VR Homework Exercises for Selective Mutism Treatment

SM symptoms (frequent measurement)

Both parents and teachers are asked to report on SM symptoms. This is done by answering 9 yes/no questions on the child's speaking behavior and communication, including non-verbal communication, making sounds and conversing with others (more yes indicates more speaking behavior). The short assessment is specifically designed for this study in collaboration with experienced SM therapists and a statistician, specialized in SCED's.

SM symptoms (SMQ-NL)

Evaluated by parents. The SMQ consists of 23 questions that are scored on a 4-point Likert scale ranging from "always" to "never." The symptom subscale consists of 17 questions (0-68; higher scores indicate more SM symptoms), that assess the severity of the symptoms across different situations (family, school and public situations). The second subscale indicates to what extend a child experiences problems due to not speaking in certain situations.

SM symptoms (Social context of speaking)

The questionnaire consists of 16 questions assessing (0-64; higher scores indicate less SM symptoms) the social context of speaking assesses the severity of symptoms at school across different social situations (e.g. their own teacher, another teacher, in the classroom or in the presence of peers), speaking behaviour (e.g. whispering and functional speech) and its interference at school. Teachers are asked to evaluate how often child is showing different speaking behaviours and in which social context on a 4-point Likert scale. The questionnaire includes 8 questions that are based on the School Speech Questionnaire (SSQ). For the purpose of our study, the SSQ does not provide enough detail on the child's speaking behaviour, for that reason 8 more questions were included.

VR data

Each parent has a unique ID to sign-in to a web-based application that is used to guide the child through the virtual school. Parents will indicate that when the next exercise is presented. These responses are saved. Every time the parent signs in, the total time and the time spent playing the different games will be automatically stored on a secured database. This will be recorded in seconds.

VR completion

Parents are asked to track the time they spend working on the VR homework exercises on a VR tracking sheet on a weekly basis. They are asked to fill out how long and which days they practiced. The number of days practiced will be divided by the total number of days in the week. This yields a percentage of VR completion per week.

VR immersion

Specifically for this study three questions were designed to measure the level of immersion children experience while practicing with the VR. Children are asked to rate their immersive experience on 4-point Likert scale ranging from strongly disagree to strongly agree.

Structured Clinical Interview for DSM-5 Junior (SCID-5-Junior)

Semi-structured interview for children and adolescents between 8 -18. The interview is suitable for both children and their parents. The SCID-5 Junior consists of 17 modules to classify DSM-5 disorders. The SCID-5 Junior is used in standard clinical care, to check for additional anxiety disorders and disorders that might look like SM. The SCID-5 Junior will be administered in the same manner as in regular clinical care, meaning that parents only report on the modules: anxiety, autism and obsessive-compulsive behavior, unless there are indications that suggest the presence of another co-morbid disorder.

Adult Self Report (ASR)

The ASR is a self-report questionnaire for adults (ages 18-59) assessing aspects of adaptive functioning and problems. The questionnaire provides a Total score (123 items, 0-252, higher scores indicate more behavioral and emotional problems) and scores for an Internalizing and Externalizing subscale.

EMBU-P

The EMBU-P (with the Swedish name Egna Minnen Beträffende Uppfostran - Parent version) rates the parents' own rearing behavior with their children. Rearing behavior is scored on across 4 dimensions: Rejection, Emotional Warmth, Control Attempts and Favoring Subject. It has 83 items (higher scores per dimension indicate more of that rearing behavior, which can be positive or negative).

Communication - Vineland-3-NL

This questionnaire evaluates adaptive behavior on five domains: communication, daily living skills, socialization, motor skills and maladaptive behavior. The questionnaire is suitable for both parents and teachers. Only the domain communication will be assessed as the presence of speech and language problems is often linked to SM.

Immersive Tendencies Questionnaire - Parent report

For the purpose of this study, the questions were rephrased to turn the original questionnaire into a parent-report. Parents are asked to evaluate their child's immersive tendencies on a 7-point likert scale, ranging from strongly disagree to strongly agree (10 items, 0-70, higher scores indicate more immersive tendencies).