A Multiple Baseline Feasibility Trial of Social Management Training for People With Sex Chromosome Aneuploidies

Background: Persons with sex chromosome aneuploidies (SCAs, i.e., a number of sex chromosomes that is different from the most common 46,XX and 46,XY), often struggle with social interactions. A Dutch pilot study examined Social Management Training (SMT), an intervention designed to help people develop their abilities to navigate interactions with others in men with Klinefelter syndrome (KS; 47,XXY). SMT was adapted to target executive functions, emotion regulation, and social cognition in a novel neurocognitive-behavioral program tailored to the specific vulnerabilities of men with KS, and showed promising outcomes. The current study aims to expand on the Dutch pilot study by (1) Adapting SMT to Norwegian individuals with SCAs in an online-delivered format enabling wide geographic reach; (2) Testing the feasibility, acceptability, and potential benefits of SMT; and (3) Examine the use of SMT on SCAs beyond KS. Methods: The intervention comprises 10 group sessions. Through a single-group multiple baseline design, measures are collected at six time points; three pre- and three post-intervention. The main effect to be examined is the difference between pre- and post-intervention. The primary outcome is mental health, and the secondary outcomes are social and executive functioning. Participants are recruited through the Norwegian National Center for Rare Diseases, the Norwegian Klinefelter association, and endocrinologists. We plan to include 20-30 participants by the end of 2028. Discussion: SMT aims to evaluate the feasibility of a digitally based psychosocial intervention designed to improve mental health, as well as social, emotional and executive functioning among individuals with SCAs. The findings will inform intervention refinement and the design of a future definitive randomized controlled trial. The development of such interventions can lead to socio-economic benefits in the form of long-term improved health outcomes for people by improving overall functioning.

The inclusion criteria are: (a) Proficiency in a Scandinavian language. Participants must state that they have satisfactory skills to participate in group discussions, and answer questionnaires in Norwegian; (b) Age 16 to 69 years. The age range is set to include adults of the age of consent for participation in health research. The upper age limit was set to prevent measurements from being affected by age-related factors; (c) Access to a computer (or smartphone) with internet connection - but note that we can lend a computer to participants who may require this; (d) Genetically confirmed SCA. Participants provide medical confirmation of diagnosis, unless participants are recruited via Frambu (where medical confirmation is available in the user registry for KS 47,XXY karyotype; Jacobs 47,XYY karyotype; Triple X, 47,XXX karyotype; and Turner 45,X karyotype).

There are no explicit exclusion criteria. Ongoing assessments are made during eligibility screening and when conducting training program regarding appropriateness of the training program, both individually and in groups. If the group leader becomes aware of information that indicates the need for specialist health services (e.g., indication of severe mental illness or acute suicidality), this is handled on a case-by-case basis, and the person concerned is then put in contact with the appropriate health care services.

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