Cases reported "Mutism"

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1/10. Treating selective mutism in a paediatric rehabilitation patient by altering environmental reinforcement contingencies.

    Selective mutism is a disorder which can cause severe social and academic impairment, and for which a wide variety of treatment approaches have been used, with varying degrees of success. Selective mutism can be conceptualized as the lack of generalization of a class of operant responses (e.g. audible and comprehensible verbalizations) across environmental contexts. The rehabilitation hospital setting, in which the patient is seen daily by multiple people in multiple settings, is particularly well-suited for implementing a systematic behavioural intervention to establish verbal behaviour and simultaneously reinforce its generalization. Data are presented on a 7-year-old female admitted to a rehabilitation hospital following orthopaedic surgery, who met the DSM-IV diagnostic criterion for selective mutism. Additional medical diagnoses included cerebral palsy, microcephaly, and mild mental retardation. A behavioural programme was developed and implemented to reinforce differentially first any communication, then verbal communication across staff and settings. Results were evaluated using a modified multiple baseline across settings design, and demonstrate that verbal, written, and tangible reinforcement effectively increased verbal behaviour where it previously rarely occurred. Results are discussed in terms of the relationship between selective mutism, social phobia and related disorders. The theoretical roles of behavioural phenomena (discriminative stimuli, stimulus generalization) in the development and treatment of these disorders are discussed.
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ranking = 1
keywords = communication
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2/10. Elective mutism: origins in stranger anxiety and selective attention.

    Through a focus on the events of early infancy, the author interprets elective mutism on the basis of the infant's responses to discrepancies from expected stimuli. Initially, the child's silence derives from a "freezing" of action when exposed to perceived danger. Subsequently, aberrant or fearful stimuli are minimized by the child's apparent unresponsiveness. Through identification with the parent, the child imbues elective mutism with information value as a pause to signal impending communication. mutism later represents an identification that is displaced from the parent to "stranger" adults.
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keywords = communication
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3/10. Unexpected recovery of functional communication following a prolonged period of mutism post-head injury.

    A case is presented of a seven-year-old female who showed an unexpected recovery of functional communication skills following a prolonged period of traumatic mutism subsequent to a severe closed head injury. The patient initially presented as comatose. A period of mutism subsequent to the coma extended for ten months. Following this protracted period of mutism the child demonstrated rapid and unexpected recovery of functional communication skills, despite the persistence of higher level language deficits. The findings of a neurological assessment, neuroradiological assessment and battery of speech/language tests are described. The present case is discussed in light of the existing literature on recovery from paediatric head trauma.
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ranking = 3
keywords = communication
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4/10. Communication training in mute autistic adolescents using the written work.

    The expressive and receptive use of three written words was taught to three mute autistic adolescents using a procedure based on Terrace's errorless discrimination model and Premack's language training with chimps. Expressive language was measured by the subject's selection of the appropriate word card from among the available alternatives when the corresponding object was presented. Receptive language was measured by the subject's selection of the appropriate object from among the available alternatives when the corresponding word card was presented. The sequence of the presentations and the order of placement of the available alternatives were randomized. The three subjects required 979, 1,791, and 1,644 trails, respectively, to master both the expressive and receptive use of the three words. The correct response rates for the three subjects over the entire training program were 92, 92, and 90%, respectively. It was concluded that, as concrete visual symbols, written words may provide a viable communication system for the mute autistic. The implications for treatment are discussed and suggestions for future research are made.
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ranking = 0.5
keywords = communication
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5/10. mutism after closed head injury.

    Prospective study of patients admitted to a hospital for closed head injury showed that nine patients (nearly 3%) became mute for varying periods despite recovery of consciousness and communication through a nonspeech channel. Computed tomography (CT) showed subcortical lesions situated primarily in the putamen and internal capsule of four patients, whereas four of the five patients without subcortical lesions had left-hemisphere cortical injury. The patients without subcortical injury visualized by CT exhibited a longer duration of impaired consciousness consistent with severe diffuse brain injury and they showed more long-term linguistic deficits. We related our findings to recent studies of atypical aphasia after occlusive vascular lesions of the basal ganglia.
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keywords = communication
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6/10. A simultaneous treatment comparison of three expressive language training programs with a mute autistic child.

    A study was conducted in order to simultaneously compare the relative effectiveness of three different language training models (total communication sign training, nonverbal "sign-alone" training, and oral [vocal] training) for teaching expressive language skills to a 4 1/2-year-old mute autistic child. A single-subject, alternating-treatment (multielement) design with replication within subject was used to compare the rate of expressive word acquisition across training models. Results show the total communication model to be substantially superior to both oral and sign-alone training models, and place in question the theory of an intersensory integration disability to explain the success of sign language. Alternatively, the data suggest that the use of physical prompts combined with multisensory inputs provide a basis for the demonstrated success.
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ranking = 1
keywords = communication
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7/10. mutism and auditory agnosia due to bilateral insular damage--role of the insula in human communication.

    We report a case of transient mutism and persistent auditory agnosia due to two successive ischemic infarcts mainly involving the insular cortex on both hemispheres. During the 'mutic' period, which lasted about 1 month, the patient did not respond to any auditory stimuli and made no effort to communicate. On follow-up examinations, language competences had re-appeared almost intact, but a massive auditory agnosia for non-verbal sounds was observed. From close inspection of lesion site, as determined with brain resonance imaging, and from a study of auditory evoked potentials, it is concluded that bilateral insular damage was crucial to both expressive and receptive components of the syndrome. The role of the insula in verbal and non-verbal communication is discussed in the light of anatomical descriptions of the pattern of connectivity of the insular cortex.
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ranking = 2.5
keywords = communication
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8/10. Language acquisition after mutism: a longitudinal case study of autism.

    This longitudinal case study challenges the assumption that individuals with autism who have severely restricted speech and language skills have a poor prognosis for further development of expressive oral language. The study follows the development of a woman with autism from mutism at age 10 to acquisition of a range of spoken and written language skills at age 26. The intervention in which the woman participated and her skills pre- and post-intervention and at two follow-up assessments are documented. The results support the hypotheses that speech and language development may proceed after mutism associated with limited verbal imitation and phoneme production skills, that some skills may plateau or decline, and that both spoken and written language may become viable forms of communication.
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ranking = 0.5
keywords = communication
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9/10. Language, communication, and transference in child analysis. I. Selective mutism: the medium is the message.

    Selective mutism is a psychiatric condition in which children stop speaking to all except their closest family members. Analytic material from a 4 1/2-year-old selectively mute child demonstrates how his symptom of mutism was embedded in a character structure in which not only verbal dialogue but play and other nonverbal communication were disrupted. Because communication was severely limited, I modified my analytic technique. Despite obstacles to communication, conflicts from different developmental levels were revived in the transference. Even in these difficult circumstances, analytic work in the transference resulted in significant change.
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ranking = 3.5
keywords = communication
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10/10. Language, communication, and transference in child analysis. II. Is child analysis really analysis?

    Is child analysis really analysis? The child patient does not free associate, communicates to the analyst in large measure nonverbally, and operates from a different psychic organization than the adult. Nevertheless, child and adult analysis share the same basic principles, despite different techniques. Using clinical examples from Jeremy's analysis, I discuss how child analysis could benefit from greater use of analysis of transference and analysis of defense. I then discuss recent questions about the place of verbalization and interpretation in child analysis. This issue parallels polarities in adult theory concerning insight and relationship. Analysts should pay more attention to the similarities between child and adult analysis, so that information can be shared between both subspecialties.
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ranking = 2
keywords = communication
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