Trial Outcomes & Findings for Treatment of Social Anxiety Disorder and Selective Mutism (NCT NCT02554929)

NCT ID: NCT02554929

Last Updated: 2019-10-29

Results Overview

The Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): Parent Version (ADIS-P) is a semi-structured, clinician-administered, interview of parents used to diagnose anxiety and other related disorders in children and adolescents. Parents were asked to rate for interference or impairment using a 9-point scale ranging from 0 to 8, with 0 being not impaired or not interfering and 8 being significant impairment or interference. A final Clinician Severity Rating (CSR) was then established using the same scale, with a CSR of 4 (moderate degree of impairment) or greater required to establish a diagnosis.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

93 participants

Primary outcome timeframe

Change from Baseline in CSR of SAD & SM at 6 months after treatment ends. Treatment groups run for 11 weeks.

Results posted on

2019-10-29

Participant Flow

This study was conducted at the Hospital for Sick Children (SickKids). Children, aged 4-7 years, were screened to participate in the treatment study by one of the principal investigators (child psychiatrists) at an anxiety disorders clinic in SickKids.

Of the n=93 consented participants, 3 withdrew consent prior to randomization and treatment assignment.

Participant milestones

Participant milestones
Measure
Taming Sneaky Fears Group
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Overall Study
STARTED
46
44
Overall Study
Per Protocol Received Intervention
44
36
Overall Study
Per Protocol Post-Intervention
42
36
Overall Study
Per Protocol 6 Month Follow-up
40
32
Overall Study
COMPLETED
40
32
Overall Study
NOT COMPLETED
6
12

Reasons for withdrawal

Reasons for withdrawal
Measure
Taming Sneaky Fears Group
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Overall Study
Lost to Follow-up
4
4
Overall Study
Withdrawal by Subject
2
8

Baseline Characteristics

Treatment of Social Anxiety Disorder and Selective Mutism

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Total
n=90 Participants
Total of all reporting groups
Age, Categorical
<=18 years
46 Participants
n=99 Participants
44 Participants
n=107 Participants
90 Participants
n=206 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Age, Categorical
>=65 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Age, Continuous
5.9 years
STANDARD_DEVIATION 1.0 • n=99 Participants
5.8 years
STANDARD_DEVIATION 1.1 • n=107 Participants
5.9 years
STANDARD_DEVIATION 1.1 • n=206 Participants
Sex: Female, Male
Female
32 Participants
n=99 Participants
31 Participants
n=107 Participants
63 Participants
n=206 Participants
Sex: Female, Male
Male
14 Participants
n=99 Participants
13 Participants
n=107 Participants
27 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants
n=99 Participants
2 Participants
n=107 Participants
3 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
45 Participants
n=99 Participants
42 Participants
n=107 Participants
87 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Asian
12 Participants
n=99 Participants
10 Participants
n=107 Participants
22 Participants
n=206 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Black or African American
1 Participants
n=99 Participants
2 Participants
n=107 Participants
3 Participants
n=206 Participants
Race (NIH/OMB)
White
25 Participants
n=99 Participants
30 Participants
n=107 Participants
55 Participants
n=206 Participants
Race (NIH/OMB)
More than one race
8 Participants
n=99 Participants
2 Participants
n=107 Participants
10 Participants
n=206 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Region of Enrollment
Canada
46 Participants
n=99 Participants
44 Participants
n=107 Participants
90 Participants
n=206 Participants
The Anxiety Disorders Interview Schedule (ADIS), Clinical Severity Rating (ADIS-CSR)
SAD ADIS-CSR Score
5.2 units on a scale
STANDARD_DEVIATION 1.7 • n=99 Participants
5.7 units on a scale
STANDARD_DEVIATION 1.3 • n=107 Participants
5.5 units on a scale
STANDARD_DEVIATION 1.6 • n=206 Participants
The Anxiety Disorders Interview Schedule (ADIS), Clinical Severity Rating (ADIS-CSR)
SM ADIS-CSR Score
4.8 units on a scale
STANDARD_DEVIATION 2.4 • n=99 Participants
4.3 units on a scale
STANDARD_DEVIATION 2.5 • n=107 Participants
4.5 units on a scale
STANDARD_DEVIATION 2.5 • n=206 Participants

PRIMARY outcome

Timeframe: Change from Baseline in CSR of SAD & SM at 6 months after treatment ends. Treatment groups run for 11 weeks.

The Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): Parent Version (ADIS-P) is a semi-structured, clinician-administered, interview of parents used to diagnose anxiety and other related disorders in children and adolescents. Parents were asked to rate for interference or impairment using a 9-point scale ranging from 0 to 8, with 0 being not impaired or not interfering and 8 being significant impairment or interference. A final Clinician Severity Rating (CSR) was then established using the same scale, with a CSR of 4 (moderate degree of impairment) or greater required to establish a diagnosis.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Change in Clinical Severity Ratings (CSR) of SAD & SM on the Anxiety Disorders Interview Schedule - Parent Version (ADIS-P)
Change in SAD ADIS-CSR from baseline to 6 months
-1.26 units on a scale
Standard Error 0.35
-1.65 units on a scale
Standard Error 0.37
Change in Clinical Severity Ratings (CSR) of SAD & SM on the Anxiety Disorders Interview Schedule - Parent Version (ADIS-P)
Change in SM ADIS-CSR from baseline to 6 months
-1.51 units on a scale
Standard Error 0.37
-1.24 units on a scale
Standard Error 0.40

SECONDARY outcome

Timeframe: Change from Baseline in CSR within 4 weeks of treatment end. Treatment groups run for 11 weeks.

The Anxiety Disorders Interview Schedule for DSM-IV: Parent Version (ADIS-P) is a semi-structured, clinician-administered, interview of parents used to diagnose anxiety and other related disorders in children and adolescents. Parents were asked to rate for interference or impairment using a 9-point scale ranging from 0 to 8, with 0 being not impaired or not interfering and 8 being significant impairment or interference. A final Clinician Severity Rating (CSR) was then established using the same scale, with a CSR of 4 (moderate degree of impairment) or greater required to establish a diagnosis.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Change in Clinical Severity Ratings (CSR) of SAD & SM on the Anxiety Disorders Interview Schedule - Parent Version (ADIS-P)
Change in SAD ADIS-CSR baseline to 4-weeks
-1.12 units on a scale
Standard Error 0.34
-1.46 units on a scale
Standard Error 0.37
Change in Clinical Severity Ratings (CSR) of SAD & SM on the Anxiety Disorders Interview Schedule - Parent Version (ADIS-P)
Change in SM ADIS-CSR baseline to 4-weeks
-1.49 units on a scale
Standard Error 0.37
-0.66 units on a scale
Standard Error 0.40

SECONDARY outcome

Timeframe: Change from Baseline on the CGAS within 4 weeks of treatment end. Treatment groups run for 11 weeks.

The Children's Global Assessment Scale (CGAS) is a clinician rating of overall adaptive functioning during the previous month for children and adolescents between 4 to 16 years of age. CGAS scores are rated on a 100-point scale, with 1 being the most impaired and 100 being least impaired, and descriptors for each 10-point interval such that each 10-point interval defines a range of children's functioning in all areas of their life. CGAS scores were secondary outcome measures. The Change in Children's Global Assessment Scale (CGAS) measures level of general functioning on a 100 point scale - 1 (needs constant supervision) to 100 (superior functioning). Every 10 points global functioning moves to the next category.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Change in Children's Global Assessment Scale (CGAS)
12.8 units on a scale
Standard Error 2.4
11.1 units on a scale
Standard Error 2.5

SECONDARY outcome

Timeframe: Change from Baseline on the CGAS at 6 months post-treatment end. Treatment groups run for 11 weeks.

The Children's Global Assessment Scale (CGAS) is a clinician rating of overall adaptive functioning during the previous month for children and adolescents between 4 to 16 years of age. CGAS scores are rated on a 100-point scale, with 1 being the most impaired and 100 being least impaired, and descriptors for each 10-point interval such that each 10-point interval defines a range of children's functioning in all areas of their life. CGAS scores were secondary outcome measures. The Change in Children's Global Assessment Scale (CGAS) measures level of general functioning on a 100 point scale - 1 (needs constant supervision) to 100 (superior functioning). Every 10 points global functioning moves to the next category.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Change in Children's Global Assessment Scale (CGAS)
15.2 units on a scale
Standard Error 2.5
14.3 units on a scale
Standard Error 2.6

SECONDARY outcome

Timeframe: The SMQ was completed by parents at all 3 time-points: 1) Pre-treatment (baseline), 2) Post-treatment, and 3) 6-month follow-up (from baseline date).

The Selective Mutism Questionnaire (SMQ) is a 17-item parent questionnaire that assesses the degree and frequency of speech in 3-to-11-year-old children and provides a proxy measure of selective mutism severity. Parents report on their child's behavior with regards to speaking in the previous two weeks across three broad domains (or subscales): at school (five items), at home/with family (five items), and in social situations (seven items). Parents rate items using a three-point scale that ranges from 0 = never to 3 = always. Lower total scores on the Selective Mutism Questionnaire suggest less speech.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
Selective Mutism Questionnaire (SMQ)
Pre-treatment SMQ
20.0 units on a scale
Standard Deviation 9.6
19.2 units on a scale
Standard Deviation 9.5
Selective Mutism Questionnaire (SMQ)
Post-treatment SMQ
26.2 units on a scale
Standard Deviation 9.6
23.4 units on a scale
Standard Deviation 9.5
Selective Mutism Questionnaire (SMQ)
6 month follow-up SMQ
30.2 units on a scale
Standard Deviation 11.9
27.6 units on a scale
Standard Deviation 10.1

SECONDARY outcome

Timeframe: The PAS-P was completed by parents at all 3 time-points: 1) Pre-treatment (baseline), 2) Post-treatment, and 3) 6-month follow-up (from baseline date).

The Preschool Anxiety Scale - Parent report (PAS-P) is a 29-item parent-report questionnaire for use with 3- to 6-year-old children. Parents report on their child's anxiety symptoms in different scenarios. Parents rate items on a 5-point Likert scale.

Outcome measures

Outcome measures
Measure
Taming Sneaky Fears Group
n=46 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol utilizing cognitive behavioral therapy (CBT) strategies specifically developed for children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Taming Sneaky Fears: Parents received coping strategies based on CBT in parent group and children received coping strategies based on CBT in child group.
Parent Psychoeducation and Child Socialization Group
n=44 Participants
An 11 week (introduction plus 10 week) manualized treatment protocol focusing on parent psychoeducation and child socialization in children 4 to 7 years of age with social anxiety disorder (SAD) and/or selective mutism (SM). Parent and child groups were conducted separately but concurrently. Parent Psycho-education and Child Socialization: Parents received psycho-education in parent group and children received socialization skills in child group.
The Preschool Anxiety Scale - Parent Report
Pre-treatment PAS-P Score
36.7 units on a scale
Standard Deviation 20.2
39.6 units on a scale
Standard Deviation 16.3
The Preschool Anxiety Scale - Parent Report
Post-treatment PAS-P Score
32.3 units on a scale
Standard Deviation 16
35.8 units on a scale
Standard Deviation 13.4
The Preschool Anxiety Scale - Parent Report
6 month follow-up PAS-P Score
26.5 units on a scale
Standard Deviation 16
31.4 units on a scale
Standard Deviation 17.5

Adverse Events

Taming Sneaky Fears Group

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Parent Psychoeducation and Child Socialization Group

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Suneeta Monga

The Hospital for Sick Children

Phone: 416-813-8954

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place