Integrated Behavioral Therapy for Treating Children With Selective Mutism
Condition: Selective Mutism
MeSH terms: Mutism
Study type: Interventional

Summary: 
      This study will determine the effectiveness of integrated behavior therapy in treating
      children with selective mutism.
    

Detailed description: 
      Selective mutism (SM) is a childhood behavior disorder that interferes with social and
      educational development. It is characterized by a persistent failure to speak in specific
      social situations, despite being able to speak in other situations. Children with SM
      typically speak when they are at home with immediate family, but fail to speak in other
      settings. Behavior therapy (BT), commonly used for treating anxiety disorders and phobias, is
      a type of treatment that uses training and desensitization methods to help patients become
      more comfortable in situations that cause anxiety. Based on available evidence, integrated
      BT, which involves parents, teachers, and the therapist, may be an effective treatment for
      SM. This study will determine the effectiveness of integrated BT in treating children with
      selective mutism.

      Following a diagnostic assessment to determine eligibility, participants in this single-blind
      study will be randomly assigned to receive BT either immediately upon study entry or after a
      3-month waiting period. BT will consist of 20 1-hour treatment sessions over 6 months. In BT,
      children will practice speaking to people with whom it has been difficult to speak in the
      past. Parents, teachers, and children will be taught about anxiety related to SM, setting
      treatment goals, monitoring anxiety, learning skills to relax, and gradually entering
      situations that may trigger anxiety. These skills will be practiced during treatment
      sessions, in school with other children and teachers, and at home on a daily basis. Both
      parents and teachers will record activities that children have been able to accomplish. In
      addition, participants will attend study visits at Weeks 8, 12, and 24 for assessments of
      outcomes.

      Participants who are assigned to the waitlist group will not receive treatment during their
      first 3 months in the study. They will attend study visits at Weeks 8 and 12 to assess any
      improvement in symptoms. Participants whose symptoms do not improve by the end of the 3-month
      period may either stop participation or receive 6 months of BT.

      All participants will attend one 2- to 3-hour follow-up visit 3 months post-treatment. This
      visit will include interviews and questionnaires about SM symptoms.
    

Intervention name(s): Integrated behavioral therapy (BT)
Intervention type(s): Behavioral
Intervention description(s): Participants in the BT condition will receive twenty 60-minute sessions over 24 weeks. Sessions will focus on graduated exposure to new speaking situations as the primary agent of anxiety reduction. Behavioral procedures will include systematic desensitization, shaping, and self-modeling procedures. Although a variety of exposure exercises will be routinely conducted in-session, any behavioral assignments will take place outside of session. Behavioral exercises will be implemented, as needed, in a modular fashion. For example, exercises may focus on speaking in-session to therapist, either at school or at home with others present. The therapist will be primarily responsible for developing the exposure parameters, but collaboration of parent, teacher, child will be emphasized increasingly over time. Reinforcement for attempts to complete assignments (contingency management program) will occur throughout treatment.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Selective Mutism