Isabelle is not diagnosed in the book, but were she to be, she would probably be
diagnosed with Selective Mutism, a childhood anxiety disorder. Some
therapists might even diagnose her with Traumatic Mutism because of the
immediate onset and her total silence. Most children with SM are not completely
silent all the time. They are silent as a result of deep anxiety, but will talk
normally when they are in 'safe' environments. Isabelle would be a rare case
because she is completely silent for nine months.
Children with SM often have "severely inhibited temperaments" and are more prone to anxiety. When we become stressed, the amygdala (the brain's "emergency manager") responds to the potential crisis by overriding thought and instigating a reaction intended to protect the body. In children with SM, that reaction is silence. Fearful situations can be birthday parties, school, family gatherings, or routine errands. Many children with SM also have Sensory Integration Dysfunction (SID), which means they have trouble processing sensory information. A child with SID may have trouble comprehending social cues, which can lead to anxiety and fear and, in some cases, silence.
Selective Mutism is treated using a variety of tactics: Behavioral therapy,
play therapy, medication, self-esteem boosters (parents should emphasize their
child's positive attributes), frequent socialization, school involvement, and
family involvement. The ultimate goals being to decrease anxiety, and increase
social confidence and self-esteem. As the child feels more comfortable and
self-esteem builds, he/she should progress from nonverbal to verbal
More information at the Selective Mutism Foundation.
This article was originally published in June 2008, and has been updated for the
July 2009 paperback release.
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