#123: Selective Mutism and Autism: Interview with Chelsea Gamache

BCBA Chelsea Gamache joins me to talk about selective mutism and the similarities and differences between selective mutism and autism. She describes herself as having been born into the world of selective mutism. She was an anxious baby, and she grew up afraid to interact with people. When she started formal schooling, her teacher mentioned to her parents that she didn’t speak for the entire year and that it might be a problem. For many children with selective mutism, they’re often officially diagnosed after they go into the public school system and are placed into settings where they are unable to speak.

Selective mutism is an anxiety disorder where a child is unable to speak in certain settings even though they can speak in other settings where they feel more comfortable. It can look like autism if a teacher or therapist doesn’t realize that the speech delay is related to the child’s environment. Children with SM may also have some behaviors that are repetitive, like stimming, but the root causes are not the same as autism.

68% of children with selective mutism have a history of developmental delays, and while there is no statistic on how many children with autism have selective mutism, it’s a pretty high comorbidity rate. Chelsea says that it’s not just a fear of talking. It’s also a fear of having attention on you, which can show up as a reluctance to even ask to go to the bathroom in class.

Today Chelsea works as a BCBA with the autism community because she’s always felt like she understood these individuals well. We discuss some of the ABA techniques that can be used for a child with selective mutism, including pairing and shaping procedures. As children return to schools and preschools, many of them will need help dealing with new emotions and fears, so Chelsea also wrote and illustrated a book last year to help children who are dealing with their anxiety called I Am Brave. Check out her book and her podcast called Outloud: The Selective Mutism Podcast.

TODAY’S GUEST

Chelsea Gamache is a Board Certified Behavior Analyst. She was diagnosed with Selective Mutism and Sensory Processing Disorder at 5 years old. She now hosts Outloud the Selective Mutism Podcast with her mom and recently wrote a children’s book called I Am Brave.

YOU’LL LEARN

  • How therapists and parents can “contaminate” a place for a child with a negative experience, and how they can carefully repair the damage.
  • 1 in 140 children are diagnosed with selective mutism, but the statistic keeps changing and it is becoming more common.
  • How therapy can be used to break the cycle and help the child slowly and carefully face their fears.
  • The similarities between autism and selective mutism mean that they can sometimes be misdiagnosed or undiagnosed; we talk about the overlap between the two disorders.
  • What are shaping procedures and how can they help a child that is reluctant to speak independently?
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Transcript for Podcast Episode: 123
Selective Mutism and Autism: Interview with Chelsea Gamache
Hosted by: Dr. Mary Barbera

Mary: You're listening to another episode of the Turn Autism Around podcast. I'm your host, Dr. Mary Barbera, and I am thrilled that you are tuning in today. The topic is selective mutism, whether that's a comorbid diagnosis or on its own. We are talking with our guests, Chelsea Gamache who is a board-certified behavior analyst, and she herself was diagnosed with selective mutism at the age of five. She also was diagnosed with a sensory processing disorder. Chelsea host the OutLoud, the Selective Mutism Podcast with her mom. And Chelsea also recently wrote a children's book called I Am Brave. So she's a wealth of information for us. We are talking all about the science, the myths, how often it occurs with autism, which is a lot, and just getting some tips for how we can make things better both for kids with autism and kids with selective mutism. So you're not going to want to miss this special episode. So let's get to that right now.

Mary: Thanks so much for joining us today, Chelsea. It's great to have you here.

Chelsea: Thanks for having me. I'm excited to talk about selective mutism.

Mary: Yeah, I'm excited, too. OK, so today we are going to talk about selective mutism. And I usually start with describe your fall into the autism world, but why don't you first tell us how you fell into the world of selective mutism?

Chelsea: Yeah, I like to say I was actually born into the world of selective mutism because I think I was born with this heightened anxiety as a baby. I was described as very shy and I didn't want people looking at me. I would cry if people laughed. I was also dealing with a lot of sensory issues, with having to do with light and textures and sound. Just generally. I was an anxious baby and I grew up kind of afraid to interact with people. I was more comfortable with my family, but I was still showing signs of anxiety at home and selective mutism kind of started showing itself when I started school, which is pretty typical for that diagnosis, because you're starting out in an environment where you're expected to speak to new people and then you're seeing that absence of speech and it's really standing out there. So that's usually when you seek a diagnosis.

Mary: OK, and did you go to like preschool or camps or anything?

Chelsea: Yeah, I was going to preschool and I wasn't speaking there. I did have one friend who I would talk to. I knew her from my neighborhood, so I felt comfortable talking to her as long as no one else was around and could hear me or see me speaking. It was still pretty limited, I would say. I whispered a lot and I really avoided speaking to anyone else. It kind of went unnoticed in preschool and it was more recognized when I was in kindergarten by my teacher, who was like, she hasn't spoken a word like all year, so maybe we should look into that.

Mary: Yeah. So many of my listeners are probably not familiar with selective mutism. And so can you, like, tell us what it is and how it differs from autism if it differs?

Chelsea: Yeah. So it's an anxiety disorder. It's categorized as an anxiety disorder where a child is unable to speak in certain settings despite being able to speak freely in another setting where there more usually where they're more comfortable. So they say child, but this can last into adulthood and we see teens who are still struggling with this and even adults. So I like to make that point. When I talk about selective mutism, I guess you asked how it differs from autism. They do get mixed up quite a bit. And I think people are misdiagnosed with one or the other sometimes, which is probably true for other diagnoses with autism gets mixed up with like ADHD. But I think selective mutism, you see a child who is not speaking. So they appear nonverbal. They're socially withdrawn. A lot of the time they're not pointing or gesturing. Sometimes they rely on nonverbal communication. But me personally, I could I wouldn't even point to something I wanted. I wouldn't gesture. I wouldn't do hand motions to songs. So that can really look like autism if you don't see the child in a more comfortable setting. So it's always important to get baseline. A lot of the time you can record video at home or where they're most comfortable and comparing that to a school, you can really see the differences. But I will say I think it's hard to pull the two apart. I think you can absolutely have both diagnoses and it's hard to tell the difference sometimes.

Mary: Yeah, I worked with a few clients with selective mutism. One little girl I worked with at home and then a few clients within the verbal behavior project had it. And then I did a couple independent evaluations where they had both autism and selective mutism. So how common is selective mutism? Do you now or.

Chelsea: Yeah, it's one in one hundred forty children are diagnosed. Wow. Yeah. I've heard that statistic keeps changing and becoming a little bit more common because I think it's so unknown. Like people don't have never heard of selective mutism or I think kids definitely go undiagnosed for a long time and depending on your resources, it's hard to get treatment and get that diagnosis.

Mary: So yeah. So how, how did you get interested in autism and, you know, interested in becoming a BCBA?

Chelsea: Yeah, it's. It's been a journey, I guess, growing up, I was always anxious and I I really tried hard to educate myself about anxiety. Like in high school, I was Googling, doing my own research, reading. I just really wanted to get to the root cause. And I wanted to help kids that were going through what I went through. So I volunteered to help other kids with selective mutism when I was in high school. And that kind of led me into the psychology realm. And then I did that for my undergrad and I found eBay after I graduated when I was looking for jobs. And I don't know, I just I really loved how it was more scientific than just your general psychology, which I love psychology, but I really loved taking data and trying to get to the root cause of problems and figuring out how to solve them. And I fell in love with working with autistic people. I felt like I understood them on a level because of my sensory processing. And I saw a lot of myself in them, I think. And it's just been a really exciting journey and it feels like what I was meant to do.

Mary: Yeah, so we just met online just last week, and I did send you a copy of my book so that you could at least glance at the first couple of chapters and look at the book and so that we could talk about, you know, the signs in Chapter two, the signs of autism. And let's just talk about them. Is there anything in here that. Is not a part of selective mutism, like is there anything in here that's kind of missing? So let me just go through Chapter two. So Chapter two is called Is it autism, ADHD or just a speech delay? Now, I told you, I haven't mentioned selective mutism in the whole book. I know while I worked with a couple of kids, I personally feel like especially when you're talking about a young child, one, two, three, four. You know, especially during the pandemic, they're pretty much at home. So we may be in for a whole lot more selective mutism when the world opens up and these kids are actually going to preschool or going to the grocery store or perhaps for the very first time, because I think part of it is exposure. Right. And so if you think of a one year old, they've spent their entire lives in isolation wherever you are listening around the world. And then two- and three-year-olds have spent half their lives in isolation with just their family. So, you know, this may be an even more important. So pointing you said that can be delayed with selective mutism, right?

Chelsea: It can. Yeah. You might not see it at all or only when they're comfortable. I didn't mention eye contact as well, something I struggled with a lot. And it's common with this diagnosis not being able to make eye contact.

Mary: So with speech and language delays, which is also definitely a sign that could be autism. Are you seeing both expressive and receptive delays in some kids or mostly just expressive?

Chelsea: It's mostly expressive, but there are I don't know the statistics, but there's both. I think it's expressive.

Mary: Yeah. And then excessive tantrums. You described yourself as being shy and withdrawn, but did you also have tantrums when things didn't go your way?

Chelsea: Yeah, I would say not in public where I felt comfortable. That's where I felt safe enough to have a tantrum, kind of let myself go. And I think that is seen a lot with selective mutism where kids go through their whole day withdrawn and holding everything and not reacting to anything. And I remember there was so many moments where I felt like crying at school and I just hold it in because I didn't want the attention. When you get home and you let it all out, so you see this behavior contrast, I guess, where when you get home, it's just behavior. And parents are often like, why is my kid so misbehaved? And they're so good at school? It's like, yeah, you just see that difference.

Mary: OK, the next sign in Chapter two is not responding to name. Is that a problem?

Chelsea: No, I don't think. I mean, there's definitely people who fall under autism and selective mutism, but I think that's not a typical characteristic of select mutism.

Mary: Yeah, playing behaviors like playing and social, like playing with toys, playing with peers. Yeah, I'm sure playing with peers is a problem. But how about independent play? Is that delayed?

Chelsea: It's not, not with just selective mutism. I mean, there's no research that shows that. I mean, you will look like that, especially with peers where you're not seeing interaction and maybe they're just like parallel play or they're not doing anything, which is what I often did in preschool. I would kind of just sit there and didn't want to draw any attention to myself and playing might get someone to come talk to me. So I would just avoid anything at all.

Mary: Yeah. And then what about repetitive behaviors, living things up or stemming, flapping your hands in front of your face or rocking?

Chelsea: I don't think that's not brought up a lot with selective mutism, but a high percentage of I don't know what the percentages. I think it's pretty high, though, but kids with us usually have sensory processing issues. And I think that might lead to some behaviors that are repetitive, like stimming or sensory overload.

Mary: Right. Or covering your ears. That would be definitely a sensory issue. How about insistence on sameness, like wanting to wear the same shirt or use the same bowl for certain things? I mean, that or maybe just environmental like you want to be in the same?

Chelsea: It's interest, the same people. I think it's more I don't it's hard for me to know what the function is with autism and sameness, but with selective mutism. I think it's very clear that it's anxiety driven. And wanting to control what's happening around you and wanting to know what's coming next, and I think if there's some sudden change that can be very problematic to someone with selective mutism.

Mary: And many kids with, wow, I don't know what I don't I don't know if this is even documented anywhere, if you would know. But like, do you know how many kids have selective mutism plus autism?

Chelsea: Yeah, there's some research by the Selective Mutism Research Institute, if you want to look at that. OK, so I found that 68 percent of children this is one of the studies I saw with selective mutism, also had a history of developmental delays. And we talked about that earlier. It's mostly speech and language. And then we also have a little bit of gross motor and fine motor skills that are delayed and then sensory processing disorder.

Mary: OK, so 60 percent.

Chelsea: Yeah, I don't have an exact statistic for autism, but one of the top comorbidities is autism, as well as sensory processing disorders and anxiety disorders.

Mary: OK, OK, so it's a pretty good percentage. And especially given the fact that, like, when I wrote my book just last year, while it was just published a month ago, but I wrote it in 2020, you know, the stats are one in fifty-four have autism, one in every six eight-year-olds have some kind of diagnosis of a developmental disorder, including autism, ADHD, learning disabilities, speech and language disorders. So selective mutism. You're saying the one study showed 60 percent have had developmental delays in the past for sure. So there is a ton of overlap, but just keep just a couple more symptoms of possible autism or delays in Chapter two as sensory issues which we talked about, like covering your ears or input with lights and sounds. And I mean, it sounds like selective mutism would have a lot of sensory issues.

Chelsea: Yeah, it's very common. I feel like I did polls like not that those are Instagram polls or super scientific, but it's usually like a high percentage of kids who are experiencing selective mutism and sensory processing disorder.

Mary: Yeah, yeah. And motor delays and toe walking. That's probably just more of an autism thing.

Chelsea: I mean, if you have sensory processing issues, though, like you can, you can see toe walking for a number of reasons. Yeah, I personally did not toe walk, but I did have issues with different clothing textures. I wouldn't wear jeans. I didn't like seams and tags in my clothes. So you definitely see some overlap there.

Mary: And then how about imitation delays like lack of imitation? I can see that being not necessarily like a developmental delay kind of thing, but more of like you said, you didn't want to be in the spotlight. You don't want attention. So like if somebody, a physiotherapist is coming in saying do this and you are like, not comfortable, you probably aren't going to perform imitation or a receptive touching your body parts and that sort of thing.

Chelsea: Yeah, it's I think that's one of those things that's really hard to measure with selective mutism, because so many kids will not do that. And I think it's you need to have someone they're comfortable with or you need to do some parenting to get them comfortable with the person who is initiating the invitations. But I think it's just there's so many things that you can't test with selective mutism because they are it's more than speaking. And people focus so much on the not talking, but kids are afraid to get up to go to the bathroom because they're afraid to raise their hand. It's not just talking. It's a fear of having attention on you and. Potentially having some kind of interaction,

Mary: So if someone has autism and selective mutism, is the treatment different or, you know, what is the treatment for selective mutism with or without autism?

Chelsea: Yeah, so without autism, I would think with both it would be graduated exposure. We all the evidence-based treatments for selective mutism involve exposure to facing their fears. And we have to keep in mind that there is an anxiety component, which I think sometimes with autism we don't. At least in ABA, we don't think about anxiety a lot and the social anxiety that comes with autism, I think that's such an important factor in selective mutism treatment. We need to shape up behavior by building comfort and remembering that these kids are highly anxious. And that is why they're having this freeze response where they feel unable to talk and unable to do certain things.

Mary: Yeah. So when you say graduated exposure, you're talking about pairing, you're talking about desensitization procedures. So that and I a Chapter 13. I don't know if you got a chance to glance at that, but Chapter 13 in my book is all about doctors, dentists, haircuts, how to desensitize. And in the kids that I worked with was selective mutism. It was a lot of pairing, pairing the new environment, pairing the new people, pairing the new toys. Even if your child doesn't have selective mutism, it really does come back to pairing the environment, the table, the whatever. You're going to use materials to make the child comfortable, to get the child writing to you, to learn and to be comfortable. But it is a little bit more tricky with selective mutism, especially as the child enters school, especially if they don't have a diagnosis of autism and they're in the general curriculum where there are not experts and selective mutism. Are there any things that, like I've seen that where parents are like, oh, stop being shy or you're just being shy and that sort of thing? Like, is that is that a bad idea? Or like what should parents do to not make the situation worse?

Chelsea: Right. So one of the biggest myths about selective mutism is that it's just shyness and that they'll get over it on their own. They'll just grow out of it, come out of their shell. That's really usually not the case. It takes exposure and intervention. We see this cycle where parents are rescuing their child, I guess, like where a child will be asked a question and they do not answer because they're terrified. They just feel frozen. That's their go to move to get out of that situation. And a parent will swoop in because you have that awkward silence. They see their child in distress and they go in and either answer the question or remove them from the situation. So therapy is usually about breaking that cycle and still being supportive to the child, but also having them face their fears and do those exposures.

Mary: Have you seen anything different with the pandemic in terms of interacting with kids with selective mutism?

Chelsea: I think at the beginning it was really hard with switching to zoom. And this is another thing that seems to be very common with selective mutism. Not wanting to be on camera or recording your voice or seeing yourself on camera. It can be really hard. So I think being on Zoom was a whole new world for kids with SM And for some it was a lot easier because there's kind of this barrier and you can use the chat to type, which a lot of kids relied on in the beginning. But I think in the long run it was good because it for some kids that were not able to speak to their therapist in person, for some reason, Zoom was like a stepping stone in between non-verbal, the verbal. And I think it actually helped a lot of kids.

Mary: Hmm, that's interesting and I wonder, as the world opens up and as little toddlers or preschoolers are being exposed to preschool and grocery stores and libraries, story time if it's going to be worse because of the lack of exposure for the past year and a half. Right.

Chelsea: I know. I think there's been different kinds of exposures, which is good in some ways. But there's also going back into the world. I think it's going to be harder to do in-person interactions again. But I mean, you face that the same way you face any exposure by taking little baby steps and role playing and practicing. Just taking it one step at a time.

Mary: Yeah, yeah. In in Chapter 13 of my book on the doctors, Dennis Haircut's, I talk about this, the gradual exposure and that, you know, maybe we could talk about that a little bit more like in specifically in terms of, you know, breaking down the steps. So on page 203 of my book and you don't have to go there, but maybe if people at home, you know, graduated exposure sounds good, but like, how are we going to do that? How are we going to do that for like a haircut or dental visit? And luckily, because I'm a nurse and a behavior analyst like and I have a son who needed help in this area, is one of the things that you can do is you can kind of break down the steps of so on page two or three, making your haircuts better. And our hair salon child sits in the chair, the cap is put on, hair is sprayed with water, hair is cut with scissors back of the neck as shave with a razor, hairbrushes, whatever your steps are, exit the salon, wait while paying. Did you ever have problems in in those kind of settings like going to the doctor or a haircut or dentist?

Chelsea: Absolutely. I would say mostly because of my sensory issues, but also because of the scripts that were involved and the interactions with doctors who were trying to ask me questions. And then when you don't answer, they go, oh, you're so shy or someday you'll answer me. Things like that can actually be kind of damaging to your relationship. We say that there's contamination when something like that happens and a child is unable to speak to someone for whatever reason, it becomes harder for them to speak to them ever again in the future. It kind of builds.

Mary: And I do talk about that later in this chapter is one of our online participants. She did great. She's in Chapter eight on talking in Chapter nine. Her name's Elena. It's a little girl. Her mom did podcast number seventy-eight, which we can link in the show notes. It was great transformation that Elena had. And a couple of months after she made all that transformation, I was still in the process of writing my book. Her mom, Elena's mom, Michelle, posted in our Facebook group that all of a sudden, you know, bath time was the little girl was freaking out and she was only two. So she was freaking out. And I said, I'm trying to tie it in with the contamination because this is exactly what happened. And I posted like was she held down for a procedure in the past couple of weeks and she said, yes, actually, she had an MRI the previous week and she was held down and screaming and that carried over that contamination, like I like that term carried over to bath time. And then all of a sudden she freaked out getting a bath. So we gave her some ideas. And a week later, a few weeks later, following the advice of the community, Michelle had turned things around completely and Elena was asking for a bath. She won't even wait for me to fill the tub before climbing in. So like I asked her to list what she did and then that's all on page 210. But, you know, we can desensitize, we can repair, we can pair or repair anything. But when kids are brought to school or to a doctor's visit or a haircut, and they are screaming or being held down in some of these situations, it does it does really set you back quite a bit, right?

Chelsea: Yeah. I mean, we see a lot of the time school is the contaminated place with kids us. So you need to kind of pair it with reinforcement and build a good relationship with the teachers and the you kind of fade in gradually classmates. I mean, you can we always talk about that using the bathroom at school can be hard for kids with us because they don't want to ask and they also don't want to draw attention to themselves getting up and walking to the bathroom or having to go ask the teacher. There's also all the sensory stuff in the bathroom that can be a problem like automatic toilets. But I guess working up gradually to that is super important and I think. That's something that comes up a lot as well.

Mary: Yeah, so as a behavior analyst, we briefly mentioned the functions and I've done other podcasts on the functions of behavior. So there are four. And what, in your experience is the main function of this?

Chelsea: Mm hmm. I would say escape is huge. You are not speaking, which you would say is not a behavior, but not speaking in the absence of when there's an expectation to speak. If you pick that as our target behavior, that is happening over and over to avoid ever having to interact with people. And it works, which is why we see this go on for so long for so many kids. And once you're not rescuing a kid anymore, you can see that kind of fall apart a bit, which is good.

Mary: And so just, you know, the intervention is basically pairing desensitization and breaking things down, getting to the child, like for dental visits and for haircuts. We practice that. We practice that at home in the environment where the child's comfortable. We might go into a kid friendly haircut place after we get the child comfortable at home with the steps we might go in and not even get a haircut, just sit in the chair, desensitize, maybe put the cable and then we leave for some reinforcement and then go back and do many trials of this. And so my whole thing is like, don't hold the child down if unless it's an absolute emergency where the child needs stitches or they need something that there's just no other way and they're small enough because what's happening now, and I see it all over the Internet, is 10-year-olds are flopping on the ground. It's like there's no good things that are coming out of that. Right. So any other like would you recommend, like a specialist in selective mutism or a therapist or depends on the age or ability level or family therapy? Is there anything else on medication?

Chelsea: We can get into that. Yeah, I think it's very, very important that whatever treatment therapy you're taking, that the person is highly educated in selective mutism and they've treated it before because it can be so harmful to have someone not understand it and take the wrong way about it, because taking pressure off the child to speak is counterintuitive. And I think that is a huge component in treatment for them. I would say parent child interaction therapy is a big behavioral treatment protocol for some. And it involves kind of taking the child's lead in the beginning. You're not expecting them to speak. You're just going with whatever they're doing. Like if you get them comfortable playing with toys and you can feed people and feed people out, and then you're kind of shaping up that behavior into speaking verbally. And you can it's really cool. You can transfer who they're verbal with. Like if they're verbal with mom, they can play a game that they love with mom and you can fade someone else and fade mom out gradually. And before you know it, they're verbal with someone new. So it's all about shaping and taking one step at a time. There's also ESCAT, which is, oh my God, I hope I can remember it. Social communication, anxiety treatment protocol developed by Elisa Shippenblum. And that involves looking at a range of non-verbal to verbal. They call it the communication bridge. And you kind of find where your child's at, which I love because it's making it very individual approach and it's all about just building their comfort level and learning a lot about emotions and anxiety, which I think is really cool to self-educate kids about their own brains and what's going on and why they're having this response.

Mary: And I talk somewhere in my book I think about, you know, an experience with one of my online members who, you know, learned about paring the table and all the materials and got the child talking. And it was only two years old. They finally got on top of the line for the waiting list for ABA to start. And when BCBA and therapists came in, they basically said they were going to work, work, work with him in his bedroom with the closed door. And that the mom, you know, just had to get used to a lot of crying. Yeah. And we were all I'm like, you know, it's hard to post online community. And I'm like, time out. Like, no, like we can't unpair things. So, you know, we can't let kids cry it out. We can't do the kind of old school ABA whether we're talking selective mutism or autism or both, we have to pair the situation where the people and the materials, the table, the environment every step of the way, even if the child is completely typical. Right. It's just it's traumatic for kids to be in a brand-new environment without their parent, without the person that already has been trained to pair everything up. You don't just rip that away. Right. And it could really do, like you said, a lot of damage.

Chelsea: Yeah, I really think, yeah, exposure doesn't have to be dramatic, it can be gradual. Yeah, sort of. Well, we're I'll be right. We can, I mean, you're not allowing escape, but you're still allowing, you're building comfort and you're making it doable for the child.

Mary: Yeah. A really good shaping procedure that I use and I have used in the past is a tag teach. I don't know if you've ever heard of it, but. Yeah, yeah. So we did a podcast episode we can link in the show notes on that, but that's a really good way to shape things up to be positive. And if your child or clients are crying or you think that something is traumatic, like dental visits or even going to school, then you need to stop and think and read my book and learn my materials. And we're going to talk about how people can find you to Chelsea, because I think your great wealth of information on this specific topic for sure. So is that what you work with now is just selective mutism or how do you?

Chelsea: I actually don't oh, I work mostly with autistic adults and people with developmental disabilities. That is kind of my long-term goal. And it always has been working with kids with SM. And I've done volunteer opportunities and I've done trainings. So I feel like my next step would be to start consulting with kids who have said. But yeah.

Mary: I think that would be a great resource. And let's tell our listeners, too, about your book. Why don't we talk about your which came first, your podcast or your book?

Chelsea: The podcast came first. It's OK. It's almost two years old.

Mary: Yeah, OK. So what's your podcast called and why did you start it?

Chelsea: Yeah, it's called OutLoud, the Selective Mutism Podcast. It's me and my mom do it together and we kind of try to cover all the big topics that come with us. We've had a lot of experts on which have been amazing. We just really want to build like an awesome resource for people. It's also like not really talked about. So I felt like a podcast is the perfect medium for this topic just because it seems counterintuitive to talk about not talking. But it's such an important topic and we have a great response from people.

Mary: Did you have to get over your fear about talking and getting on camera and stuff or.

Chelsea: Yeah, we don't record video, but we like I've always hated my voice. That's something that is also very common with SM. You don't like hearing your voice. You don't like the feeling of the voice vibrating in your body. And I think you I kind of get used to that the more I talk. But I also edit my own podcast, so I have to listen to myself all the time. And that's a great exposure for me. It doesn't really bother me.

Mary: I listen to a part of your podcast before I asked you to be on, and I love your voice. I think it's you hear cheerful and positive and you have a lot of knowledge and I think it's great. So, OK, so and then you also wrote a book called I Am Brave.

Chelsea: Yes. I wrote that during lockdown. I also did my own illustrations, which I will say I'm not the biggest artist, but I do enjoy it. And I wanted it to be all my own work.

Mary: It's a children's book?

Chelsea: It's a children's book. I recommend it for like kindergartners and first grade, maybe up to second grade. But it's very simple. I just wanted to keep it very clear and have a book out there that kids can relate to, because when I was that age, I, I didn't know anyone else that was going through and I was going through it. It felt like there was something wrong with me and I was the only one in the world with this. So I think it's good to give kids a positive narrative about themselves and just hope that they can face their fears and get get what they want out of life.

Mary: Yeah, that's great. OK, so I think it's a good time to wrap up part of my podcast. Goals are not just to help the kids, but to have parents and professionals lead happier lives, be less stressed. Do you have any self-care tips or strategies or things that you do on a daily or regular basis to really help reduce your stress or make you happier?

Chelsea: Yeah, I mean, that's something that I'm trying to get better with, I think I've always wanted to get really into meditation and I found that yoga is super helpful with anxiety. And I've also I try to take walks every day and exercise because that makes such a big difference just in my stress levels.

Mary: I definitely agree with that. Taking walks out in nature, as is probably my number one self-care task, too. Yeah. So thank you so much. Chelsea Gamache is how you pronounce last name. And Chelsea, you've been a wealth of information about selective mutism. I hope the listeners enjoy it. Check out the podcast show notes for all the details. Remember, Chelsea's podcast is called OutLoud, the Selective Mutism Podcast, and her book is called I Am Brave. So thank you so much again. And hopefully the listeners will get a lot out of it.

Chelsea: Yeah. Thank you so much for having me.