Selective Mutism: Natural Approaches for Vocal Restoration
By Shyron Alston, ND
yet when you directly ask him or her a question there is no response? Do you re- peat the question, assuming the individual has not heard what you said? Do you move forward with the intake and make note of the individual's demeanor? These questions without a doubt leave numerous clinicians pondering what the next course of action might be.
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According to the Diagnostic and Sta- tistical Manual of Mental Disorders, Fifth Edition (DSM-5), selective mutism (SM) is a disorder in which individuals fail to speak in some social settings, despite speaking nor- mally in other settings. SM can signifi cantly interfere with the individual's ability to complete normal daily activities. There has been much debate regarding SM and its for- mal classifi cation. Most recently it has been reclassifi ed from “disorders of childhood and adolescence” to “anxiety disorder.” It is no longer viewed as behavior (opposi- tional defi ance or avoidant behavior) and may coexist with social and developmental disorders, neurocognitive defi cits and even auditory processing disorders.
Girls are twice as likely to exhibit SM compared to boys. Current conventional treatment for SM includes 2 main therapies: cognitive behavioral therapy and pharma- cotherapy, primarily selective serotonin reuptake inhibitors (SSRIs).
Possible Causes of Selective Mutism
Traumatic Events: One of the fi rst things that should be determined is whether a traumatic event has occurred. The trauma need not be physical or sexual. Emotional and verbal abuse can trigger anxiety and therefore infl uence the devel- opment of SM.
hat do you do when your patient or client appears to respond to every instruction you give them
Lead Toxicity: Lead is a heavy metal
known to cause cognitive and neurological issues in children. It crosses the blood- brain barrier, interferes with production and release of brain chemistry molecules (aka neurotransmitters) and neurotrans- mission, and decreases neuronal growth. Paints, soil, toys, and water pipes are com- mon exposures. Chlorella, cilantro, milk thistle, bentonite clay and activate charcoal gently assist lead detox.
Genetics: MTHFR is responsible for
converting a B vitamin called folate into an active, or bioavailable, form that the body can utilize. Methylfolate has two impor- tant functions in the body. The fi rst is to help make neurotransmitters in the brain. Neurotransmitters are brain chemistry molecules that enable us to sleep, express emotion, learn, and respond to stress. The second function of methylfolate is to create another molecule in the body called SAMe, which is responsible for regulating over 200 different enzymes in the body, some of which are linked directly to our abil- ity to detox. COMT assists the body with breaking down catecholamines (dopamine, norepinephrine, and epinephrine).
Variations in another gene, contactin- associated protein-like 2 (CNTNAP2), have been implicated in neurodevelopmental and language impairment disorders and is associated with an increased risk for SM. CNTNAP2 functions in the nervous system as cell adhesion molecules and receptors. Stud- ies have demonstrated high levels of expres- sion in the prefrontal and anterior temporal cortex, caudate, putamen, and amygdala.
Thyroid: The thyroid gland regulates the metabolism of every single cell in the body. Hypothyroidism (underactive thyroid) is relatively common. The gold standard for diagnosis of hypothyroidism by conven-
tional methods is dependent on measuring thyroid markers, primarily thyroid stimulat- ing hormone (TSH), secreted from the ante- rior pituitary. In addition to TSH, T4 and T3 should be measured as part of the thyroid work up. The thyroid gland produces T4 and T3, which exert infl uence on tissues and is absorbed into the cells to initiate intracellular activity. Hypothyroidism may cause hypoglossal motor nerve dysfunc- tion, resulting in language disfl uency.
Iron Status: Iron is a cofactor for sero- tonin production. It is absorbed much more effi ciently from meat products than from plant-based products. Vitamin C can en- hance iron absorption. Best food sources: protein (meat, poultry, fi sh), blackstrap molasses lentils, beans, green leafy veggies. quinoa, almonds, and sunfl ower seeds.
Foundational Support for SM
Diet: The body requires adequate levels of nutrients to function. When it comes to diet, macronutrient (carbohydrates, pro- tein, and fat) balance is essential. Protein is of importance as it has a wide variety of physiological roles. Protein is the building block of DNA, our genetic profi le; and helps to transport molecules around the body through the bloodstream and into the cells for metabolism; immune and enzymatic functions; homeostasis, and yes, the forma- tion of neurotransmitters. Inadequate levels of protein can wreak havoc on the body in many ways, including brain function. Many food components are essential, meaning the body cannot make them on its own accord, so we must ensure the foods consumed are supplying those essential nutrients. Phenyl- alanine and tryptophan are essential amino acids required for catecholamine (dopa- mine, norepinephrine, and epinephrine) and serotonin formation, respectively.
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