儿童和青少年选择性缄默症非药物干预的系统综述和荟萃分析。

JCPP advances Pub Date : 2023-05-03 DOI:10.1002/jcv2.12166

Gino Hipolito, Emma Pagnamenta, Helen Stacey, Emily Wright, Victoria Joffe, Kou Murayama, Cathy Creswell

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引用次数: 2

摘要

背景：选择性缄默症（SM）是一种焦虑症，通常始于早年，后果严重而持久。非药物干预通常被视为首选的第一治疗方法。这项系统综述确定了SM儿童和青少年非药物干预所使用的结果指标和取得的结果。方法：使用13个电子数据库和手工搜索进行系统搜索，包括自1992年以来的同行评审和灰色文献。结果：确定了25项研究。虽然具体的衡量标准各不相同，但所有研究都报告了说话行为的结果衡量标准，18项研究使用了焦虑的衡量标准。很少有研究报告SM缓解（k=6）、幸福感（k=6。非药物干预的受试者内部结果在改善说话行为（从很小到很大的积极影响）和减少焦虑症状（从很低到很大的消极影响）方面是可变的。只有五项随机对照试验（RCT）被纳入荟萃分析。三项研究将系统/行为组合方法与等待名单对照进行了比较，表明其具有显著和巨大的影响（Hedges g=1.06，p=.1774，95%CI:0.52-34.84），但这没有达到统计学意义。两项随机对照试验的非显著结果（Hedges g=0.55，p结论：尽管SM造成了相当大的损害，但对非药物干预的系统评估很少。尽管联合系统/行为干预很有希望，但迫切需要进一步的系统评估来为治疗方法提供信息。需要协调跨研究测量，以促进从所有研究中学习死亡，包括更广泛的临床和经济结果。临床试验注册：不适用。

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A systematic review and meta-analysis of nonpharmacological interventions for children and adolescents with selective mutism

Background

Selective mutism (SM) is an anxiety disorder that often starts in early years with serious and lasting consequences. Nonpharmacological interventions are commonly seen as the preferred first treatment. This systematic review identifies outcome measures used and outcomes achieved for nonpharmacological interventions for children and adolescents with SM.

Methods

Systematic searches were conducted using 13 electronic databases and hand searches, including peer-reviewed and grey literature since 1992.

Results

Twenty-five studies were identified. While specific measures varied, all studies reported an outcome measure for speaking behaviour and 18 used a measure of anxiety. Few studies reported measures of SM remission (k = 6), well-being (k = 6), academic impact (k = 2), or quality of life (k = 1). Within subject outcomes for nonpharmacological interventions were variable for improvements in speaking behaviours (very small to large positive effects) and reduction in anxiety symptoms (very small negative to large positive effects). Only five randomised controlled trials (RCTs) were included in the meta-analysis. Three studies compared a combined systems/behavioural approach with waitlist controls indicating a significant and large effect (Hedges g = 1.06, p < .0001, 95% CI: 0.57–1.56) on improved speaking behaviour. Two of these RCTs showed a large effect for SM remission favouring the intervention (Risk Ratio = 4.25, p = .1774, 95% CI: 0.52–34.84) but this did not reach statistical significance. Non-significant outcomes for two RCTs with active controls (Hedges g = 0.55, p < .2885, 95% CI: −0.47 to 1.57) showed considerable heterogeneity in approach and outcomes, one with large and one with negligible effects.

Conclusion

Despite the considerable impairment caused by SM, there has been little systematic evaluation of non-pharmacological interventions. Although combined systems/behavioural interventions are promising, further systematic evaluations are urgently needed to inform treatment approaches. Cross-study measurement harmonisation is required to promote learning from all studies, including wider clinical and economic outcomes.