as well as occupational therapy and neuropsychological training to restore brain function. The treatment often takes years, and after discharge from the rehabilitation clinic is often on an outpatient treatment.

Short-term successes can not be expected from patients, relatives and doctors. On the contrary: to improve aphasia requires above all patience. The loved ones and therapists need to listen attentively, they also need to verbally support those affected, help them and accept them with their problem.

mutism

Mustism comes from the Latin word mutus, and that means dumb. However, sufferers of this disorder are not dumb in the organic sense. They can speak, but they are silent for fear.

Mutimus is a language disorder that develops in childhood. The children "fall silent" in situations that are filled with fear for them. They increasingly isolate themselves, and because they lack the exchange with their peers, they remain behind in social learning. Their social behavior develops little, their emotions often remain unreflected.

In puberty, the victims are mostly outsiders; they fail at school and work, and they suffer from depression. The suicidal risk is high.

Mutant children are different from the timid in that they can not consciously decide if they are silent. Shy children sometimes do not open their mouths in the presence of strangers. But when other people talk to them, they answer. Mutismic patients can not do this deliberately.

symptoms

Those afflicted suffer from excessive fears as young children: they cling to their parents, can not stand it without being the mother; they withdraw; they go to sleep badly; they are prone to outbursts of anger and crying.

In kindergarten, when children usually play with their peers and discover the world outside, their rhetoric reinforces their inability to speak. There is also a rigid posture, an empty look; they look away when others look into their eyes; they do not laugh loudly in public.

An anxiety disorder

Feared people have a low threshold in the amygdala. This amygdala emits nerve impulses that signal danger. Evolutionary that was important because it allows us to escape quickly from a threatening situation, and the metabolism is running at full speed and sharpens the senses.

For anxious people, the amygdala reacts more intensely than it would need for self-protection. The danger he indicates is not really there.

Children who suffer from selective mutism perceive social contact as a danger: In kindergarten, at school, at the teacher, caretaker or neighbors runs the brain's anxiety program. Making fun of it is not appropriate: although the danger is not real, it is the feelings of fear.

Even if the child knows rationally that he is not in any danger, the palms of his hands sweat, he wants to escape the situation, his heart races and his speech stops. The child becomes silent in order to escape the anxiety associated with communication through speech for it.

causes

Mutism is considered a social anxiety disorder. For those affected, the fear center in the brain reacts. It is mostly selective mutism: the language is left out when the child has to talk to people who are not part of the closest family.

Most people who suffer from the disorder have a genetic attachment to anxiety. Fear of strangers and situations is born of them.

Mutism is also associated with speech problems. Many children who suffer from this disorder also have common language disorders.

Almost all people who suffer from selective mutism have at least one parent who is also socially isolated. 3 out of 4 parents even have an anxiety disorder. As usual, the question of the genetic basis can not be clarified: did the children develop their disorder because the parents conveyed the anxiety behavior to them? Or did they inherit the behavior?

Most importantly, though there is overlap in symptoms, mutism has nothing to do with abuse or trauma. Unfortunately, parents who seek help are sometimes suspected of neglecting or even abusing their children.

diagnosis

Unfortunately, among many doctors, mutism is unknown. However, language doctors and child psychologists usually know the pattern. Psychiatry, psychology and speech therapy are the subjects that deal with mutism.

hazards

Mutism is recognized as a disorder and has serious social consequences if not detected early. The children do not cause any trouble, but miss opportunities for life and enjoy little childhood, because they exclude themselves from social actions.

In school they become outsiders, they do not participate orally and therefore get bad grades, and in puberty explode the mental health problems. Mutism is now becoming a major social phobia, and speechlessness is linked to clinical depression.

Therapies should start in the kindergarten, in the affected person need special therapy and school attendance for each level.

Mutism therapy

Various therapies lead to success in those affected. In the past, children with this disorder often came into analytic play therapy because the professionals interpreted the disorder as a result of an infantile trauma. This diagnosis is considered false today.

Other physicians suspected conflicts in the family and worked through the relationship dynamics and projections of the parents in family therapies. This therapy is also useful for a genetic disposition. Since the fathers and mothers of the affected suffer from similar problems, the dynamics in the family certainly plays a role in how the disorder develops.

However, the best results are promised by speech therapy. It does not rummage for patterns of the past, but starts from the now state. Step by step she rebuilds the speech patterns of those affected and helps them cope with the language fears in social groups. For example, the therapist starts by imitating the patient's sounds. Then they form syllables, later words and short sentences. Later, the persons concerned read texts aloud and in the end they should speak freely.

Step by step, the language is learned "new". Image: Photographee.eu - fotolia

In the last phase it goes "into the field". The people involved rehearse real situations: for example, they ask strangers about the time of day or shop at the bakery.

Speech therapy is a behavioral therapy here, and behavioral therapies have also proven useful for controlling mutism. Even behavioral therapists are only secondarily interested in the past causes of harmful behavior. On the other hand, they assume that those affected learned the avoidance behavior and therefore can unlearn it again.

Even more: Speechless people reinforce their fears by their behavior in the long term. Language is always a system of relationships and changes the relationship dynamics. We can not not communicate. Who closes himself, whether willingly, or involuntarily, as if suffering from mutism, signals to others: I do not want to talk to you. For the others, the message comes: I distance myself from you, and that means that the others exclude those affected.

If you do not talk to your classmates, especially during joint celebrations or outings, the others do not invite you to group events. At some point, those affected look at social life only from the outside. The relationships of others become more and more alien to the speechless, making it even more difficult to establish contacts.

Mutants of sufferers show the entire spectrum of closed-mindedness. They stifle the language, the main means of our understanding, but they also freeze their gestures and facial expressions. The others do not know what's going on in them, and that makes them look weird.

The behavioral therapy promotes the desired behavior by shaping. The sufferer takes simple steps towards a different pattern of behavior, the therapist encourages him in, for example, by showing how this behavior has positive consequences.

In chaining, behavioral therapy networks affected individuals with fragments of active communication that already exist. For example, a patient may be speechless when in a group, but hesitantly seeks eye contact. Then the therapist can train specifically to endure this eye contact, to extend it and connect with language, the affected can, for example, only nod to questions or shake his head and later quietly answer yes or no.

During the prompting, the therapist deliberately directs the attention of the affected person to a specific behavior in order to prepare or accelerate a changed behavior. If the patient forms words with his lips without speaking, he may ask him, "Please say that out loud."

If the therapy starts, the fading out begins. The therapist now slowly but surely takes the supports back until those affected use their new behavior in everyday life.

Psychiatry and Neurology focuses on the neurobiological and biochemical dimension of the disorder. If the anxiety center is hypersensitive, serotonin levels are low. Serotonin reuptake inhibitors cause serotonin to increase in brain metabolism.

Such agents are effective against depression, anxiety disorders, anxiety disorders, Boderline syndrome and post-traumatic disorders and also against mutism. However, drug treatment alone is dangerous in all these diseases. Whether organically conditioned or not, mental disorders have enormous social implications, and the learned avoidance behavior in speechless individuals can not be altered by increased serotonin levels.

Today, combined speech and behavioral therapy that supports medication is the best way to treat mutism.

Recognize mutism

Many doctors do not know the disease, and many parents are the same. Mutism as a social disorder can be handled very well if it is detected early. The child can then learn the social patterns in good time; it only becomes difficult when they solidify.

Parents and teachers should be aware of the following symptoms:

1) If a child dies in certain situations or against certain people without a general speech disorder?

2) If the child talks a lot (and at ease) to people they trust, it stops when strangers arrive?

3) If the child hardly participates in actions of peers, but is constantly in the focus of the family?

4) Prevents the child from testing his or her physical abilities, be it cycling, running or climbing?

Mutism and autism

Also autistic children often do not speak, incomprehensible, or they close to strangers. It is very hard for laypersons to tell if a child suffers from mutism or autism disorder such as Autism or Asperger.

Three features, however, significantly differentiate autistic from mutismic patients:

1) Autistic children always withdraw, they always avoid contacts and always ward off stimuli from their environment. In contrast to patients with mutism, they build their own world and thus stimulate themselves. Mutants, on the other hand, remain silent about classmates, teachers and strangers, but are extremely affectionate towards their parents.

2) That also applies to the feelings. Autists are already "cold" as babies; they have an abstract relationship to their parents and siblings. Mutants, on the other hand, are very emotional in the family when the fear center does not report a threat.

3) Autistic people usually suffer from a speech disorder at the neurolinguistic level. Their language differs massively from others when it comes to communication in everyday life; Often they develop their own grammar and unusual language characters. They learn language as social communication like a telephone book, without grasping the sensual content.

But mutists have no organic disorder to learn language, but inhibitions to use it. They are often very good at school and thus compensate for their silence if they are to contribute verbally.

Notes for teachers

Teachers who do not know the incident are overwhelmed with mutist children. Unfortunately, they often behave completely wrongly towards those affected. A child who does not speak is traditionally regarded as obdurate, even when the times are over when a "proper beating" was considered the number one means to force children to speak.

But mutists are not truants who want to show teachers that they reject communication - they can not help but be silent.

To keep the disorder secret is the wrong way. All adults who are in contact with the child at school must know about the behavioral pattern and not force the child to speak.

1. You should, on the other hand, praise it when it speaks.

2. Teachers should be aware of whether classmates are bullying or marginalizing the child.

3. The child should stay in the normal classroom.

4. Teachers can offer the child equivalent tasks in which they do not need to speak: painting, writing, reading or playing.

5. Teachers can kindly support the child to play with other children, for example to paint with them.

6. The child can use computers to communicate, or even symbols and gestures.

7. Group work can break the boundaries that the language barrier sets.

8. The child can sit with children who are not afraid of it and the working group should not change.

Help for the families

To overcome mutism, the family is the linchpin, especially in the early years. Many parents get used to a behavioral pattern that seems to protect the child, but makes the disorder worse: they know about the child's fears of social relationships outside the family. Because it is so difficult for the child to talk to strangers, they themselves speak - even to the doctor, therapist or teacher.

As a result, the child remains trapped in his speechlessness. Parents, on the other hand, have to support the child to speak for themselves, and, as hard as it may seem, it exposes them step by step to situations in which they can manage their anxiety.

You must not grant the "sensitive" child at home any privileges.

Conversely, parents should not exert excessive pressure. If the child does not speak, it is not because he does not feel like it, but because he can not talk because of his fear. When parental pressure builds up additional stress, it only worsens the symptoms.

Above all, parents need to know that coming out of the snail shell is a long process in which success is only very hesitant.

Speechlessness and trauma

Mutism is probably not due to traumatic experiences. But traumatization can also lead to speechlessness.

Brain research today explains why that is. Amygdala and hippocampus are the regions of the brain that are most important for the symptoms of traumatized individuals. The amygdala processes reactions to experiences that have been associated with strong emotions and saves them. The hippocampus processes conscious memories and rearranges them.

The hippocampus can no longer fulfill its function under stress, because an increased secretion of cortisol then suppresses its activity. That's probably why people with post-traumatic stress syndrome suffer from distorted memories. The Brocasche center in the left half of the cortex controls the linguistic expression. During a traumatic event, it is inhibited as well as the hippocampus. In the traumatic situation we are therefore speechless.

However, since the traumatized situation in the brain is repeated in the traumatized person with corresponding triggers, the words are also missing.

In these phases, outsiders best deal with those affected by giving them the opportunity not to express their feelings verbally. This is true for therapists, but especially for traumatized persons in court.

Depression and suicide

People who suffer from clinical depression, bipolars in a depressive state and borderline patients also go through periods when they are more or less speechless.

Depressed people report a wall between them and the outside world; they feel a wall between themselves and other people, which they can not break communicatively.

However, while they are barely able to speak and often merely expel phrases of sentences, stammer, or remain silent, many of these patients compensate for their inability to speak by writing. This should definitely be supported by a therapist.

Especially important is the specific speechlessness when it comes to the disorder. When affected people are referred to depression, they often sting in the air, say nothing, and can not say anything.

suicide risk

Therapists should speak openly in this phase that those affected may be in suicidal motion. Suicide is often announced by a withdrawal from communication and in particular the breaking off of speech.

Angry people tell of an "other world" they were in, in which they no longer really seem to communicate about everyday life, that is, real social relationships. A stare that seems to look into the other world joins in speechlessness.

To think that talking about the danger only fuels suicidal intent is wrong. Unconscious suicidal phases, collapse of communication and loss of linguistic understanding go hand in hand. Talking about the danger alone often builds the bridge for those affected to get back to "this world". (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)