Randomised Controlled Treatment Study of Selective Mutism
Condition: Selective Mutism
MeSH terms: Mutism
Study type: Interventional
Phase: Phase 2

Summary: 
      Selective mutism (SM) describes inhibited and withdrawn children who are persistently mute in
      central situations despite ability to talk. SM may cause great suffering and create problems,
      both socially and related to learning. SM is associated with social anxiety,
      neurodevelopmental delay and bilingualism. The prevalence is about .7-8 ‰. Adequate
      assessment and treatment of SM is seldom provided in the mental health services. SM is
      considered hard to treat, and randomised treatment studies are lacking. This study will
      examine the effect of a manual based treatment for SM. The treatment consists of home- and
      kindergarten /school based interventions including behaviour techniques and psychoeducation.
      Defocused communication is a general treatment principle. Comorbidity, including
      neurodevelopmental delay /disorder, and predictors of outcome, will be examined. A pilot
      study was conducted to ensure the feasibility of the planned effectiveness study. Seven
      children, aged 3-5 years were included. Six has started treatment, and all talked in the
      kinder garden within the first 3 months. The present study will have a randomised controlled
      design with 1. Manual based intervention for 6 months compared to 2. Waiting list controls (3
      months), and then manual based intervention. The sample: Children aged 3-9 years
      consecutively referred to the school psychology- or the mental health services in Oslo and
      Eastern Norway. Expected N = 24 based on the pilot study, is a sufficient sample size to
      answer our primary research question. The treatment will be given by a therapist from the
      research group or by a local clinician under supervision. The study can add essential
      knowledge on treatment of SM and make effective treatment available to clinicians in the
      community.
    


Intervention name(s): Stimulus fading procedures; Guidance on defocused communication
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Core elements : 1.Behavior techniques (BT's) are used to gradually master the anxiety ("stimulus fading" and reward).
2. Children are first met at home where they feel most safe, and the BT's are first conducted at home in cooperation with the parents.
3.The same interventions are then continued in the environment where the problem primarily exist (kindergarten / school) not at the clinic.
4.Defocused communication- and interaction is a general treatment principle (e.g. avoid looking directly at the child, sit beside not opposite to the child, no direct questioning, and communication is based upon a motivating activity, not about the child).
5.Frequent and short interventions. 6.Information to parents and teachers on how to communicate with children with SM; Guidance and supervision to teachers working with the children with SM. Frequency: Twice during three months
Other intervention name(s): stimulus fading technique; defocused communication
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Selective Mutism; Intervention