Cool Kids Program

OVERVIEW

The Cool Kids program is a group therapy treatment aimed at teaching children how to manage anxiety disorders. Parents and children both attend therapist-led sessions and are exposed to cognitive-behavioral techniques for dealing with anxiety. Two experimental evaluations of the program indicate that the Cool Kids program significantly impacts children’s mental health. Specifically, children who participated in the Cool Kids program were significantly more likely to no longer have a diagnosable anxiety disorder, and demonstrated significantly greater reductions in internalizing symptoms, externalizing symptoms, and anxiety symptoms, than children assigned to control conditions.

DESCRIPTION OF PROGRAM

Target Population: Children with anxiety disorders

The Cool Kids group therapy program uses cognitive-behavioral techniques to manage broad-based child anxiety disorders.  Children and parents attend eight sessions on a weekly basis, followed by two sessions that occur bi-weekly.  Sessions are two hours long, and include approximately seven families and two therapists (primarily graduate students in a clinical psychology program).  Topics include assertiveness, dealing with teasing, child management strategies, recognition of emotion and anxiety, exposure to feared cues, and realistic thinking.  Families also receive worksheets, summaries, and guides for practicing techniques at home between sessions.

EVALUATION(S) OF PROGRAM

Rapee, R. M., Abbott, M. J., Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436-444.

Evaluated population: Participants included 260 children in Years 1 through 6 (the Australian categorizations for primary/elementary school – ages 6 through 12).  To be eligible, children had to meet the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for having an anxiety disorder (as diagnosed by trained clinical psychology graduate students or qualified clinical psychologists).  Principal diagnoses of participating children included generalized anxiety disorder, social phobia, separation anxiety disorder, specific phobia, obsessive-compulsive disorder, and panic disorder.

Approach: Participants were randomly assigned to either the Cool Kids (N=90), bibliotherapy treatment (N=90; program is summarized here), or a waitlist condition (N=87).  The only significant difference between groups at baseline was that the Cool Kids group had a larger proportion of female participants. Children assigned to the waitlist condition were told that they had been randomly selected to wait for treatment and would be re-assessed after a three-month period, at which point the group treatment program would be made available to them.

To measure the effectiveness of the Cool Kids program, data were collected from diagnostic interviews, child self-report measures and parent reports of their child’s behavior.  Scales covered outcomes such as anxiety symptoms (as reported by child and parent), negative thoughts/beliefs (child), and child internalizing and externalizing behavior (parent).  All measures and diagnostic interviews were completed at baseline, and immediately following the conclusion of the treatment programs, for all three conditions. Only children in the Cool Kids treatment and bibliotherapy conditions were assessed at a three-month follow-up.

A total of 29 children assigned to the bibliotherapy condition, 14 assigned to the Cool Kids group treatment condition, and 12 assigned to the waitlist-control condition dropped out of the study.  A comparison on psychopathology measures demonstrated that those who dropped out had significantly higher scores on several psychopathology measures and significantly greater numbers of multiple diagnoses of disorders. Thus, intent to treat (ITT) analyses were conducted.

Results: Immediately following the intervention, a significantly greater number of children in the Cool Kids program were free of an anxiety disorder, compared with those in the bibliotherapy and waitlist conditions.  Similarly, children in the Cool Kids program had a significantly greater reduction in (1) the severity of their disorder, (2) anxiety symptoms, and (3) internalizing and externalizing behavior from pretest to posttest than children in either the bibliotherapy or waitlist conditions. In contrast, there were no significant differences across groups in children’s negative thoughts/beliefs.

At the three month follow-up, children in the Cool Kids group were significantly less likely than children in the bibliotherapy group to meet the criteria for having an anxiety disorder. Additionally, children in the Cool Kids group demonstrated significantly greater reductions in the severity of their diagnosis, anxiety symptoms, and internalizing and externalizing behavior from baseline to follow-up than children in the bibliotherapy group.

Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lynham, H.J ., Bocopoulos, N. (2008). Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of American Academy of Child and Adolescent Psychiatry, 48(5), 533-544.

Evaluated population: A total of 112 children who met the criteria for a principal anxiety disorder were randomly assigned to either a group cognitive-behavioral therapy program based on the Cool Kids model (N=51), or a control condition that included group support and attention (N=44). On average, children were 10.2 years old, and the majority were male (57 percent) and Australian (66 percent).

Approach: Across both groups, families attended weekly two-hour sessions for a total of 10 weeks. Nine children (15 percent) in the Cool Kids condition, and seven children in the control condition (14 percent), dropped out of the study. All analyses were based on intent to treat (ITT) analyses. Data were collected at entry into the intervention (pretest), following the completion of the intervention (posttest), and three months following the intervention (follow-up). Outcome variables collected included presence of a diagnosable anxiety disorder (assessed by a structured clinical interview), and anxiety and internalizing symptoms (parent and child surveys).

Results: Results of this experimental evaluation indicated that the Cool Kids program had a significant impact on children’s mental health. Specifically, children who participated in the Cool Kids program were significantly more likely to be free of their principal anxiety diagnosis at follow-up than children who participated in the control condition. Additionally, compared with children in the control condition, children who participated in the Cool Kids program had (1) a significantly greater reduction in anxiety symptoms between pretest and posttest, and pretest and follow-up, and (2) a significantly greater reduction in internalizing problems between pretest and posttest.

SOURCES FOR MORE INFORMATION

References

Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C.A., Lynham, H. J., Bocopoulos, N. (2008). Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of American Academy of Child and Adolescent Psychiatry, 48(5), 533-544.

Rapee, R. M., Abbott, M. J., Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436-444.

Website: http://centreforemotionalhealth.com.au/pages/Workshops.aspx

Contact Information

Centre for Emotional Health

Building C3A, Level 7

Department of Psychology

Macquarie University

NSW 2109

Australia

ehc.admin@mq.edu.au

(02) 9850-4084

 

KEYWORDS: Children, Adolescents, Elementary, Middle School, Males and Females (Co-ed), Clinic/Provider-Based, Counseling/Therapy, Parent or Family Component, Anxiety Disorders/Symptoms, Manual.

Program information last updated 8/21/14