1. Down Syndrome and Selective Mutism 13 and 14 may 2010 Wies Laurijssens, speech therapist Marijke Tonino, MD.PhD Bridge 2010, Bristol

2. 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. 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

4. 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

5. Selective Mutism The cardinal characteristic: persistent failure to speak in specific social situations © Laurijssens, Ipse de Bruggen

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Hypothesis Diagnosis The diagnosis Selective Mutism can be used with adults with Down Syndrome © Laurijssens, Ipse de Bruggen

13. Wies.Laurijssens@ipsedebruggen.nl Ipse de Bruggen Brasserskade 4 2631 NC Nootdorp

14. Wies.Laurijssens@ipsedebruggen.nl Ipse de Bruggen Brasserskade 4 2631 NC Nootdorp

15. 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

16. To empahsize only the verbal communication lays an extra limitation in the communication and enhances the overloading of the person © Laurijssens, Ipse de Bruggen