Down Syndrome and Selective Mutism
13 and 14 may 2010
Wies Laurijssens, speech therapist
Marijke Tonino, MD.PhD
Bridge 2010, Bristol
Case Sarah
Symptoms
1. Language comprehension is very good
2. There is no evidence or indication for a
communication disorder or a psychotic
disorder.
© Laurijssens, Ipse de Bruggen
3. She could not take part in specific
verbal work situations
4. Duration of several years
5. She did speak at home and on holiday
but not at the daycentre
© Laurijssens, Ipse de Bruggen
Aspects of communication
• vulnerable in their expressive language
• speech tends to be unintelligible
• language comprehension is of a higher level
than the level of expressive language
•particular vulnerability in the capability to
cope with stress
© Laurijssens, Ipse de Bruggen
Selective Mutism
The cardinal characteristic:
persistent failure to speak in specific
social situations
© Laurijssens, Ipse de Bruggen
And
the diagnosis does not exclude other
forms of communication, such as
gesturing, shaking the head, pulling or
pushing, or grunting.
© Laurijssens, Ipse de Bruggen
DSM-IV Selective Mutism
1. a persistent failure to speak in specific social
situations in which speech is typically expected,
despite speaking in other situations
2. It is not the result of an organic inability to
understand language or a lack of knowledge of , or
comfort with, the spoken language in the social
situation
© Laurijssens, Ipse de Bruggen
3. it interferes with educational or occupational
achievement or with social communication
4. the duration is at least 1 month, not including the
first month of school
© Laurijssens, Ipse de Bruggen
5. the disturbance is not be better
accounted for by a communication
disorder (e.d. stuttering) and does not
exclusively occur during the course of
a pervasive developmental disorder,
schizophrenia, or other psychotic
disorder
© Laurijssens, Ipse de Bruggen
Case Kelly
DSM-IV
1. Failure to speak in
social situations
2. not the result of an
organic inability to
understand
language
Symptoms
1. speaks in a
microfone and
telephone. She uses
other communication
forms actively
2. wordvocabulary 8;1
years. She can read
and write.
© Laurijssens, Ipse de Bruggen
3. interferes with
occupational
achievement or with
social communication
4. the duration is at least 1
month
5. It is not because of a
communication disorder
and does not
exclusively occur during
the course of a
pervasive
developmental disorder
3.She could no longer work
at the social work place
4. It started in 1995 till now
5. There is no evidence for
dementia and depression
© Laurijssens, Ipse de Bruggen
Hypothesis Diagnosis
The diagnosis Selective Mutism can be
used with adults with Down Syndrome
© Laurijssens, Ipse de Bruggen
Wies.Laurijssens@ipsedebruggen.nl
Ipse de Bruggen
Brasserskade 4
2631 NC Nootdorp
Wies.Laurijssens@ipsedebruggen.nl
Ipse de Bruggen
Brasserskade 4
2631 NC Nootdorp
Treatment (best practice)
We think treatment should not only include
pharamcological treatment but also psycho
education, restructuring of environment,
lowering of demands.
Also we recommend the use of augmentative
or alternative communication (AAC) to
enhance and to fascilitate speech, to
structure life and life events.
© Laurijssens, Ipse de Bruggen
To empahsize only the verbal communication
lays an extra limitation in the
communication and enhances the
overloading of the person
© Laurijssens, Ipse de Bruggen