You are on page 1of 18

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/334779466

Selective mutism – an overview of the condition and etiology: is the absence


of speech just the tip of the iceberg?

Article in Psychiatria Polska · July 2019


DOI: 10.12740/PP/OnlineFirst/108503

CITATIONS READS

9 1,445

5 authors, including:

Emil Bartosz Rozenek Zuzanna Nowicka

9 PUBLICATIONS 23 CITATIONS
Medical University of Łódź
41 PUBLICATIONS 176 CITATIONS
SEE PROFILE
SEE PROFILE

Napoleon Waszkiewicz
Medical University of Bialystok
238 PUBLICATIONS 3,203 CITATIONS

SEE PROFILE

All content following this page was uploaded by Emil Bartosz Rozenek on 14 May 2020.

The user has requested enhancement of the downloaded file.


Psychiatr. Pol. ONLINE FIRST Nr 141: 1–21 1-17
Published ahead of print 24 July 2019
www.psychiatriapolska.pl
ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE)
DOI: https://doi.org/10.12740/PP/OnlineFirst/108503

Mutyzm wybiórczy – opis zaburzenia i etiologia:


F]\Z\ELyUF]\EUDNPRZ\MHVW]DOHGZLHZLHU]FKRáNLHP
góry lodowej?

Selective mutism – an overview of the condition and etiology:


is the absence of speech just the tip of the iceberg?
Emil Bartosz Ro z en e k 1, Wiktor O rlo f 1, Zuzanna Maria N o w ic k a 2,
.DUROLQD:LOF ]\ Ĕ V N D 3, Napoleon Wa sz k iew ic z 3
1
6WXGHQFNLH.RáR1DXNRZHSU]\.OLQLFH3V\FKLDWULL8QLZHUV\WHW0HG\F]Q\Z%LDá\PVWRNX
2
8QLZHUV\WHW0HG\F]Q\ZàRG]L=DNáDG%LRVWDW\VW\NLL0HG\F\Q\7UDQVODF\MQHM
3
8QLZHUV\WHW0HG\F]Q\Z%LDá\PVWRNX.OLQLND3V\FKLDWULL

Summary
7KHLQDELOLW\WRVSHDNLQFHUWDLQVLWXDWLRQVDVRQHPD\EULHÀ\FKDUDFWHUL]HVHOHFWLYHPXWLVP
60 DFFRUGLQJWRWKHPRVWUHFHQWFODVVL¿FDWLRQV '60,&' EHORQJVWRWKHDQ[LHW\
GLVRUGHUVSHFWUXP7KHRQVHWRIPXWLVPLQHDUO\FKLOGKRRGPD\LPSDLUIXUWKHUGHYHORSPHQW
DQGDGYHUVHO\D൵HFWHGXFDWLRQDODFKLHYHPHQWV,WLVHVVHQWLDOWKDWSV\FKLDWULVWVDVZHOODV
other physicians, speech therapists, nurses and teachers are familiar with this disorder, since
the early start of treatment is associated with better prognosis.
7KLVOLWHUDWXUHUHYLHZDLPVWRSUHVHQWWKHFRQWHPSRUDU\YLHZRIWKLVUHODWLYHO\UDUHSV\FKR-
pathological syndrome. In light of most recent studies on the etiology of SM, the sole symptom
of mutism appears to represent an underlying heterogenic group of disorders. Based on the
GHYHORSPHQWDOSV\FKRSDWKRORJ\WKHLQWHUUHODWLRQVEHWZHHQRYHUODSSLQJDEQRUPDOLWLHVIDYRU
60PDQLIHVWDWLRQLQVRPHFUXFLDOPRPHQWLQDQLQGLYLGXDO¶VOLIH7KHHWLRORJLFFRPSOH[LW\
strongly suggests multimodal approach in the diagnostic and treatment process, which has
been postulated by many authors.
6áRZDNOXF]HPXW\]PZ\ELyUF]\±60]DEXU]HQLDOĊNRZHVSHNWUXP]DEXU]HĔDXW\VW\F]-
nych – ASD
Key wordsVHOHFWLYHPXWLVP±60DQ[LHW\GLVRUGHUDXWLVPVSHFWUXPGLVRUGHU±$6'
2 Emil Bartosz Rozenek i wsp.

Wprowadzenie
Jako pierwszy mutyzm wybiórczy (selective mutism±60 RSLVDáZURNX
.XVVPDXORNUHĞODMąF]DEXU]HQLHMDNRaphasia voluntaria. W 1934 roku Tramer za-
SURSRQRZDáWHUPLQelective mutism2ELHQD]Z\PLDá\SRGNUHĞODüĞZLDGRPąRGPRZĊ
PyZLHQLD Z NRQWDNWDFK ] ZLĊNV]RĞFLą RVyE FR WáXPDF]RQR SUyEDPL Z\ZLHUDQLD
ZSá\ZXRFKDUDNWHU]HPDQLSXODF\MQ\P-HV]F]HSRGNRQLHFXELHJáHJRVWXOHFLD60
UR]SDWU\ZDQRMDNRRGPLDQĊ]DFKRZDĔRSR]\F\MQREXQWRZQLF]\FK>@'RSLHURZUD]
]XDNWXDOQLHQLHPNODV\¿NDFML'60SU]H]$PHU\NDĔVNLH7RZDU]\VWZR3V\FKLDWU\F]QH
ZURNX '60,9 GRV]áRGR]PLDQ\WHMNRQFHSFMLF]HJRZ\NáDGQLNLHPE\áD
]DPLDQDVáRZDelective na selective2GWHJRPRPHQWXEUDNPRZ\Z60QLHE\áWUDN-
WRZDQ\MDNRĞZLDGRP\]DPLDUDQRZRZSURZDG]RQDQD]ZDSRGNUHĞODáDĪHPXW\]P
SRMDZLDVLĊMHG\QLHZZ\EUDQ\FKV\WXDFMDFK QSZV]NROH >@
2VWDWQLHODWEDGDĔQDGPXW\]PHPZ\ELyUF]\PGRVWDUF]\áRGRZRGyZQDWR
ĪH RGF]XZDQLH Z\VRNLHJR SR]LRPX OĊNX MHVW ZLRGąFą FHFKą WHJR ]DEXU]HQLD >@
6SRZRGRZDáRWR]PLDQĊMHJRSR]\FMLZQDMQRZV]HMZHUVMLNODV\¿NDFML'60>@LSOD-
QRZDQHMGRZGURĪHQLD,&'>@JG]LH60]RVWDáZáąF]RQ\GRVSHNWUXP]DEXU]HĔ
OĊNRZ\FK:LHOHSUDFZVND]XMHQDLVWQLHQLHSRZLą]DĔPLĊG]\60DIRELąVSRáHF]Qą
(social phobia – 63 MHGQDNĪHW\ONRZQLHNWyU\FKEDGDQLDFKSRUyZQDZF]\FKZV]\VWNLH
G]LHFL]60VSHáQLDá\MHMNU\WHULD>@:RVWDWQLFKODWDFKGRPLQXMąFąWHRULąQDWHPDW
HWLRORJLL 60 VWDMH VLĊ WHRULD RSDUWD QD SV\FKRSDWRORJLL UR]ZRMX NáDGąFD QDFLVN QD
ZLHORF]\QQLNRZRĞü HWLRORJLF]Qą> @ &]\QQLNL WH QS KDPRZDQLH EHKDZLRUDOQH
ZVSyáWRZDU]\V]ąFH]DEXU]HQLDUR]ZRMX F]ĊVWRVWDQRZLąIXQGDPHQWUR]ZRMXOĊNXFR
XPDFQLD]QDF]HQLHVNáDGRZHMOĊNRZHM60>@1LHMHVWMDVQHF]\60MHVW]DEXU]HQLHP
psychicznym per seF]\URG]DMHPZ\XF]RQHJR]DFKRZDQLDXQLNDMąFHJR>@1DM-
VNXWHF]QLHMV]\PLPHWRGDPLOHF]HQLD60RND]XMąVLĊWHNWyUHVąVWRVRZDQHZLQQ\FK
G]LHFLĊF\FK]DEXU]HQLDFKOĊNRZ\FK>@

Cel i struktura pracy


&HOHPQLQLHMV]HJRSU]HJOąGXDNWXDOQHMOLWHUDWXU\SU]HGPLRWXMHVWSU]HGVWDZLHQLH
ZVSyáF]HVQHJRVSRMU]HQLDQDPXW\]PZ\ELyUF]\SRVWXOXMąFHJRXMDZQLHQLHVLĊRPD-
ZLDQHJR ]DEXU]HQLD Z Z\QLNX Z]DMHPQHJR RGG]LDá\ZDQLD RUD] QDZDUVWZLDQLD VLĊ
F]\QQLNyZSUHG\VSRQXMąF\FK]ZLą]DQ\FKUyZQLHĪ]HWLRSDWRORJLąOĊNX$E\]ZLĊNV]\ü
SU]HMU]\VWRĞüRSLVXSUDFD]RVWDáDSRG]LHORQDQDF]ĊĞFLWHPDW\F]QHWDNLHMDNV\PSWR-
PDWRORJLDLGLDJQRVW\NDZVSyáFKRURERZRĞüHSLGHPLRORJLDHWLRORJLDLOHF]HQLH1D
NRĔFXSU]HJOąGX]QDOD]áRVLĊSRGVXPRZDQLHRUD]]HVWDZLHQLHF]\QQLNyZNWyUHPRJą
SUHG\VSRQRZDüGRXMDZQLHQLDVLĊ60

0DWHULDáLPHWRG\
3U]HJOąG]RVWDáRSDUW\QDED]DFK0('/,1(RUD]:HERI6FLHQFH]Z\NRU]\-
VWDQLHP KDVHá Z\V]XNLZDQLD ]ZLą]DQ\FK ] DNWXDOQ\P QD]HZQLFWZHP MHGQRVWNL
FKRURERZHM selective mutism). Przeanalizowano prace na temat symptomatologii,
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 3

GLDJQRVW\NL FKRUyE WRZDU]\V]ąF\FK HSLGHPLRORJLL HWLRORJLL L OHF]HQLD PXW\]PX


:SU]HJOąG]LHXZ]JOĊGQLRQRSUDFHRU\JLQDOQHRSLVXMąFHEDGDQLDSU]HSURZDG]RQH
QDUHSUH]HQWDW\ZQ\FKJUXSDFKRUD]QDMZDĪQLHMV]HSUDFHSRJOąGRZH

Symptomatologia i diagnostyka
6áRZRÄPXW\]P´ áDFmutismus UR]XPLDQHMHVWMDNREUDNNRQWDNWXZHUEDOQHJR
SU]\QLHXV]NRG]RQ\FKRĞURGNDFKPRZ\>@2NUHĞOHQLHÄZ\ELyUF]\´ZW\PNRQWHNĞFLH
R]QDF]DĪHXWUZDORQDQLHPRĪQRĞüPyZLHQLD]DFKRG]LMHG\QLHZZ\EUDQ\FKĞURGRZL-
VNDFKVSRáHF]Q\FK QSZV]NROH OXEZREHFQLHNWyU\FKRVyESRGF]DVJG\ZLQQ\FK
RNROLF]QRĞFLDFK ]D]Z\F]DMZGRPXZRGQLHVLHQLXGRQDMEOLĪV]\FKF]áRQNyZURG]LQ\ 
FKRU\QLHRGF]XZDWDNLHMQLHPRĪQRĞFLLQLHZ\ND]XMHFHFKPXW\]PX>@
=JRGQLH]'60RSLV\ZDQ\]HVSyáSV\FKRSDWRORJLF]Q\PRĪHE\üGLDJQR]RZDQ\
QDNDĪG\PHWDSLHUR]ZRMXF]áRZLHNDSRGZDUXQNLHPĪHQLH]QDMG]LHVLĊOHSV]HJR
Z\WáXPDF]HQLD VWZLHUG]DQ\FK REMDZyZ SU]H] ]DEXU]HQLH NRPXQLNDFML ]DEXU]HQLH
MĊ]\NDLOXEPRZ\ 0XW\]PZ\ELyUF]\QLHSRZLQLHQVWDQRZLüWHĪREMDZXFDáRĞFLR-
ZHJR]DEXU]HQLDUR]ZRMX QSDXW\]PG]LHFLĊF\ F]\LQQ\FK]DEXU]HĔSV\FKLF]Q\FK
QS VFKL]RIUHQLD  1DMF]ĊĞFLHM 60 XMDZQLD VLĊ Z RNUHVLH ZF]HVQHJR G]LHFLĔVWZD
FR F]ĊVWR NRUHOXMH ] UR]SRF]ĊFLHP QDXNL SU]HGV]NROQHMV]NROQHM -HVW WR ]ZLą]DQH
]SRMDZLHQLHPVLĊSLHUZV]\FKSRZDĪQLHMV]\FKWUXGQRĞFLQDWOHVSRáHF]Q\PLHGXND-
F\MQ\P]NWyU\PL]PDJDVLĊG]LHFNR'ODZLHOX]GURZ\FKG]LHFLSLHUZV]\NRQWDNW
]HĞURGRZLVNLHPV]NROQ\PPRĪHE\üGRWHJRVWRSQLDVWUHVXMąF\ĪHEĊGąRQHFKZLOR-
ZRSUH]HQWRZDüREMDZ\60=WHJRSRZRGXNU\WHULDGLDJQRVW\F]QH60Z\PDJDMą
VWZLHUG]HQLDXWU]\P\ZDQLDVLĊZ\ELyUF]HJREUDNXPRZ\SU]H]FRQDMPQLHMPLHVLąF
=D60QLHXZDĪDVLĊWDNĪHWDNLHJRQLHPyZLHQLDNWyUHMHVWZ\QLNLHPQLH]QDMRPRĞFL
GDQHJRMĊ]\NDLPLMDSRXSá\ZLHF]DVXSRWU]HEQHJRGRMHJRQDXNL QSLPLJUDQFL >@
%UDNPRZ\RJUDQLF]D]GROQRĞüXF]HQLDVLĊZSá\ZDMąFQDRVLąJQLĊFLDHGXNDF\MQH
G]LHFND>@:\ELyUF]RPXW\VW\F]QHG]LHFLPRJąVSHáQLDüGRGDWNRZRNU\WHULD]DEXU]HĔ
NRPXQLNDFML QDZHW]QLFKZQRUZHVNLPEDGDQLXZSRUyZQDQLXGRG]LHFL
]JUXS\NRQWUROQHM>@1LHNLHG\FKRU]\]DPLDVWSRVáXJLZDüVLĊPRZą ZZ\EUDQ\FK
V\WXDFMDFK PRJąSRGHMPRZDüSUyE\NRPXQLNDFMLQLHZHUEDOQHM QSNLZDQLHJáRZą
F]\JHVW\NXODFMH 1LHMHVWWRMHGQDNFKDUDNWHU\VW\F]QHGODZV]\VWNLFKG]LHFL]60
>@1DOHĪ\]D]QDF]\üĪHF]ĊVWRGRFKRG]LGRXWUZDOHQLDVLĊQLHZáDĞFLZ\FK]DFKRZDĔ
PLPRXVWĊSRZDQLD]ZLHNLHPVDPHJRPXW\]PX>@

:VSyáFKRURERZRĞü
= 60 ZVSyáZ\VWĊSXMą F]ĊVWR LQQH ]DEXU]HQLD OĊNRZH RUD] ]DEXU]HQLD F]\
RSyĨQLHQLH UR]ZRMX 3RWZLHUG]D WR PLQ EDGDQLH SRUyZQDZF]H .ULVWHQVHQ >@
XZ]JOĊGQLDMąFHJUXSĊQRUZHVNLFKG]LHFL]60RĞUHGQLHMZLHNXZ\QRV]ąFHMODW
6WZLHUG]RQRĪHG]LHFL]60VSHáQLD]DUyZQRNU\WHULD]DEXU]HQLDOĊNRZHJR
MDNL]DEXU]HQLDF]\RSyĨQLHQLDUR]ZRMXZSRUyZQDQLXGR]DOHGZLHZJUXSLH
NRQWUROQHM=JRGQLH]NU\WHULDPL'60,9 NU\WHULDGLDJQRVW\F]QH60Z'60QLH
XOHJá\]PLDQLH XG]LHFL]60ZVSyáZ\VWĊSRZDáOĊNVSRáHF]Q\X]HVSyá
4 Emil Bartosz Rozenek i wsp.

OĊNXVHSDUDF\MQHJRX]HVSyáOĊNXXRJyOQLRQHJRLXIRELDVSHF\¿F]QD>@
=NROHLZEDGDQLXSU]HSURZDG]RQ\PSU]H]&KDYLUĊLZVS>@ZĞUyGG]LHFL]60
RĞUHGQLHMZLHNXODWZV]\VWNLHEDGDQHG]LHFLVSHáQLDá\NU\WHULD63D]QLFK
GRGDWNRZR]HVSyáOĊNXVHSDUDF\MQHJR:REXEDGDQLDFKRGVHWHNG]LHFL]60VSHáQLD-
MąF\FKNU\WHULD]DEXU]HĔOĊNRZ\FKUyĪQLáVLĊ]QDF]QLHRGJUXS\NRQWUROQHM]Z\MąWNLHP
OLF]E\GLDJQR]IRELLVSHF\¿F]QHMZEDGDQLX.ULVWHQVHQ>@'RPLQXMąF\PL]D-
EXU]HQLDPLUR]ZRMXZEDGDQLXWHMDXWRUNLRND]Dá\VLĊ]DEXU]HQLDNRPXQLNDFMLNWyUH
GRW\F]\á\DĪG]LHFL]60>@,VWQLHMąUyZQLHĪLQQHGRQLHVLHQLDSRWZLHUG]DMąFH
ZVSyáZ\VWĊSRZDQLHW\FK]DEXU]HĔXG]LHFL]60WDNLHMDN)RUGLZVS  >@
6WHLQKDXVHQDL-X]L  >@
60 PRJą WRZDU]\V]\ü WDNĪH FDáRĞFLRZH ]DEXU]HQLD UR]ZRMX QS ]H VSHNWUXP
autyzmu (Autism Spectrum Disorder±$6' :URNX6WH൵HQEXUJLZVS>@
RSXEOLNRZDOLEDGDQLHUHWURVSHNW\ZQHNWyUHJRFHOHPE\áDRFHQDZVSyáZ\VWĊSRZDQLD
]DEXU]HĔ]HVSHNWUXPDXW\]PXZRVRERZHMSUyELHG]LHFL]SRVWDZLRQąGLDJQR]ą
60%DGDQLH]RVWDáRSU]HSURZDG]RQHZRĞURGNXVSHFMDOL]XMąF\PVLĊZ]DEXU]HQLDFK
QHXURUR]ZRMRZ\FK$ĪG]LHFL]60VSHáQLDáRNU\WHULXP]DEXU]HQLD]HVSHNWUXP
DXW\]PX FLHUSLDáRQDDXW\]PG]LHFLĊF\QDDXW\]PDW\SRZ\OXEFDáRĞFLRZH
]DEXU]HQLHUR]ZRMXQLH]GLDJQR]RZDQHLQDF]HMLQD]HVSyá$VSHUJHUD .ROHMQH
FHFKRZDáRVLĊFRSUDZGDVXENOLQLF]Q\PLREMDZDPLDXW\VW\F]Q\PLÄQLHPQLHMMHGQDN
Z\ZLHUDMąF\PLZSá\ZQDFRG]LHQQHIXQNFMRQRZDQLH´>V@:VSyáZ\VWĊSR-
ZDQLH]HVSRáX$VSHUJHUDXG]LHFL]60]RVWDáR]DREVHUZRZDQHWDNĪHSU]H]LQQ\FK
EDGDF]\WDNLFKMDN.RSSL*LOOEHUJ  >@.ULVWHQVHQ  >@$QGHUVVRQ
L7KRPVHQ  >@7RáDJRGQH]DEXU]HQLH]HVSHNWUXPDXW\]PXZSRSXODFMLRJyOQHM
Z\VWĊSXMH]F]ĊVWRĞFLąRNRáRDZLĊF]QDF]QLHU]DG]LHMQLĪXG]LHFL]60>@
:RSLV\ZDQ\PEDGDQLX6WH൵HQEXUJDLZVS>@G]LHFL]60]RVWDá\SRG]LHORQHQD
GZLHJUXS\3LHUZV]ąJUXSĊWZRU]\á\G]LHFLVSHáQLDMąFHNU\WHULD$6' 60$6' 
D Z GUXJLHM ]QDOD]á\ VLĊ G]LHFL QLHVSHáQLDMąFH W\FK NU\WHULyZ 60 ±$6' ']LHFL
] SLHUZV]HM JUXS\ FHFKRZDá\ VLĊ SyĨQLHMV]\P Z\VWąSLHQLHP SLHUZV]\FK REMDZyZ
PXW\]PX ĞUHGQLRZZLHNXODWYVODW DWDNĪH]RVWDá\]GLDJQR]RZDQHSyĨQLHM
%DGDF]HVXJHUXMąĪHG]LHFL]60PRJąSUH]HQWRZDüQLĪV]\SR]LRP]GROQRĞFLSR]QDZ-
F]\FKZSRUyZQDQLXGRG]LHFL]GURZ\FKMHGQDNPRĪHWRZ\QLNDü]HVSRVREXSRPLDUX
$E\WDNLSRPLDUE\áPLDURGDMQ\ELRUąFSRGXZDJĊLVWRWĊ]DEXU]HQLDSRZLQLHQ]RVWDü
Z\NRQDQ\SU]H]RVRE\ZREHFNWyU\FKG]LHFNRQLHSUH]HQWXMHFHFKPXW\]PX>@
5yZQLHĪLQQH]DEXU]HQLDSV\FKLF]QHWDNLHMDN]DEXU]HQLHREVHV\MQRNRPSXO-
V\ZQH 2&'  >@ ]DEXU]HQLD G\VRFMDF\MQH GHSUHVMD ]HVSyá OĊNX SDQLF]QHJR>@
]HVSyáQDGSREXGOLZRĞFLSV\FKRUXFKRZHM]GH¿F\WHPXZDJL $'+' >@F]\]HVSyá
áDPOLZHJRFKURPRVRPX;>@F]ĊĞFLHMZVSyáZ\VWĊSXMą]60

Epidemiologia
60MHVWVWRVXQNRZRU]DGNLP]DEXU]HQLHPOĊNRZ\P'RNáDGQLHMV]HRV]DFRZDQLH
MHJR UR]SRZV]HFKQLHQLD QLH MHVW MHGQDN áDWZH ]H Z]JOĊGX QD QLHMHGQROLWH NU\WHULD
GLDJQRVW\F]QHMDNLQLHZLHONąOLF]HEQRĞüJUXSEDGDQ\FKZGRQLHVLHQLDFKQDXNRZ\FK
:]ZLą]NX]W\PĪHG]LHFL]D]Z\F]DMVWDMąVLĊZ\ELyUF]RPXW\VW\F]QHZĞURGRZL-
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 5

VNXV]NROQ\PQDMEDUG]LHMZLDU\JRGQHZ\GDMąVLĊEDGDQLDHSLGHPLRORJLF]QHRSDUWH
QDUDSRUWDFKQDXF]\FLHOL>@=Z\NRU]\VWDQLHPWHMPHWRG\RUD]NU\WHULyZGLDJQR-
VW\F]Q\FK'60,9]RVWDá\]EDGDQHG]LHFL]H6]ZHFML ±ODW >@]86$ ±ODW 
>@L],]UDHOD ±ODW >@:GZyFKRVWDWQLFK]Z\PLHQLRQ\FKEDGDĔRV]DFRZDQR
F]ĊVWRĞüZ\VWĊSRZDQLD60QDRGSRZLHGQLRLSRGF]DVJG\ZEDGDQLX
REHMPXMąF\PV]ZHG]NLHG]LHFLZDUWRĞüWDE\áD]QDF]QLHQLĪV]DLZ\QRVLáDMHG\QLH
'ODSRUyZQDQLDF]ĊVWRĞüZ\VWĊSRZDQLD63 QDMF]ĊVWV]H]DEXU]HQLHOĊNRZH
WRZDU]\V]ąFH60 >@Z86$V]DFXMHVLĊQDZRNUHVLHG]LHFLĔVWZDLDGROHVFHQFML
>@
7DNQLVNLRGVHWHNUR]SR]QDĔ60ZEDGDQLXV]ZHG]NLPPRĪHZ\QLNDü]SU]\MĊWHJR
NU\WHULXPZLHNRZHJRSR]ZDODMąFHJR]DNZDOL¿NRZDüGRWHJREDGDQLDG]LHFLVWDUV]H
QLĪZGZyFKSR]RVWDá\FKEDGDQLDFK-HVWWRRW\OHLVWRWQHĪHRPDZLDQH]DEXU]HQLH
QDMF]ĊĞFLHMGRW\NDG]LHFLZZLHNXRGGRODWSRGF]DVJG\VDPREMDZPXW\]PXPD
WHQGHQFMĊGRXVWĊSRZDQLDSRĞUHGQLRODWDFKWUZDQLDFKRURE\QDWRPLDVWQLHOHF]RQH
ZáDĞFLZLHGH¿F\W\ZXPLHMĊWQRĞFLDFKVSRáHF]Q\FK]D]Z\F]DMVLĊXWU]\PXMą>@
60PRĪHZ\VWĊSRZDüURG]LQQLH>@3RQDGWRF]ĊVWV]HZ\VWĊSRZDQLH60]DREVHU-
ZRZDQRXG]LHZF]\QHN QDZHWGZXNURWQLH >@DWDNĪHXRVyEGZXMĊ]\F]Q\FK>@

Etiologia
*HQHW\NDLF]\QQLNLĞURGRZLVNRZH
&]ĊVWHZ\VWĊSRZDQLH60ZURG]LQDFKG]LHFL]60>@VNáRQLáREDGDF]\GR
SRV]XNLZDQLDJHQXRGSRZLHG]LDOQHJR]DWR]DEXU]HQLH6WHLQLZVS>@Z\ND]DOL
ĪHSROLPRU¿]PJHQX&171$3 UV MHVWSRZLą]DQ\]ZLĊNV]\PU\]\NLHP
SRMDZLHQLDVLĊ60ZRNUHVLHG]LHFLĔVWZDRUD]]ZLĊNV]\PU\]\NLHPRGF]XZDQLDQDVL-
ORQHJROĊNXVSRáHF]QHJRZRNUHVLHGRURVáRĞFL>@&171$3 contactin-associated
protein-like 2 MHVWJHQHPNRGXMąF\PELDáNR]URG]LQ\QHXUHNV\QEĊGąFHPHGLDWRUHP
LQWHUDNFML PLĊG]\ QHXURQDPL D NRPyUNDPL JOHMRZ\PL Z UR]ZLMDMąF\P VLĊ Py]JX
3ROLPRU¿]P\ZREUĊELHWHJRJHQXPRJąZ\ZLHUDüHIHNWSOHMRWURSRZ\ZDUXQNXMąF
SRZVWDQLHUyĪQ\FK]DEXU]HĔQHXURUR]ZRMRZ\FK>@:EDGDQLDFKSRUyZQDZF]\FK]H
]GURZąNRQWUROąVWZLHUG]RQRĪHURG]LFHG]LHFL]60VąEDUG]LHMQLHĞPLDOLLSUH]HQWXMą
Z\ĪV]\SR]LRPOĊNXVSRáHF]QHJRDWDNĪHZ\ND]XMąRJyOQąWHQGHQFMĊGR]DFKRZDĔ
XQLNDMąF\FKLĪ\FLDZRGRVREQLHQLX>±@
2ND]XMHVLĊĪHGR60PRĪHSUHG\VSRQRZDüZSá\ZURG]LFDQDG]LHFNR1DĞOD-
GRZDQLH XQLNDMąFHJR Z]RUFD UHDJRZDQLD URG]LFD PRĪH LQGXNRZDü OXE Z]PDFQLDü
]DFKRZDQLDXQLNDMąFHG]LHFNDDSU]H]WR]ZLĊNV]DüSUDZGRSRGRELHĔVWZRXMDZQLHQLD
VLĊPXW\]PXOXE]ZLĊNV]DüQDVLOHQLHREMDZyZ60>@&RZLĊFHMZURG]LQDFK]]DEX-
U]HQLDPLOĊNRZ\PLF]ĊVWR]DXZDĪDVLĊQDGPLHUQHSU]\ZLą]DQLHG]LHFLGRURG]LFyZ OĊN
VHSDUDF\MQ\MHVW]DEXU]HQLHPVWRVXQNRZRF]ĊVWRZVSyáZ\VWĊSXMąF\PXG]LHFL]60 
>@RUD]QDGPLHUQąNRQWUROĊURG]LFLHOVNą:EDGDQLX(GLVRQDLZVS]DREVHUZRZDQR
ĪHURG]LFHG]LHFL]60E\OLQDGRSLHNXĔF]\RUD]EDUG]LHMNRQWUROXMąF\ZSRUyZQDQLX
GRURG]LFyZSDFMHQWyZ]JUXSNRQWUROQ\FK>@0RĪQDWXWDMSU]\ZRáDü]DáRĪHQLD
WHRULLV\VWHPRZHMPXW\]PXZ\ELyUF]HJRZHGOHNWyUHMNRQWURODURG]LFLHOVNDRFKD-
6 Emil Bartosz Rozenek i wsp.

UDNWHU]HQHXURW\F]Q\PJHQHUXMHQDGPLHUQHSU]\ZLą]DQLHG]LHFNDGRURG]LFD6NXWNXMH
WRZ\WZRU]HQLHPZVSyá]DOHĪQRĞFLZUHODFMLURG]LF±G]LHFNRLSU]HMDZLDVLĊEUDNLHP
]DXIDQLDGRSR]DURG]LQQHJRĞURGRZLVND'RFKRG]LGRZ]EXG]HQLDOĊNXZW\POĊNX
SU]HGNRPXQLNDFMąVáRZQąFRSU]HMDZLDVLĊPLOF]HQLHP>@
:DUWRWHĪ]ZUyFLüXZDJĊQDF]\QQLNLNWyUHPRJąSUHG\VSRQRZDüGRXMDZQLHQLD
VLĊ60SU]\]HWNQLĊFLX]HĞURGRZLVNLHPV]NROQ\PNLHG\WRQDMF]ĊĞFLHMXMDZQLDVLĊ
WR ]DEXU]HQLH ']LHFL ] 60 ]Z\NOH Vą NZDOL¿NRZDQH GR VSHFMDOQ\FK SURJUDPyZ
HGXNDF\MQ\FK]SRZRGX]DEXU]HĔNRPXQLNDFMLLRSyĨQLHQLDUR]ZRMXMĊ]\NRZHJR>@
0RĪQD ZLĊF ZQLRVNRZDü ĪH GH¿F\W\ Z NRPXQLNDFML PRJą JHQHURZDü WUXGQRĞFL
ZQDXFHDSU]H]WREUDNLHGXNDF\MQH=DVSUDZąQLHPyZLHQLDZV]NROH XQLNDQLH
PRZ\ QLHZ\FKRG]ąRQHQDĞZLDWáRG]LHQQHLQLHQDUDĪDMąG]LHFNDQDGR]QDZDQLH
QHJDW\ZQ\FK HPRFML JáyZQLH OĊNX>@ ']LHFL ] 60 Vą SRVWU]HJDQH MDNR EDUG]LHM
QLHSHZQHZNRQWDNWDFK]UyZLHĞQLNDPLRGG]LHFL]GURZ\FKRUD]MDNRPDMąFHSUREOH-
P\]QDZLą]\ZDQLHPSU]\MDĨQLF]\GRáąF]DQLHPGRJUXS>@7DNLH]DFKRZDQLH
VSU]\MDRGU]XFDQLXL]DVWUDV]DQLXG]LHFL]60SU]H]UyZLHĞQLNyZ>@7HRUHW\F]QLH
PRĪH WR ZSá\ZDü QD SRJRUV]HQLH VWDQX G]LHFND ] 60 ]H Z]JOĊGX QD ]ZLĊNV]HQLH
SR]LRPXRGF]XZDOQHJROĊNX
:DĪQD Z\GDMH VLĊ WDNĪH NZHVWLD VWDWXVX LPLJUDQWD %DGDQLH HSLGHPLRORJLF]QH
Z,]UDHOXZ\ND]DáRSRQDGF]WHURNURWQLHZLĊNV]ąF]ĊVWRĞüZ\VWĊSRZDQLD60ZĞUyG
LPLJUDQWyZ Z SRUyZQDQLX GR UG]HQQ\FK L]UDHOVNLFK URG]LQ  YV  >@
3U]\F]\QąPRJąE\üUyĪQLFHNXOWXURZHLG\VNU\PLQDFMDLPLJUDQWyZFRMHVWF]ĊVW\P
ĨUyGáHPOĊNXRNUHVXG]LHFLĊFHJRZVSRáHF]QRĞFLDFKPQLHMV]RĞFLHWQLF]Q\FK>@

&HFK\WHPSHUDPHQWX
']LHFL]60Z\ND]XMą]DKDPRZDQ\WHPSHUDPHQWFRZSU]\SDGNX60R]QDF]D
VW\O]DFKRZDQLD]EOLĪRQ\GRKDPRZDQLDEHKDZLRUDOQHJR>@3ROHJDRQRQDW\P
ĪHQRZHERGĨFH PLHMVFDOXG]LHSU]HGPLRW\ EXG]ąQDGPLHUQąRVWURĪQRĞüLVWUDFKFR
SRZRGXMHLFKXQLNDQLH>@:RNUHVLHSU]HGV]NROQ\PPRĪHVLĊWRSU]HMDZLDüZQLH-
QDZLą]\ZDQLX]REF\PLNRQWDNWXVáRZQHJRDZLĊFEDUG]RSU]\SRPLQD]DFKRZDQLH
G]LHFL]60>@=DVSRáHF]Q\DVSHNWKDPRZDQLDEHKDZLRUDOQHJRPRĪQDX]QDüQLH-
ĞPLDáRĞüF]\OLWHQGHQFMĊGRF]XFLDVLĊQLH]UĊF]QLHRUD]RGF]XZDQLDQDSLĊFLDSRGF]DV
VSRWNDĔ V]F]HJyOQLH ] QLH]QDMRP\PL RVREDPL 1LHĞPLDáRĞü MHVW VSRW\NDQD QDZHW
XG]LHFL]60>@:URNX]RVWDáRRSXEOLNRZDQHUHWURVSHNW\ZQHEDGDQLH
SRUyZQDZF]HZNWyU\PZ]LĊá\XG]LDáG]LHFL]GLDJQR]ą60G]LHFL]GLDJQR]ą63
G]LHFL]GLDJQR]ą]DFKRZDQLDLQWHUQDOL]XMąFHJRRUD]]GURZHG]LHFLVWDQRZLąFHJUXSĊ
NRQWUROQą*HQVWKDOHULZVS>@RSLHUDMąFVLĊQDNZHVWLRQDULXV]X5,%, parent-rated
Retrospective Infant Behavioral Inhibition SRND]DOLZQLPĪHHNVWUHPDOQHKDPRZDQLH
EHKDZLRUDOQHVWZLHUG]DQHZRNUHVLHQLHPRZOĊFWZDLZF]HVQHJRG]LHFLĔVWZDPRĪHSR-
SU]HG]DüXMDZQLHQLHVLĊPXW\]PXZ\ELyUF]HJRQDSyĨQLHMV]\FKHWDSDFKĪ\FLD3RQDGWR
QLHPRZOĊWDXNWyU\FKZSyĨQLHMV]\FKHWDSDFKĪ\FLDXMDZQLDáVLĊ60SUH]HQWRZDá\
VLOQLHMV]HKDPRZDQLHERGĨFyZVSRáHF]Q\FKZSRUyZQDQLXGRQLHPRZOąWXNWyU\FK
ZNROHMQ\FKHWDSDFKĪ\FLDGLDJQR]RZDQR63>@SRWZLHUG]DMąF]DáRĪHQLHSURSRQR-
ZDQH SU]H] QLHNWyU\FK DXWRUyZ X]QDMąF\FK 60 ]D VNUDMQą SRVWDü IRELL VSRáHF]QHM
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 7

ZLHNXZF]HVQRG]LHFLĊFHJR>@+DPRZDQLHEHKDZLRUDOQHZSRF]ąWNRZ\FKHWDSDFK
Ī\FLD]ZLĊNV]DU\]\NRXMDZQLHQLDVLĊWDNĪHLQQ\FK]DEXU]HĔOĊNRZ\FKV]F]HJyOQLH63
ZSU]\V]áRĞFL>@*HQVWKDOHULZVSSRVWXOXMąZSURZDG]HQLHEDGDĔVFUHHQLQJRZ\FK
NWyUHXPRĪOLZLá\E\]DVWRVRZDQLHZF]HVQHMLQWHUZHQFML]DSRELHJDMąFHMZ\VWąSLHQLX
60XG]LHFL]HNVWUHPDOQ\PKDPRZDQLHPEHKDZLRUDOQ\P>@
&]ĊĞü G]LHFL ] 60 SU]HMDZLD ]DFKRZDQLD RSR]\F\MQREXQWRZQLF]H QS XSyU
GUDĪOLZRĞü NáyWOLZRĞü  MHGQDN Z ]ZLą]NX ] Z\NOXF]HQLHP HOHNW\ZQHM NRQFHSFML
60QLHWUDNWXMHVLĊW\FK]DFKRZDĔMDNR]ZLą]DQ\FK]HWLRORJLąWHJR]DEXU]HQLD>@

=DEXU]HQLDQHXURUR]ZRMRZH
8]QDF]QHMF]ĊĞFLG]LHFL]60MDNZVSRPQLDQRMXĪZF]ĊĞFLDUW\NXáXSRĞZLĊFRQHM
ZVSyáFKRURERZRĞFLVWZLHUG]DQHVą]DEXU]HQLDNRPXQLNDFMLLOXEXRJyOQLRQH]DEXU]H-
QLDF]\WHĪRSyĨQLHQLHUR]ZRMX1LHNWyU]\EDGDF]HVąVNáRQQLX]QDZDüWH]DEXU]HQLD
]DĨUyGáRQHJDW\ZQ\FKHPRFMLRGF]XZDQ\FKSU]H]G]LHFL]60QSZNRQIURQWDFML
]G]LHüPLUR]ZLMDMąF\PLVLĊSUDZLGáRZR>@%UDNPRZ\ZZ\EUDQ\FKĞURGRZLVNDFK
PRĪQDE\WáXPDF]\üMDNRSU]HMDZXQLNDQLDSU]HZLG\ZDQ\FKWUXGQRĞFLV]F]HJyOQLH
XG]LHFLSUHG\VSRQRZDQ\FKGRUR]ZRMX]DEXU]HĔOĊNRZ\FK1LHNWyUHEDGDQLDZVND]XMą
UyZQLHĪQDSRZLą]DQLH]DEXU]HĔUR]ZRMX]LQQ\PL]DEXU]HQLDPLOĊNRZ\PLZLHNX
G]LHFLĊFHJR>@

1HXURORJLF]QHGH¿F\W\SU]HWZDU]DQLDVáXFKRZHJR
:SURFHVLHNRPXQLNDFMLZHUEDOQHMGRFKRG]LGRLQWHUDNFMLPLĊG]\SURFHVDPLPy-
ZLHQLDLVá\V]HQLD']LĊNLWHPXPRĪOLZHMHVWFLąJáHPRQLWRURZDQLHRUD]UHJXODFMDSHU-
FHSFMLGĨZLĊNyZLMDNRĞFLPRZ\MDNUyZQLHĪ]DSRELHJDQLHSU]HVW\PXORZDQLXĞOLPDND
SU]H]QDGPLHUQąZRNDOL]DFMĊ0DWRQDFHOX]DSHZQLHQLHMHGQRF]HĞQLHRGSRZLHGQLHM
MDNRĞFLPRZ\RUD]SUHF\]\MQHJRRGELRUXLQIRUPDFMLVáXFKRZ\FK>@-HGQ\P
]HIHUHQWQ\FKV\VWHPyZSU]HWZDU]DQLDVáXFKRZHJRELRUąF\FKXG]LDáZPRQLWRURZDQLX
LUHJXODFMLSURFHVyZZRNDOL]DFMLMHVWV\VWHP0($5 0LGGOH(DU$FRXVWLF5HÀH[).
:RGSRZLHG]LQDLQIRUPDFMĊ]ZURWQąRGQRĞQLHGRĞZLDGF]DQLDRGELRUXZáDVQHMPRZ\
GRFKRG]LGRVNXUF]XPLĊĞQLXFKDĞURGNRZHJR3RZRGXMHWRPDVNRZDQLHVá\V]HQLD
ZáDVQHJRJáRVXSRGF]DVPyZLHQLDG]LĊNLF]HPXQLHGRFKRG]LGR]DEXU]HĔZRGELR-
U]HLQIRUPDFMLVáXFKRZ\FK1DGPLHUQDZRNDOL]DFMDEH]WHJRPHFKDQL]PXPRJáDE\
SRZRGRZDüSU]HVW\PXORZDQLHVáXFKRZ\FKGUyJQHUZRZ\FK7DNLHSU]HVW\PXORZD-
QLH Z\ZRáDáRE\ LFK QDVWĊSF]ą GHVHQV\W\]DFMĊ FR SURZDG]LáRE\ GR RJUDQLF]RQHJR
RGELHUDQLDERGĨFyZGĨZLĊNRZ\FK]RWRF]HQLDSRGF]DVPRZ\>±@=DEXU]HQLD
V\VWHPX0($5XOXG]LF]ĊVWRZLąĪąVLĊ]H]ZLĊNV]RQąZUDĪOLZRĞFLąVáXFKRZąLPRJą
VNXWNRZDüXQLNDQLHPJáRĞQ\FKĞURGRZLVNSU]H]RVRE\]WDNLPL]DEXU]HQLDPL>@
:HGáXJKLSRWH]\+HQNLQDL%DU+DLPD>@]DEXU]HQLDHIHUHQWQHJRSU]HWZDU]DQLD
VáXFKRZHJR X G]LHFL ] 60 SRZRGXMą DGDSWDFMĊ SROHJDMąFą QD PyZLHQLX V]HSWHP
OXE ]DQLHFKDQLX PRZ\ Z FHOX GRĞZLDGF]DQLD QLH]DEXU]RQHJR RGELRUX LQIRUPDFML
GĨZLĊNRZ\FK=SRZRGXQDGZUDĪOLZRĞFLVáXFKRZHMQDZáDVQąPRZĊ QS]DEXU]HQLD
0($5 SRGF]DVZRNDOL]DFMLGRFKRG]LáRE\GRQDVWĊSF]HMGHVHQV\W\]DFMLLPDVNRZDQLD
8 Emil Bartosz Rozenek i wsp.

]HZQĊWU]Q\FKERGĨFyZVáXFKRZ\FK>@:EDGDQLX0XFKQLNDLZVS>@DĪX
G]LHFLZ\ELyUF]RPXW\VW\F]Q\FKVWZLHUG]RQRQLHSUDZLGáRZRĞFLZHIHUHQWQ\FKGURJDFK
SU]HWZDU]DQLDVáXFKRZHJRZSRUyZQDQLXGR]JUXS\NRQWUROQHM
:\ELyUF]RĞüPXW\]PXQDSRGVWDZLHSRZ\ĪV]\FKZQLRVNyZPRĪQDE\Z\WáXPD-
F]\üZQDVWĊSXMąF\VSRVyEZRWRF]HQLXQDMEOLĪV]HMURG]LQ\G]LHFNR]F]DVHPZ\XF]D
VLĊ NRQVWUXNWyZ ZHUEDOQ\FK FKDUDNWHU\VW\F]Q\FK GOD NDĪGHM RVRE\ ] URG]LQQHJR
ĞURGRZLVND:WHQVSRVyEG]LHFNR]60PRĪHáDWZLHM]UR]XPLHüWDNLHRVRE\PLPR
]DEXU]RQHJR RGELRUX ERGĨFyZ GĨZLĊNRZ\FK SRGF]DV UR]PRZ\>@ 2]QDF]DáRE\
WRUyZQLHĪĪHG]LHFNR]60EĊG]LHSUH]HQWRZDüREMDZ\PXW\]PXV]F]HJyOQLHSU]\
W\FKREF\FKRVREDFKNWyU\FKNRQVWUXNW\ZHUEDOQHQDMEDUG]LHMRGELHJDMąRGWDNLFK
]MDNLPLG]LHFNRVW\NDVLĊZĞURGRZLVNXURG]LQQ\P:\QLNDVWąGĪHJG\E\G]LHFNR
]60EUDáRXG]LDáZG\VNXVMLZUD]]NLONRPDLQQ\PLRVREDPL ĞURGRZLVNRV]NROQH 
RGJU\ZDáRE\RQRUROĊZ\áąF]QLHVáXFKDF]D]HZ]JOĊGXQDPQRJRĞüGRFLHUDMąF\FKGR
QLHJRNRQVWUXNWyZMĊ]\NRZ\FK=ZLHORNURWQLRQDWUXGQRĞüSá\QąFD]MHGQRF]DVRZH-
JRSU]HWZDU]DQLDUyĪQLąF\FKVLĊREF\FKNRQVWUXNWyZMĊ]\NRZ\FKXQLHPRĪOLZLáDE\
ZáąF]HQLHVLĊZG\VNXVMĊQDSR]LRPLHZHUEDOQ\PSU]\]DFKRZDQLXVDW\VIDNFMRQXMąFHM
MDNRĞFLVá\V]HQLD0XULVL2OOHQGLFN>@NRQNOXGXMąĪHMHVWPDáRSUDZGRSRGREQHE\
L]RORZDQHQHXURORJLF]QHGH¿F\W\SU]HWZDU]DQLDVáXFKRZHJRVDPHZVRELHEH]GR-
GDWNRZ\FKF]\QQLNyZSUHG\VSRQXMąF\FKPRJá\ZDUXQNRZDüXMDZQLHQLHVLĊ60>@

0XW\]PZ\ELyUF]\DIRELDVSRáHF]QD
1DSRGVWDZLHGRVWĊSQHMOLWHUDWXU\PRĪQDSU]\MąüĪHG]LHFL]L]RORZDQ\P60
EH]LQQ\FKWRZDU]\V]ąF\FK]DEXU]HĔOĊNRZ\FKQDOHĪąGRPQLHMV]RĞFL>@1DMF]ĊĞFLHM
WRZDU]\V]ąF\P]DEXU]HQLHPOĊNRZ\PRND]XMHVLĊIRELDVSRáHF]QD8Z]JOĊGQLDMąF
SU]\NáDGRZHEDGDQLDUHSUH]HQWDW\ZQHSRGZ]JOĊGHPOLF]HEQRĞFLJUXSRGVHWHNMHM
ZVSyáZ\VWĊSRZDQLD]60Z\QRVLáRGGR>@'RFHFKF]ĊVWR
VSRW\NDQ\FK]DUyZQRXG]LHFL]60MDNLXG]LHFL]63QDOHĪąQLHĞPLDáRĞüKDPR-
ZDQLHEHKDZLRUDOQHF]\OĊNVHSDUDF\MQ\>@:]ZLą]NX]W\PQLHNWyU]\EDGDF]H
SURSRQXMąWUDNWRZDQLH60MDNRZF]HVQRG]LHFLĊFHJRZDULDQWX63EąGĨWHĪMHMVNUDMQHM
PDQLIHVWDFML>@
=DKLSRWH]ąZF]HVQHJRG]LHFLĊFHJRVWDGLXP63SU]HPDZLDWRĪHVDPPXW\]P
PDWHQGHQFMĊGR]DQLNDQLDĞUHGQLRSRRĞPLXODWDFKFKRURE\SRGF]DVJG\XWUZDORQH
]DFKRZDQLD ]ZLą]DQH ] V\PSWRPDWRORJLą 60 PRJą SURZDG]Lü GR XMDZQLHQLD VLĊ
IRELLVSRáHF]QHMZSU]\V]áRĞFL>@:DUWRWXWDMSU]\SRPQLHüĪH60XMDZQLDVLĊ
]D]Z\F]DMPLĊG]\DURNLHPĪ\FLDSRGF]DVJG\63SyĨQLHMWRMHVWPLĊG]\D
URNLHPĪ\FLD>@
=DGUXJąKLSRWH]ąSU]HPDZLDMąEDGDQLDSRUyZQDZF]HZNWyU\FKG]LHFL]60
SUH]HQWXMąVLOQLHMZ\UDĪRQHREMDZ\OĊNXVSRáHF]QHJRQLĪG]LHFL]63EH]WRZDU]\V]ą-
FHJRPXW\]PX3U]\NáDGRZR<HJDQHKLZVS>@SRUyZQDOLG]LHFLVSHáQLDMąF\FK
NU\WHULD]DUyZQR60MDNL63]WDNVDPROLF]QąJUXSąG]LHFLVSHáQLDMąF\FKNU\WHULD
L]RORZDQHM63']LHFL]SLHUZV]HMJUXS\E\á\XZDĪDQHSU]H]REVHUZDWRUyZ]DSUH-
]HQWXMąFHVLOQLHMZ\UDĪRQHREMDZ\OĊNXVSRáHF]QHJRZSRUyZQDQLXGRGUXJLHMJUXS\
:EDGDQLX0DQDVVLVLZVS>@SRUyZQDQRSR]LRPRGF]XZDOQHJROĊNXVSRáHF]QHJR
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 9

]JáDV]DQHJRSU]H]G]LHFL]60 ]QLFKVSHáQLDáRWDNĪHNU\WHULXP63 LG]LHFL


]LQQ\PL]DEXU]HQLDPLOĊNRZ\PL ZW\P]IRELąVSRáHF]Qą 1DMZ\ĪV]\SR]LRPRG-
F]XZDOQHJROĊNXVSRáHF]QHJR]JáDV]DQ\E\áSU]H]G]LHFLVSHáQLDMąFHNU\WHULD60>@
1DOHĪ\]D]QDF]\üĪHQLHZV]\VWNLHG]LHFLVSHáQLDMąFHNU\WHULD60VSHáQLDMąNU\-
WHULD63>@=WHJRZ]JOĊGXKLSRWH]\UR]ZDĪDMąFHWUDNWRZDQLH60MDNRZDULDQWX63
QLHZ\GDMąVLĊZSHáQLRGGDZDü]áRĪRQRĞFLWHJR]DEXU]HQLDVNXSLDMąFVLĊMHG\QLHQD
MHJRSLHUZRWQLHOĊNRZHMHWLRORJLL3RGHMĞFLHVNRQFHQWURZDQHZ\áąF]QLHQDVNáDGRZHM
OĊNRZHM]DEXU]HQLDPRĪHVNXWNRZDüQLHSRZRG]HQLHPZSURFHVLHWHUDSHXW\F]Q\P>@
3R]DSRGRELHĔVWZDPL]DXZDĪDOQHVąWHĪUyĪQLFHPLĊG]\G]LHüPL]60DG]LHüPL
]63F]\LQQ\PL]DEXU]HQLDPLOĊNRZ\PL']LHFL]60F]ĊĞFLHMVSHáQLDMąNU\WHULD]D-
EXU]HĔNRPXQLNDFMLRUD]]DEXU]HĔUR]ZRMX>@:SU]HFLZLHĔVWZLHGRG]LHFL]63
G]LHFL]60Z\ND]XMąFKĊüZFKRG]HQLDZLQWHUDNFMH]UyZLHĞQLNDPLFKFąEDZLüVLĊ
]SU]\MDFLyáPLRUD]G]LHOLüVLĊ]QLPLVZRLPLSRP\VáDPL>@3U]\MDĨQLH]DZLHUDQH
SU]H]G]LHFL]60F]ĊVWRRSDUWHVąQDNRPXQLNDFMLQLHZHUEDOQHM>@

0XW\]PZ\ELyUF]\MDNRURG]DM]DFKRZDQLDXQLNDMąFHJR
:HZVSRPLQDQ\PMXĪEDGDQLX.ULVWHQVHQ>@]HZ]JOĊGXQDGXĪ\RGVHWHNZVSyá-
Z\VWĊSRZDQLD]DEXU]HĔUR]ZRMXXG]LHFL]60DXWRUND]DSURSRQRZDáDX]QDQLHEUDNX
PRZ\]DVSRVyEPDVNRZDQLDZVSyáZ\VWĊSXMąF\FK]DEXU]HĔ3LĊüODWSyĨQLHM0ROGDQ
>@VWDUDáVLĊSU]HGVWDZLüREMDZPXW\]PXMDNRVWUDWHJLĊUHJXODFMLQHJDW\ZQ\FKHPRFML
WDNLFKMDNOĊNF]\SRF]XFLHZVW\GX :URNX6FRWWL%HLGHO>@QDSRGVWDZLH
DQDOL]\OLWHUDWXU\SU]HGPLRWX]DNODV\¿NRZDOLPXW\]PMDNRVSHF\¿F]Q\URG]DM]DFKR-
ZDQLDXQLNDMąFHJRSRMDZLDMąF\VLĊXG]LHFLPáRG\FK]MHV]F]HQLHZ\NV]WDáFRQ\PL
VWUDWHJLDPLUHJXODFMLHPRFMLSU]\F]\PFHFKXMąF\FKVLĊSHZQ\PLSUHG\VSR]\FMDPL
GRUR]ZRMX]DEXU]HĔOĊNRZ\FK
:VSRPQLDQLDXWRU]\NáDGąQDFLVNQDSV\FKRSDWRORJLĊUR]ZRMX2NUHVG]LHFLĔVWZD
ZLąĪHVLĊF]ĊVWR]SU]\PXVHPFKRG]HQLDGRV]NRá\']LHFNRQLHPRJąFXQLNDüV]NRá\
VWDUDVLĊXQLNDüVWUHVXMąF\FKV\WXDFMLZF]\PSRPRFQ\RND]XMHVLĊEUDNPRZ\>@
:W\PPLHMVFXQDOHĪ\RGQLHĞüVLĊGRSUDZGRSRGREQHMJHQH]\OĊNXLLQQ\FKQHJDW\Z-
Q\FKHPRFMLNWyU\FKGRĞZLDGF]DG]LHFNRZV]NROH±ZĞURGRZLVNXJG]LHPXW\]P
XMDZQLDVLĊQDMF]ĊĞFLHM0RĪQDWXWDMSRUyZQDüPXW\]PGRRGPRZ\XF]ĊV]F]DQLDQD
]DMĊFLDV]NROQH>@JG]LHĨUyGáHPRGPRZ\PRĪHE\ü]DUyZQRRGF]XZDQLHOĊNX
QSF]ĊVWRVSRW\NDQDXG]LHFL]60IRELDVSRáHF]QDF]\OĊNVHSDUDF\MQ\ >@MDN
LLQQ\FKQHJDW\ZQ\FKHPRFMLZ\ZRá\ZDQ\FKSU]H]UyĪQHSU]\F]\Q\=DSR]DOĊNRZH
SU]\F]\Q\PXW\VW\F]QHJR]DFKRZDQLDXQLNDMąFHJR MHGQDNZWyUQLHJHQHUXMąFHOĊN
LLQQHQHJDW\ZQHHPRFMH PRĪQDX]QDü]DEXU]HQLDUR]ZRMX]NWyU\FKSRZRGXG]LHFNR
PRĪHGRĞZLDGF]DüWUXGQRĞFLZQDXFH>@3RGREQLHG]LHFNR]QHXURORJLF]Q\PL
G\VIXQNFMDPLSU]HWZDU]DQLDVáXFKRZHJRPRĪHE\üQDUDĪRQHQDFLąJá\G\OHPDWSRGF]DV
G\VNXVMLVáXFKDüF]\PyZLü>@"
9LDQDLZVS>@ZVZRMHMSUDF\SRGVXPRZXMąFHMyZF]HVQąZLHG]ĊQDWHPDWPXW\-
]PXSRGNUHĞOLOLĪHQLHQDOHĪ\SRV]XNLZDüMHGQHJRF]\QQLNDGHWHUPLQXMąFHJRUR]ZyM
PXW\]PX]HZ]JOĊGXQDZ\UDĨQąZLHORF]\QQLNRZRĞüQDUDVWDMąFąZF]DVLHZSá\ZDMąFą
QDXMDZQLHQLHVLĊRPDZLDQHJR]DEXU]HQLD-HVWWR]JRGQH]NRQFHSFMąUR]ZRMRZąlife
10 Emil Bartosz Rozenek i wsp.

spanJG]LHZLĊNV]RĞü]DEXU]HĔSV\FKLF]Q\FKXMDZQLDVLĊZSU]HáRPRZ\PRNUHVLH
UR]ZRMXF]áRZLHNDQDSRGáRĪXVWRSQLRZRQDUDVWDMąF\FKREMDZyZ>@=SHZQRĞFLą
WDNLPSU]HáRPRZ\PZ\GDU]HQLHPZĪ\FLXF]áRZLHNDMHVWUR]SRF]ĊFLHSU]HGV]NROQHM
OXEV]NROQHMHGXNDFMLQDSU]\NáDGSU]H]G]LHFNRRSUHG\VSR]\FMLOĊNRZHMNWyUHQLH
]GDZDáRVRELHGRWHMSRU\VSUDZ\]HVZRLFKGH¿F\WyZZNRPXQLNDFMLZHUEDOQHM7DNLH
G]LHFLPRJąVWRVRZDü]DFKRZDQLHXQLNDMąFHZFHOXQLHQDUDĪDQLDVLĊQDZ\ĞPLHZDQLH
]HVWURQ\UyZLHĞQLNyZNRPXQLNXMąF\FKVLĊDGHNZDWQLHGRZLHNX>@3URZDG]LWR
GRZ\XF]HQLDVLĊIXQNFMRQDOQHMVWUDWHJLLXQLNDQLDQHJDW\ZQ\FKHPRFMLMDNąMHVWEUDN
PRZ\ZZ\EUDQ\FKV\WXDFMDFK>@,VWRWQąUROĊPRĪHRGJU\ZDüXQLNDMąF\Z]RU]HF
UHDJRZDQLDVWZLHUG]DQ\XURG]LFyZZ]PDFQLDMąF\]DFKRZDQLDXQLNRZHG]LHFL>@
.ZHVWLąZ\PDJDMąFąUR]VWU]\JQLĊFLDSR]RVWDMHF]\IHQRPHQPXW\]PXZ\ELyU-
F]HJRMHVWSHáQRSUDZQąMHGQRVWNąQR]RORJLF]QąF]\WHĪMHVWVSHF\¿F]Q\PURG]DMHP
]DFKRZDQLDXQLNDMąFHJRZWyUQ\PGRSLHUZRWQ\FKSU]\F]\QWDNMDNWRVLĊG]LHMHSU]\
RND]MLRGPRZ\XF]ĊV]F]DQLDQD]DMĊFLDV]NROQH>@:URNX<RXQJLZVS>@
SU]HSURZDG]LOLEDGDQLHZNWyU\PSRUyZQDOLRFHQĊSR]LRPXOĊNX]ZLą]DQHJR]]DGD-
QLDPLRSDUW\PLQDLQWHUDNFMLVSRáHF]QHM:]LĊá\ZQLPXG]LDáJUXS\OLF]ąFH]DOHGZLH
SRNLONDQDĞFLRURG]LHFLMHGQDNMHJRZ\QLNLVNRQVWUXRZDQHQDSRGVWDZLHUDSRUWyZ
G]LHFLLREVHUZDWRUyZVą]JRGQH]EDGDQLDPLSU]HSURZDG]DQ\PLQDOLF]QLHMV]\FK
SUyEDFK >@: EDGDQLX<RXQJD L ZVS >@ G]LHFL ] 60 E\á\ SRVWU]HJDQH SU]H]
REVHUZDWRUyZMDNREDUG]LHMOĊNOLZHZ]JOĊGHPG]LHFL]63L]GURZHMNRQWUROL-HVWWR
]JRGQH]Z\QLNDPLEDGDQLD<HJDQHKDLZVS>@ZNWyU\PG]LHFLVSHáQLDMąFHNU\WHULD
60]GDQLHPREVHUZDWRUyZSUH]HQWRZDá\]QDF]QLHZ\ĪV]\SR]LRPRGF]XZDQLDOĊNX
VSRáHF]QHJRQLĪG]LHFL]L]RORZDQą633RGREQLH]DUyZQRZEDGDQLX<RXQJDLZVSMDN
L<HJDQHKDLZVSSR]LRPOĊNX]JáDV]DQHJRSU]H]ELRUąFHXG]LDáZEDGDQLXG]LHFL]60
QLHUyĪQLáVLĊLVWRWQLHRGSR]LRPXOĊNXG]LHFLQLHVSHáQLDMąF\FKNU\WHULyZ60>@
2U\JLQDOQRĞüEDGDQLD<RXQJDLZVS>@SROHJDáDQDSU]HSURZDG]HQLXSRPLDUX
SREXG]HQLDSV\FKR¿]\F]QHJRXEDGDQ\FKG]LHFL QSF]ĊVWRĞüELFLDVHUFDDNW\ZQRĞü
HOHNWURGHUPDOQD  : F]DVLH Z\NRQ\ZDQLD ]DGDĔ RSDUW\FK QD LQWHUDNFML VSRáHF]QHM
G]LHFL]60Z\ND]\ZDá\]QDF]QLHPQLHMV]\VWRSLHĔSREXG]HQLDZVWRVXQNXGRSR]R-
VWDá\FKJUXS1DSRGVWDZLHZ\QLNyZEDGDĔ<RXQJLZVSVąVNáRQQLX]QDZDüIHQRPHQ
PXW\]PXMDNRURG]DMZ\XF]RQHJR]DFKRZDQLDXQLNDMąFHJRSR]ZDODMąFHJRREQLĪ\ü
SR]LRP RGF]XZDOQHJR QLHSRNRMX Z Z\EUDQ\FK V\WXDFMDFK RSDUW\FK QD LQWHUDNFML
VSRáHF]QHM>@
: ĞZLHWOH QDMQRZV]\FK EDGDĔ ] ]DNUHVX SV\FKLDWULL ELRORJLF]QHM ]DFKRZDQLH
XQLNDMąFHUR]SDWU\ZDQHMHVWMDNRQLHĞZLDGRPDUHDNFMDREURQQD>@-HVWWR]JRGQH
]RGU]XFHQLHPNRQFHSFMLHOHNW\ZQRĞFLPXW\]PXZNWyUHMEUDNPRZ\E\áSRVWU]HJDQ\
MDNRRGPLDQD]DFKRZDĔRSR]\F\MQREXQWRZQLF]\FKOXEFKĊüĞZLDGRPHMPDQLSXODFML
RWRF]HQLHPZFHOXX]\VNDQLDRGSRZLHGQLFKNRU]\ĞFL>@8QLNDQLHMHVWEDUG]R
HIHNW\ZQąPHWRGąUHGXNFMLREMDZyZ]ZLą]DQ\FK]OĊNLHP3U]HNáDGDVLĊWRQDGąĪHQLH
GRSRZWDU]DQLD]DFKRZDĔXQLNRZ\FKF]\OLLFKZ]PRFQLHQLDZSURFHVLHXF]HQLDVLĊ
XZDUXQNRZDQHJR VSUDZF]R GUXJL F]\QQLN UR]ZRMX ]DEXU]HQLD OĊNRZHJR Z WHRULL
0RZUHUD >@3DWU]ąFV]HU]HMQD]DFKRZDQLDXQLNRZHPRĪQDVWZLHUG]LüĪHLFK
Z\XF]RQHQDGXĪ\ZDQLHSU]\F]\QLDVLĊGRRJUDQLF]HQLDPRĪOLZRĞFLUR]ZRMXG]LHFND
8QLNDQLHSUHG\VSRQXMHGRSRMDZLHQLDVLĊZWyUQ\FKGH¿F\WyZVSRáHF]Q\FKLMĊ]\NR-
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 11

Z\FKZ\ZLHUDMąFZSá\ZQDV]HURNRSRMĊWHIXQNFMRQRZDQLHVSRáHF]QHZW\PNDULHUĊ
HGXNDF\MQąL]DZRGRZą>@

3HZQHV\WXDFMHZ\PDJDMąFH
komunikacji werbalnej

&]\QQLNLJHQHW\F]QH
=DEXU]HQLDUR]ZRMRZH
LĞURGRZLVNRZH

/ĉ.
i inne negatywne
emocje

Zahamowany temperament
ZLĊNV]RĞüG]LHFL )RELDVSRáHF]QD

0XW\]P]IRELąVSRáHF]Qą 0XW\]PEH]IRELLVSRáHF]QHM

Rysunek 10RGHOWáXPDF]ąF\HWLRORJLĊ60XZ]JOĊGQLDMąF\SV\FKRSDWRORJLĊUR]ZRMX

1LHMHVWMDVQHF]\EUDNPRZ\ZSHZQ\FKV\WXDFMDFKMHVWMHGQRVWNąFKRURERZą
per seF]\URG]DMHP]DFKRZDQLDXQLNDMąFHJR&]\QQLNLSUHG\VSRQXMąFHGR60F]ĊVWR
SUHG\VSRQXMąUyZQLHĪGR63']LHFL]60ZSRUyZQDQLXGRG]LHFL]63F]ĊĞFLHMVSHá-
QLDMąNU\WHULD]DEXU]HĔUR]ZRMX3U]HZDĪDMąFDF]ĊĞüG]LHFLZ\ELyUF]RPXW\VW\F]Q\FK
VSHáQLDNU\WHULD63

Leczenie
2VWDWQLHODWDGRVWDUF]\á\GRZRGyZQDXVDQNFMRQRZDQLHOĊNRZHMHWLRORJLL60FR
PDVZRMHRG]ZLHUFLHGOHQLHZQDMQRZV]\FKNODV\¿NDFMDFKZáąF]DMąF\FK60GR]DEX-
U]HĔOĊNRZ\FK>@=WHJRSRZRGXDNWXDOQHVWDQGDUG\OHF]HQLD60SU]\SRPLQDMą
WHQDMVNXWHF]QLHMV]HLQDMF]ĊĞFLHMVWRVRZDQHZLQQ\FK]DEXU]HQLDFKOĊNRZ\FKZLHNX
G]LHFLĊFHJR6ąWRSV\FKRWHUDSLDSR]QDZF]REHKDZLRUDOQD &%7 RUD]IDUPDNRWHUDSLD
VHOHNW\ZQ\PLLQKLELWRUDPL]ZURWQHJRZ\FKZ\WXVHURWRQLQ\ 665, OXENRPELQDFMD
W\FKGZyFKPHWRG>@/HF]HQLHPDQDFHOXXPRĪOLZLHQLHPyZLHQLDZV\WXDFMDFK
ZNWyU\FKG]LHFNRSUH]HQWXMHFHFK\PXW\]PX>@
=DGDQLHP&%7MHVWPRG\¿NDFMD]DFKRZDĔLZ]RUFyZP\ĞOHQLD>@=HZ]JOĊGX
QDWRĪHNRQWDNWWHUDSHXW\]G]LHFNLHPZ\ELyUF]RPXW\VW\F]Q\PPRĪHE\üXWUXGQLRQ\
]DOHFDVLĊ]DDGDSWRZDQLHPHWRGSV\FKRWHUDSHXW\F]Q\FKWDNE\]DSHZQLüWHUDSHXFLH
12 Emil Bartosz Rozenek i wsp.

MDNQDMOHSV]\NRQWDNW]SDFMHQWHP>@%HUJPDQLZVS>@SURSRQXMą]LQWHJURZDQą
WHUDSLĊEHKDZLRUDOQą ,%7 DQJDĪXMąFąZSURFHVWHUDSHXW\F]Q\QLHW\ONRG]LHFNRDOH
WDNĪHURG]LFyZLQDXF]\FLHOD%XGRZDQLHUHODFMLPLĊG]\WHUDSHXWąDG]LHFNLHPRUD]
VWRVRZDQLHQDJUyGEHKDZLRUDOQ\FK SR]\W\ZQHZ]PRFQLHQLH ZSá\ZDNRU]\VWQLHQD
]DDQJDĪRZDQLHVLĊG]LHFNDZSURFHVWHUDSHXW\F]Q\3RPDJDZW\PWDNLHUR]áRĪHQLH
VHVMLWHUDSHXW\F]Q\FKJG]LHZSLHUZV]\FKVHVMDFKEĊG]LHXF]HVWQLF]\üRVREDZ]JOĊ-
GHPNWyUHMG]LHFNRQLHSUH]HQWXMHFHFKPXW\]PXZWRZDU]\VWZLHRVRE\SU]\NWyUHM
G]LHFNRQLHPyZL QSURG]LFWHUDSHXWD .ROHMQHVHVMHXáRĪRQHVąZHGOHSRF]ąWNRZR
XVWDORQHMKLHUDUFKLLWRMHVWVWRSQLRZHJRZ]URVWXHNVSR]\FMLQDV\WXDFMHZ\PDJDMąFH
NRPXQLNDFMLZHUEDOQHM>@
:URNXXND]DáVLĊSU]HJOąGV\VWHPDW\F]Q\SRGVXPRZXMąF\VNXWHF]QRĞüZ\-
PLHQLRQ\FKWHUDSLLZOHF]HQLX60ZNWyU\PGRNRQDQRLORĞFLRZHMV\QWH]\Z\QLNyZ
Z\VHOHNFMRQRZDQ\FKEDGDĔ5HGXNFMDREMDZyZ EDGDQD]XĪ\FLHPZ\VWDQGDU\-
]RZDQ\FK VNDO SRPLDURZ\FK  QDMF]ĊĞFLHM E\áD RGQRWRZ\ZDQD X G]LHFL SRGGDQ\FK
&%7í  ,]RORZDQDIDUPDNRWHUDSLDSU]\QRVLáDSRSUDZĊX  
DWHUDSLDNRPELQRZDQDXG]LHFLMHGQDNZW\PRVWDWQLPZ\SDGNXEDGDQDSUyED
E\áDQLHZLHOND  >@
%DGDF]HVWZLHUG]DMąĪH&%7Z\GDMHVLĊRSW\PDOQ\POHF]HQLHPSLHUZV]HJRZ\-
ERUXXG]LHFL]60>@)DUPDNRWHUDSLDRSDUWDQD665, QDMF]ĊĞFLHMMHVWWRÀXRNVHW\QD 
>@DWDNĪHSROLWHUDSLD &%7665, SRZLQQ\E\ü]DUH]HUZRZDQHGODSRZDĪQLHM-
V]\FKSU]\SDGNyZQLHSRGGDMąF\FKVLĊSV\FKRWHUDSLL>@-HVWWR]ZLą]DQH]PRĪ-
OLZRĞFLąZ\VWĊSRZDQLDG]LDáDĔQLHSRĪąGDQ\FKIDUPDNRWHUDSLLFKRFLDĪ665,VąUDF]HM
GREU]HWROHURZDQHSU]H]G]LHFL]60>@665,XPRĪOLZLDMąUHGXNFMĊREMDZyZ
OĊNRZ\FK ]ZLą]DQ\FK ] PyZLHQLHP ZSá\ZDMą WDNĪH QD ]ZLĊNV]HQLH VNXWHF]QRĞFL
&%7>@,QQąVWRVRZDQąQLHNLHG\JUXSąOHNyZVąLQKLELWRU\PRQRDPLQRRNV\GD]\
,0$2 MHGQDNQLHVąRQHSRZV]HFKQLH]DOHFDQH]HZ]JOĊGXQDLFKG]LDáDQLDQLHSR-
ĪąGDQHLSRZLQQ\E\üZáąF]DQHMDNRWHUDSLDRVWDWQLHJRZ\ERUX>@
$XWRU]\RPDZLDQHJRSU]HJOąGXRSLHUDMąFVLĊQDZ\QLNDFKSRV]F]HJyOQ\FKED-
GDĔZQLRVNXMąĪHSRZ\ĪV]HVWUDWHJLHWHUDSHXW\F]QH V]F]HJyOQLH&%7 PRJąWDNĪH
]PQLHMV]\üQDVLOHQLHREMDZyZ]DEXU]HĔZVSyáZ\VWĊSXMąF\FK]60 WDNLFKMDN63OĊN
VHSDUDF\MQ\]HVSyáOĊNXXRJyOQLRQHJR2&'$'+' MHGQDNGRSRWZLHUG]HQLDWHM
REVHUZDFMLQLH]EĊGQHVąGDOV]HEDGDQLDQDZLĊNV]HMJUXSLHG]LHFL>@0áRGV]\ZLHN
UR]SRF]ĊFLDOHF]HQLD ]DUyZQRSV\FKRWHUDSLLMDNLIDUPDNRWHUDSLL Z\GDMHVLĊSR]\-
W\ZQLHZSá\ZDüQDURNRZDQLHFRGRVWRSQLDSRSUDZ\NOLQLF]QHMíVWąGGXĪH]QDF]HQLH
SURJQRVW\F]QHSU]\SLVXMHVLĊZF]HĞQLHSRVWDZLRQHMGLDJQR]LH>@
:LHOHG]LHFL]60VSHáQLDWDNĪHNU\WHULDLQQ\FKZVSyáWRZDU]\V]ąF\FK]DEXU]HĔ>@
NWyUHPRJąE\üĨUyGáHPRGF]XZDQHJROĊNXLLQQ\FKQHJDW\ZQ\FKHPRFML>@
0RĪQDSU]\SXV]F]DüĪHSR]QDQLHĨUyGáDOĊNXLRGSRZLHGQLDMHJRWHUDSLDPRJąGHF\GR-
ZDüRRVLąJQLĊFLXWUZDáHJRVXNFHVXWHUDSHXW\F]QHJR3U]\NáDGRZR+HQNLQL%DU+DLP
>@SURSRQXMąVSHFMDOQHWUHQLQJLVNLHURZDQHGRG]LHFL]GH¿F\WDPLSU]HWZDU]DQLD
VáXFKRZHJRSRPDJDMąFHZ]PDFQLDüV\QFKURQL]DFMĊV\PXOWDQLF]QHJRSU]HWZDU]DQLD
RWU]\PDQ\FKLQIRUPDFMLVáXFKRZ\FKSRGF]DVMHGQRF]HVQHJRJáRĞQHJRPyZLHQLD
$XWRU]\]DMPXMąF\VLĊWHPDW\Ną60]DOHFDMąPXOWLPRGDOQHSRGHMĞFLHGRRSLV\ZD-
QHJR]DEXU]HQLDXZ]JOĊGQLDMąFHZáąF]HQLHVLĊZSURFHVGLDJQRVW\F]QRWHUDSHXW\F]Q\
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 13

]DUyZQRSV\FKLDWU\SV\FKRORJDDXGLRORJDMDNLLQQ\FKVSHFMDOLVWyZ3URFHVGLDJQR-
VW\F]Q\SRZLQLHQE\üXNLHUXQNRZDQ\ZV]F]HJyOQRĞFLQDREMDZ\]DEXU]HĔOĊNRZ\FK
]DEXU]HĔ QHXURUR]ZRMRZ\FK QS$6' ]DEXU]HĔ PRZ\ L MĊ]\NRZ\FK  GH¿F\WyZ
SU]HWZDU]DQLDVáXFKRZHJRLLQQ\FK]DEXU]HĔSV\FKLF]Q\FK>@

Podsumowanie
0XW\]PZ\ELyUF]\MHVWĞFLĞOHSRZLą]DQ\]HWLRSDWRORJLąOĊNX:VSyáZ\VWĊSXMąFH
]DEXU]HQLDUR]ZRMX QS]DEXU]HQLDNRPXQLNDFMLZPRZLHLOXEMĊ]\NX$6' VSHF\-
¿F]Q\WHPSHUDPHQW KDPRZDQHEHKDZLRUDOQH F]\QQLNLĞURGRZLVNRZH QSZ]RU]HF
]DFKRZDQLD XQLNDMąFHJR Z URG]LQLH  RSLV\ZDQH Vą Z OLWHUDWXU]H SU]HGPLRWX MDNR
SUHG\VSRQXMąFHGRUR]ZRMX]DEXU]HĔOĊNRZ\FK=JRGQLH]SV\FKRSDWRORJLąUR]ZRMX
F]\QQLNLJHQHW\F]QHRUD]LQWHUDNFMHPLĊG]\ZVSRPQLDQ\PLSUHG\VSR]\FMDPL]F]D-
VHPPRJąSURZDG]LüGRXMDZQLHQLDVLĊ60 RNUHVSU]HáRPRZ\ :LHORF]\QQLNRZD
HWLRORJLDZ\PXV]DPXOWLPRGDOQHSRGHMĞFLHZSURFHVLHGLDJQRVW\F]QRWHUDSHXW\F]Q\P
NWyU\SRZLQLHQ]RVWDüSRGMĊW\MDNQDMZF]HĞQLHME\]DSRELHFQDVWĊSF]\PRSyĨQLHQLRP
ZSR]QDZF]\PLVSRáHF]Q\PUR]ZRMXG]LHFND0RĪQDZLĊFSU]\MąüĪHURNRZDQLH
LSU]HELHJ60]DOHĪąRG]DEXU]HĔZVSyáWRZDU]\V]ąF\FK
1DMVNXWHF]QLHMV]ąPHWRGąOHF]HQLDSRGREQLHMDNZLQQ\FKG]LHFLĊF\FK]DEXU]H-
QLDFKOĊNRZ\FKRND]XMHVLĊSV\FKRWHUDSLDSR]QDZF]REHKDZLRUDOQDNWyUD]DOHFDQD
MHVWMDNRPHWRGDSLHUZV]HJRZ\ERUX7HUDSLDVNXSLRQDMHG\QLHQDVNáDGRZHMOĊNRZHM
]DEXU]HQLDZUD]LHZVSyáZ\VWĊSRZDQLD]DEXU]HĔZ]PDFQLDMąF\FKRGF]XZDQLHOĊNX
PRĪHSHáQLüIXQNFMĊOHF]HQLD]DOHGZLHREMDZRZHJR,VWQLHMHSRWU]HEDSURZDG]HQLD
GDOV]\FKEDGDĔZFHOXVWZLHUG]HQLDF]\60MHVW]DEXU]HQLHPOĊNRZ\PF]\PRĪH
UDF]HMURG]DMHP]DFKRZDQLDXQLNDMąFHJRELRUąFHJRVLĊ]RGF]XZDQLDQHJDW\ZQ\FK
HPRFMLZ\ZRá\ZDQ\FKQDSRW\NDQLHPWUXGQRĞFLZNRPXQLNDFMLLHGXNDFML QSZV]NR-
OH ]SRZRGXZ\VWĊSXMąF\FK]DEXU]HĔ
&]\QQLNLNWyUHPRJą]ZLĊNV]DüU\]\NRZ\VWąSLHQLD60ZRNUHVLHZF]HVQR-
G]LHFLĊF\P
– SáHüĪHĔVND
– SROLPRU¿]PJHQX&171$3
– URG]LFHZ\ND]XMąF\WHQGHQFMĊGR]DFKRZDĔXQLNDMąF\FK
– QDGRSLHNXĔF]RĞüLQDGPLHUQDNRQWURODURG]LFLHOVND
– WUXGQRĞFLHGXNDF\MQHLOXEWUXGQRĞFLZNRQWDNWDFK]UyZLHĞQLNDPL]SRZRGX
]DEXU]HĔNRPXQLNDFMLLOXERSyĨQLHQLDZUR]ZRMXLOXE]DEXU]HQLDSU]HWZD-
U]DQLDVáXFKRZHJR
– status imigranta,
– QLHĞPLDáRĞü
– KDPRZDQLHEHKDZLRUDOQH V]F]HJyOQLHJG\MHVWVLOQLHZ\UDĪRQH 
14 Emil Bartosz Rozenek i wsp.

3LĞPLHQQLFWZR
1. 6KDUS:*6KHUPDQ&*URVV$06HOHFWLYHPXWLVPDQGDQ[LHW\$UHYLHZRIWKHFXUUHQWFRQ-
ceptualisation of the disorder-$Q[LHW\'LVRUG  ±
2. American Psychological Association (APA). Diagnostic and Statistical Manual of Mental
Disorders, 4th ed. (DSM-IV). 1994.
3. 0XULV32OOHQGLFN7+&KLOGUHQZKRDUHDQ[LRXVLQVLOHQFH$UHYLHZRQVHOHFWLYHPXWLVPWKH
1HZ$Q[LHW\'LVRUGHULQ'60&OLQ&KLOG)DP3V\FKRO5HY  ±
4. American Psychiatric Association (APA). 'LDJQRVWLFDQGVWDWLVWLFDOPDQXDORIPHQWDOGLVRUGHUV
'60. 2013.
5. .RJDQ&66WHLQ'-0DM0)LUVW0%(PPHONDPS30*5HHG*07KHFODVVL¿FDWLRQRI
DQ[LHW\DQGIHDUUHODWHGGLVRUGHUVLQWKH,&''HSUHVV$Q[LHW\  ±
6. 9LDQD$*%HLGHO'&5DELDQ%6HOHFWLYHPXWLVP$UHYLHZDQGLQWHJUDWLRQRIWKHODVW\HDUV.
&OLQ3V\FKRO5HY  ±
7. %RJHOV60$OGHQ/%HLGHO'&&ODUN/$3LQH'66WHLQ0%LZVS6RFLDODQ[LHW\GLVRUGHU
4XHVWLRQVDQGDQVZHUVIRUWKH'609'HSUHVV$Q[LHW\  ±
8. Østergaard KR.7UHDWPHQWRIVHOHFWLYHPXWLVPEDVHGRQFRJQLWLYHEHKDYLRXUDOWKHUDS\SV\-
FKRSKDUPDFRORJ\DQGFRPELQDWLRQWKHUDS\±$V\VWHPDWLFUHYLHZ1RUG-3V\FKLDWU\
72(4): 240–250.
9. Bilikiewicz A. red.3V\FKLDWULDSRGUĊF]QLNGODVWXGHQWyZPHG\F\Q\, wyd. 3. Warszawa: Wy-
GDZQLFWZR/HNDUVNLH3=:/6
10. 6PLWK6FKUDQGW+/(OOLQJWRQ(8QDEOHWRVSHDN6HOHFWLYHPXWLVPLQ\RXWK. J. Psychosoc.
1XUV0HQW+HDOWK6HUY  ±
11. .ULVWHQVHQ+6HOHFWLYH0XWLVPDQG&RPRUELGLW\:LWK'HYHORSPHQWDO'LVRUGHU'HOD\$Q[LHW\
'LVRUGHU DQG (OLPLQDWLRQ 'LVRUGHU -$P$FDG &KLOG$GROHVF 3V\FKLDWU\    
249–256.
12. 2HUEHFN%0DQDVVLV.2YHUJDDUG.5.ULVWHQVHQ+Selective mutism.W: Rey JM.red. IACA-
3$3HWH[WERRNRIFKLOGDQGDGROHVFHQWPHQWDOKHDOWK*HQHYD,QWHUQDWLRQDO$VVRFLDWLRQIRU
&KLOGDQG$GROHVFHQW3V\FKLDWU\DQG$OOLHG3URIHVVLRQV&KDSWHU)6±
13. 5HPVFKPLGW+3ROOHU0+HUSHUW]'DKOPDQQ%+HQQLJKDXVHQ.*XWHQEUXQQHU&$IROORZXS
VWXG\RISDWLHQWVZLWKHOHFWLYHPXWLVP(XU$UFK3V\FKLDWU\&OLQ1HXURVFL  
284–296.
14. 6WHLQKDXVHQ+&:DFKWHU0/DLPE|FN.0HW]NH&:$ORQJWHUPRXWFRPHVWXG\RIVHOHFWLYH
mutism in childhood-&KLOG3V\FKRO3V\FKLDWU\  ±
15. &KDYLUD'$6KLSRQ%OXP(+LWFKFRFN&&RKDQ66WHLQ0%Selective mutism and social
DQ[LHW\ GLVRUGHU $OO LQ WKH IDPLO\"-$P$FDG &KLOG$GROHVF 3V\FKLDWU\    
1464–1472.
16. )RUG 0$ 6ODGHF]HN ,( &DUOVRQ - .UDWRFKZLOO 75 6HOHFWLYH PXWLVP 3KHQRPHQRORJLFDO
characteristics6FK3V\FKRO4  ±
17. 6WHLQKDXVHQ+&-X]L&(OHFWLYHPXWLVP$QDQDO\VLVRIFDVHV-$P$FDG&KLOG$GROHVF
3V\FKLDWU\  ±
18. 6WH൵HQEXUJ+6WH൵HQEXUJ6*LOOEHUJ&%LOOVWHGW(&KLOGUHQZLWKDXWLVPVSHFWUXPGLVRUGHUV
and selective mutism1HXURSV\FKLDWU'LV7UHDW±
19. .RSS 6 *LOOEHUJ & 6HOHFWLYH PXWLVP $ SRSXODWLRQEDVHG VWXG\ $ UHVHDUFK QRWH- &KLOG
3V\FKRO3V\FKLDWU\  ±
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 15

20. $QGHUVVRQ&%7KRPVHQ3+(OHFWLYHO\PXWHFKLOGUHQ$QDQDO\VLVRI'DQLVKFDVHV.Nord.
-3V\FKLDWU\  ±
21. (KOHUV6*LOOEHUJ&7KHHSLGHPLRORJ\RI$VSHUJHUV\QGURPH-&KLOG3V\FKRO3V\FKLDWU\
  ±
22. Wong P. 6HOHFWLYHPXWLVP$UHYLHZRIHWLRORJ\FRPRUELGLWLHVDQGWUHDWPHQW. Psychiatry (Ed-
JHPRQW   ±
23. Sharkey L, McNicholas F. 0RUHWKDQ\HDUVRIVLOHQFHHOHFWLYHPXWLVP$UHYLHZRIWKH
literature(XU&KLOG$GROHVF3V\FKLDWU\  ±
24. 0HULNDQJDV .5 +H -3 %XUVWHLQ 0 6ZDQVRQ 6$$YHQHYROL 6 /LKRQJ & L ZVS Lifetime
SUHYDOHQFH RI PHQWDO GLVRUGHUV LQ 86 DGROHVFHQWV 5HVXOWV IURP WKH 1DWLRQDO &RPRUELGLW\
6XUYH\5HSOLFDWLRQ±$GROHVFHQW6XSSOHPHQW 1&6$ -$P$FDG&KLOG$GROHVF3V\FKLDWU\
  ±
25. %HUJPDQ5/3LDFHQWLQL-0F&UDFNHQ-7Prevalence and description of selective mutism in
a school-based sample-$P$FDG&KLOG$GROHVF3V\FKLDWU\  ±
26. (OL]XU<3HUHGQLN5Prevalence and description of selective mutism in immigrant and native
IDPLOLHV$FRQWUROOHGVWXG\-$P$FDG&KLOG$GROHVF3V\FKLDWU\  í
27. 6WHLQKDXVHQ+&$GDPHN57KHIDPLO\KLVWRU\RIFKLOGUHQZLWKHOHFWLYHPXWLVP$UHVHDUFK
report(XU&KLOG$GROHVF3V\FKLDWU\  ±
28. &RKDQ6/3ULFH-06WHLQ0%6XৼHULQJLQVLOHQFH:K\DGHYHORSPHQWDOSV\FKRSDWKRORJ\
perspective on selective mutism is needed-'HY%HKDY3HGLDWULFV  ±
29. &XQQLQJKDP&(0F+ROP$(%R\OH0+6RFLDOSKRELDDQ[LHW\RSSRVLWLRQDOEHKDYLRUVRFLDO
VNLOOVDQGVHOIFRQFHSWLQFKLOGUHQZLWKVSHFL¿FVHOHFWLYHPXWLVPJHQHUDOL]HGVHOHFWLYHPXWLVP
DQGFRPPXQLW\FRQWUROV(XU&KLOG$GROHVF3V\FKLDWU\  ±
30. 6WHLQ 0% <DQJ %= &KDYLUD '$ +LWFKFRFN &$ 6XQJ 6& 6KLSRQ%OXP ( L ZVS A
FRPPRQJHQHWLFYDULDQWLQWKHQHXUH[LQVXSHUIDPLO\PHPEHU&171$3LVDVVRFLDWHGZLWK
LQFUHDVHGULVNIRUVHOHFWLYHPXWLVPDQGVRFLDODQ[LHW\UHODWHGWUDLWV%LRO3V\FKLDWU\
69(9): 825–831.
31. .ULVWHQVHQ+7RUJHUVHQ60&0,,,SHUVRQDOLW\WUDLWVDQGV\PSWRPWUDLWVLQSDUHQWVRIFKLO-
GUHQZLWKVHOHFWLYHPXWLVP$FDVHFRQWUROVWXG\-$EQRUP3V\FKRO  ±
32. .ULVWHQVHQ+7RUJHUVHQ6$FDVHFRQWUROVWXG\RI($6FKLOGDQGSDUHQWDOWHPSHUDPHQWVLQ
VHOHFWLYHO\PXWHFKLOGUHQZLWKDQZLWKRXWDFRPRUELGFRPPXQLFDWLRQGLVRUGHU. Nord. J. Psy-
FKLDWU\  ±
33. &XQQLQJKDP&(0F+ROP$%R\OH0+3DWHO6%HKDYLRUDODQGHPRWLRQDODGMXVWPHQWIDPLO\
IXQFWLRQLQJDFDGHPLFSHUIRUPDQFHDQGVRFLDOUHODWLRQVKLSVLQFKLOGUHQZLWKVHOHFWLYHPXWLVP.
-&KLOG3V\FKRO3V\FKLDWU\  ±
34. (GLVRQ6&(YDQV0$0F+ROP$(&XQQLQJKDP&(1RZDNRZVNL0(%R\OH0LZVS
$Q ,QYHVWLJDWLRQ RI &RQWURO$PRQJ 3DUHQWV RI 6HOHFWLYHO\ 0XWH$Q[LRXV DQG 1RQ$Q[LRXV
Children.&KLOG3V\FKLDWU\+XP'HY  
35. +ROND3RNRUVND-3LURJ%DOFHU]DN$-DUHPD07KHFRQWURYHUV\DURXQGWKHGLDJQRVLVRIVHOHF-
WLYHPXWLVP±$FULWLFDODQDO\VLVRIWKUHHFDVHVLQWKHOLJKWRIPRGHUQUHVHDUFKDQGGLDJQRVWLF
criteria3V\FKLDWU3RO  ±
36. .XPSXODLQHQ.5lVlQHQ(5DDVND+6RPSSL9Selective mutism among second-graders in
HOHPHQWDU\VFKRRO(XU&KLOG$GROHVF3V\FKLDWU\  ±
37. %HLGDV566XDUH]/6LPSVRQ'5HDG.:HL&&RQQROO\6LZVS&RQWH[WXDOIDFWRUVDQG
DQ[LHW\LQPLQRULW\DQG(XURSHDQ$PHULFDQ\RXWKSUHVHQWLQJIRUWUHDWPHQWDFURVVWZRXUEDQ
XQLYHUVLW\FOLQLFV-$Q[LHW\'LVRUG  ±
16 Emil Bartosz Rozenek i wsp.

38. .DJDQ-6QLGPDQ1$UFXV'6WHYHQ5H]QLFN-*DOHQ¶VSURSKHF\7HPSHUDPHQWLQKXPDQ
nature1HZ<RUN1<%DVLF%RRNV
39. &ROO&*.DJDQ-5H]QLFN-6%HKDYLRUDOLQKLELWLRQLQ\RXQJFKLOGUHQ&KLOG'HY  
1005–1019.
40. *HQVWKDOHU$.KDODI6/LJJHV0.DHVV0)UHLWDJ&06FKZHQFN&Selective mutism and
WHPSHUDPHQW 7KH VLOHQFH DQG EHKDYLRUDO LQKLELWLRQ WR WKH XQIDPLOLDU (XU &KLOG$GROHVF
3V\FKLDWU\  ±
41. %LHGHUPDQ-+LUVKIHOG%HFNHU'55RVHQEDXP-)+pURW&)ULHGPDQ'6QLGPDQ1LZVS
)XUWKHUHYLGHQFHRIDVVRFLDWLRQEHWZHHQEHKDYLRXUDOLQKLELWLRQDQGVRFLDODQ[LHW\LQFKLOGUHQ.
$P-3V\FKLDWU\  ±
42. 6FRWW6%HLGHO'&6HOHFWLYHPXWLVP$QXSGDWHDQGVXJJHVWLRQVIRUIXWXUHUHVHDUFK&XUU
3V\FKLDWU\5HS  ±
43. White SW, Oswald D, Ollendick T, Scahill L. $Q[LHW\LQFKLOGUHQDQGDGROHVFHQWVZLWKDXWLVP
spectrum disorders&OLQ3V\FKRO5HY  ±
44. +R\57XQLQJLQE\WXQLQJRৼ1DWXUH±
45. &XULR*1HXORK*1XPPLQHQ--RXVPDNL9+DUL56SHDNLQJPRGL¿HVYRLFHHYRNHGDFWLYLW\
LQWKHKXPDQDXGLWRU\FRUWH[+XP%UDLQ0DSS  ±
46. +HQNLQ<%DU+DLP<$QDXGLWRU\QHXURVFLHQFHSHUVSHFWLYHRQWKHGHYHORSPHQWRIVHOHFWLYH
mutism'HY&RJQ1HXURVFL±
47. %DU+DLP<,QWURYHUVLRQDQGLQGLYLGXDOGLৼHUHQFHVLQDFRXVWLFUHÀH[IXQFWLRQ. Int. J. Psychop-
K\VLRO  ±
48. 0XFKQLN&$UL(YHQ5RWK'+LOGHVKHLPHU0$ULH0%DU+DLP<+HQNLQ<Abnormalities
LQDXGLWRU\HৼHUHQWDFWLYLWLHVLQFKLOGUHQZLWKVHOHFWLYHPXWLVP$XGLRO1HXURRWRO  
353–361.
49. 0DQDVVLV.7DQQRFN5*DUODQG(-0LQGH.0F,QQHV$&ODUN67KHVRXQGVRIVLOHQFH
/DQJXDJHFRJQLWLRQDQGDQ[LHW\LQVHOHFWLYHPXWLVP-$P$FDG&KLOG$GROHVF3V\FKLDWU\
  ±
50. Bergman RL, Keller ML, Piacentini J, Bergman AJ. 7KHGHYHORSPHQWDQGSV\FKRPHWULFSURSHU-
ties of the selective mutism questionnaire-&OLQ&KLOG$GROHVF3V\FKRO  ±
51. 'LOLEHUWR5$.HDUQH\&$$Q[LHW\DQGRSSRVLWLRQDOEHKDYLRUSUR¿OHVDPRQJ\RXWKZLWKVHOHF-
tive mutism-&RPPXQ'LVRUG±
52. %ODFN%8KGH7:3V\FKLDWULFFKDUDFWHULVWLFVRIFKLOGUHQZLWKVHOHFWLYHPXWLVP$SLORWVWXG\.
-$P$FDG&KLOG$GROHVF3V\FKLDWU\  ±
53. +XD$0DMRU1Selective mutism&XUU2SLQ3HGLDWU  ±
54. <HJDQHK5%HLGHO'&7XUQHU603LQD$$6LOYHUPDQ:.&OLQLFDOGLVWLQFWLRQVEHWZHHQ
VHOHFWLYHPXWLVPDQGVRFLDOSKRELD$QLQYHVWLJDWLRQRIFKLOGKRRGSV\FKRSDWKRORJ\. J. Am.
$FDG&KLOG$GROHVF3V\FKLDWU\  ±
55. Moldan MB. Selective mutism and self-regulation&OLQ6RF:RUN-  ±
56. :RR60.HDWLQJH&Diagnosis and treatment of mental disorders across the lifespan+RERNHQ
1-:LOH\DQG6RQV,QF
57. <RXQJ%-%XQQHOO%(%HLGHO'&(YDOXDWLRQRIFKLOGUHQZLWKVHOHFWLYHPXWLVPDQGVRFLDO
SKRELD$FRPSDULVRQRISV\FKRORJLFDODQGSV\FKRSK\VLRORJLFDODURXVDO%HKDY0RGLI
36(4): 525–544.
58. /H'RX[-(0RVFDUHOOR-6HDUV5&DPSHVH97KHELUWKGHDWKDQGUHVXUUHFWLRQRIDYRLGDQFH
$UHFRQFHSWXDOL]DWLRQRIDWURXEOHGSDUDGLJP0RO3V\FKLDWU\  ±
Mutyzm wybiórczy – opis zaburzenia i etiologia:czy wybiórczy brak mowy 17

59. 3LRQHN6WRQH%.UDWRFKZLOO76ODGH]FHN,6HUOLQ5&7UHDWPHQWRIVHOHFWLYHPXWLVP$EHVW
HYLGHQFHV\QWKHVLV6FK3V\FKRO4  ±
60. %HUJPDQ5/*RQ]DOH]$3LDFHQWLQL-.HOOHU0/,QWHJUDWHGEHKDYLRUWKHUDS\IRUVHOHFWLYH
PXWLVP$UDQGRPL]HGFRQWUROOHGSLORWVWXG\%HKDY5HV7KHU  ±
61. &DUOVRQ-.UDWRFKZLOO7-RKQVWRQ+Prevalence and treatment of selective mutism in clinical
SUDFWLFH$VXUYH\RIFKLOGDQGDGROHVFHQWSV\FKLDWULVWV-&KLOG$GROHVF3V\FKRSKDUPDFRO
  ±
62. 'XPPLW(6.OHLQ5*$VFKH%0DUWLQ-7DQFHU1.)OXR[HWLQHWUHDWPHQWRIFKLOGUHQZLWK
VHOHFWLYHPXWLVP$QRSHQWULDO-$P$FDG&KLOG$GROHVF3V\FKLDWU\  ±
63. 2HUEHFN%6WHLQ0%3ULSS$+.ULVWHQVHQ+6HOHFWLYHPXWLVP)ROORZXSVWXG\\HDUDIWHU
end of treatment(XU&KLOG$GROHVF3V\FKLDWU\  ±

Adres: Emil Bartosz Rozenek


6WXGHQFNLH.RáR1DXNRZHSU]\.OLQLFH3V\FKLDWULL
8QLZHUV\WHW0HG\F]Q\Z%LDá\PVWRNX
&KRURV]F]SO%URGRZLF]D
e-mail: e.rozenek@o2.pl

Otrzymano: 28.01.2019
Zrecenzowano: 28.03.2019
Otrzymano po poprawie: 14.04.2019
3U]\MĊWRGRGUXNX

View publication stats

You might also like