The Cool Kids program is a nine-session, group therapy treatment aimed at teaching children how to manage anxiety disorders. For this treatment, parents and children both attend therapist-led sessions and are exposed to cognitive-behavioral techniques for dealing with anxiety. An experimental evaluation of the program found that following the treatment there was a significantly greater number of children in the Cool Kids program without an anxiety disorder than those in both the comparison bibliotherapy condition and in the waitlist group (the bibliotherapy program is summarized here). Those in group treatment also demonstrated significantly more improvement across time in disorder severity, as well as for parent reports of child anxiety levels and parent reports of child internalizing and externalizing behavior, than the other two conditions. No differences were found between groups for child reports of anxiety symptoms or negative thoughts/beliefs.
Three-month follow-up assessments were conducted for the Cool Kids and bibliotherapy conditions. The proportion of those in group treatment who no longer met the criteria for being diagnosed with an anxiety disorder was significantly higher than for those in bibliotherapy. Similarly, children in group treatment improved significantly more than those in the bibliotherapy condition over time from baseline to follow-up on measures of diagnostic severity, parent ratings of symptoms of anxiety, and parent reports of internalizing and externalizing behavior. There were no significant differences between conditions on measures of children's reports of symptoms of anxiety and negative thoughts/beliefs, although scores did significantly change over time.
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 a nine-session, weekly program (bi-weekly for the last few weeks) over a twelve week period. Sessions are about two hours long and are conducted with approximately seven families and two therapists (primarily graduate students in a clinical psychology program) at once. They cover topics that 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
Evaluated population: 260 Year 1 through 6 (the Australian categorization for primary/elementary school - ages 6 through 12) children were selected for the study. To be included, 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 program group treatment (N=90), bibliotherapy treatment (N=90), or a waitlist condition (N=87). The only significant difference between groups at baseline was that the group treatment condition had a larger proportion of female participants. For a description of the bibliotherapy treatment condition, see the link provided above. 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 3 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 was collected from diagnostic interviews, and from both child self-report measures and parent reports of their child's behavior. These scales covered outcomes such as symptoms of anxiety (child and parent reports), 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, but only the Cool Kids treatment and bibliotherapy conditions were assessed at a three-month follow-up.
Results: A significant difference was found between conditions in the proportion of participants dropping out (not returning data at the end of the intervention). Twenty-nine dropouts were from bibliotherapy, 14 were from group treatment, and 12 were from the waitlist condition. 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.
Immediately following the intervention, a significantly greater number of children in the Cool Kids program were free of an anxiety disorder, as compared with those in the bibliotherapy and waitlist conditions. Similarly, across time children in the Cool Kids program improved significantly more than those in bibliotherapy and waitlist in the severity of their disorder. The same was also true for parent reports of child anxiety levels and parent reports of both child internalizing and externalizing behavior. No differences were found between groups in child reports of anxious symptoms or negative thoughts/beliefs.
At the three month follow-up, the proportion of those in the Cool Kids treatment who no longer met the criteria for having an anxiety disorder was significantly greater than for those in bibliotherapy. There was a significant difference in change across time between both groups from baseline to follow-up (group treatment improved more than bibliotherapy), but not from post-treatment to follow-up for diagnostic severity, parent ratings of symptoms of anxiety, and parent reports of internalizing and externalizing behavior. For children's reports of symptoms of anxiety and negative thoughts/beliefs, time was found to have a significant impact on scores, but there were no significant differences between conditions.
SOURCES FOR MORE INFORMATION
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
KEYWORDS: Children, Adolescents, Elementary, Middle School, Males and Females (Co-ed), Clinic/Provider-Based, Counseling/Therapy, Parent or Family Component, Anxiety Disorders/Symptoms
Program information last updated 9/14/11