Cool Kids

About This Program

Target Population: Children and adolescents suffering anxiety disorders

For children/adolescents ages: 7 – 17

Program Overview

Cool Kids is a program that teaches children and their parents how to better manage the child's anxiety. It can be run either individually or in groups and involves the participation of both children and their parents. The program aims to teach clear and practical skills to both the child and parents. The program is aimed at young people 7-17 years, is fully supported by manuals, and has slightly different versions for children and teenagers. Variations of the program also exist for children with comorbid autism, adolescents with comorbid depression, and for delivery in school settings.

Program Goals

The goals of Cool Kids are to:

  • Reduce the symptoms and amount of life interference caused by anxiety.
  • Reduce avoidance.
  • Reduce family distress.
  • Increase confidence.
  • Improve peer relationships.
  • Increase engagement in extra-curricular activities.

Essential Components

The essential components of Cool Kids include:

  • Psychoeducation: Including understanding of the components, presentation and nature of anxiety as well as factors involved in its development. Understanding of the relevant components to treatment and their purpose
  • Cognitive restructuring: Including learning to act like a detective and gather evidence about whether feared events are really highly likely
  • Parent skills: Including helping parents to manage their anxious child better and reducing their urge to control and overprotect; also teaching parents strategies to help manage their own anxious feelings
  • In-vivo exposure: Including the development of stepladders for the child that allows them to gradually face their fears and learn that feared events are unlikely to happen and that they can cope
  • Social skills: Including how to act in a more skilled manner and engage better with people and to act more assertively with peers
  • Improved coping strategies: Including dealing more effectively with teasing and bullying, developing a range of coping strategies such as relaxation and reducing poor coping such as drug-taking, and problem solving

Program Delivery

Child/Adolescent Services

Cool Kids directly provides services to children/adolescents and addresses the following:

  • Anxiety disorders of any type including separation anxiety, social anxiety, generalized anxiety, and obsessive compulsive disorder. Co-existing disorders are acceptable as long as anxiety is the primary problem.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: For children under 12, parents attend every session. For adolescents, parents attend most sessions. Parents learn how to manage children differently, how to manage their own anxieties, and how to help their child implement their new skills outside the therapy sessions.

Recommended Intensity:

Individual format: Eight hour-long weekly sessions followed by two hour-long biweekly sessions Group format: Eight two-hour long sessions followed by two two-hour long sessions

Recommended Duration:

12 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic
  • School

Homework

Cool Kids includes a homework component:

Skills learned in sessions are implemented and practiced for homework. This includes monitoring of symptoms, cognitive restructuring practice, in-vivo exposure practice, and practice of relevant skills. Parents also practice child management and anxiety management.

Languages

Cool Kids has materials available inlanguages other than English:

Chinese, Danish, Finnish, Icelandic, Korean, Spanish, Swedish, Turkish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Room space (two group rooms if running in groups)
  • Whiteboard and markers
  • Program manuals for parents and children
  • Program manual for therapist 
  • 1 therapist (2 if running in groups)

Education and Training

Prerequisite/Minimum Provider Qualifications

• 4 year undergraduate or 2 year postgraduate degree in health (psychology, counselling, social work, occupational therapy) or education

• Additional training in cognitive-behavioural therapy (dedicated postgraduate subject, introductory workshop or online training from recognised provider)

Preferable to have a degree in clinical psychology - the equivalent of a PhD in Clinical Psychology. Practitioners need to be well-trained in standard cognitive behavioral techniques and understanding of psychopathology - ideally clinical psychology training. Experience with working with children and families is preferable.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Training Contact:
Training is obtained:

Training and accreditation is obtained online, via the Centre for Emotional Health, Sydney. Onsite training can be arranged if required.

Number of days/hours:

Online training consists of 12 video modules and practice activities that you can start, pause, or stop at any time. It takes approximately six hours to complete training. Accreditation requires professionals to demonstrate their ability and skill through a series of assessment tasks. Accreditation takes approximately three hours to complete.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Cool Kids as listed below:

Accreditation is to be completed to measure provider readiness for Cool Kids

Formal Support for Implementation

There is no formal support available for implementation of Cool Kids.

Fidelity Measures

There are fidelity measures for Cool Kids as listed below:

There is a fidelity measure that was used in the clinical trials and is available upon request. The measure includes a checklist of skills and strategies that are rated by independent observers from video recordings of therapy sessions.

Implementation Guides or Manuals

There are implementation guides or manuals for Cool Kids as listed below:

The program is supported by a manual for the therapist to structure sessions. The manual and other materials are available from https://shop.centreforemotionalhealth.com.au/product/cool-kids-anxiety-program/ and https://shop.centreforemotionalhealth.com.au/product/cool-kids-chilled-adolescent-anxiety-program/

Research on How to Implement the Program

Research has been conducted on how to implement Cool Kids as listed below:

  • Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research and Therapy, 44, 1287-1300.
  • 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.
  • McLoone, J. K., & Rapee, R. M. (2012). Comparison of an anxiety management program for children implemented at home and school: Lessons learned. School Mental Health, 4(4), 231-242.
  • Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2017). Comparison of stepped care delivery against a single, empirically validated cognitive-behavioral therapy program for youth with anxiety: a randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 841-848.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Rapee, R. M. (2000). Group treatment of children with anxiety disorders: Outcome and predictors of treatment response. Australian Journal of Psychology, 52(3), 125-129. doi:10.1080/00049530008255379

Type of Study: Pretest-posttest control group design
Number of Participants: 95

Population:

  • Age — 7-16 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — 56 Females and 39 Males
  • Status — Participants were parents and children with anxiety disorders who presented following media publicity about child anxiety, referral from general practitioners and school counselors, or word of mouth communication about the program.

Location/Institution: Macquarie University Child and Adolescent Anxiety Clinic

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the outcomes from a nine-session group treatment [now called Cool Kids]. Parents and children completed the Anxiety Disorders Interview Schedule (ADIS-CP) and the self-reported Revised Children’s Manifest Anxiety Scale (RCMAS), Fear Survey Schedule – Revised (FSSC-R), Child Behavior Checklist (CBCL), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) at pretreatment, posttreatment, and 1-year follow-up. The results from active treatment are compared with a waitlisted group assessed at pretreatment and posttreatment only. Results indicated that children in the intervention group improved significantly more on several measures of anxiety than did waiting-list controls. The improvements maintained and, in several cases increased, at 1-year follow-up. Limitations include the lack of randomization to the intervention and control groups.

Length of postintervention follow-up: 1 year.

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. doi:10.1037/0022-006X.74.3.436

Type of Study: Randomized controlled trial
Number of Participants: 267

Population:

  • Age — 6-12 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — 61% Male and 39% Female
  • Status — Participants were parents with children diagnosed with anxiety disorders who were referred through school counselors, general practitioners, or mental health professionals.

Location/Institution: Macquarie University Anxiety Research Unit

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the impact of a 12-week trial of Cool Kids Outreach (bibliotherapy materials based on the Cool Kids anxiety program) for parents of children with anxiety disorders. Participants were randomized to one of three groups: group treatment (Cool Kids), bibliotherapy (Cool Kids Outreach), and to waitlist. Children completed the following measures at baseline, posttreatment, and 3-month follow-up: the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), Spence Children’s Anxiety Scale (SCAS), Children’s Automatic Thoughts Scale (CATS), and parents completed the parent version of the SCAS and the Child Behavior Checklist (CBCL). Results indicated that Cool Kids Outreach demonstrated benefit for children relative to waitlist, but was not as efficacious as standard Cool Kids group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. Children in all three groups reported significant and marked change over time, but differences between groups were not significant. Limitations include reliance on semi-structured interviews and parent-completed questionnaires as outcome measures.

Length of postintervention follow-up: 3 months.

Chalfant, A., & Rapee, R. M. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842-1857. doi:10.1007/s10803-006-0318-4

Type of Study: Pretest-posttest control group design
Number of Participants: 47

Population:

  • Age — 8-13 years
  • Race/Ethnicity — 100% Caucasian
  • Gender — 35 Males and 12 Females
  • Status — Participants were children with anxiety disorders and co-morbid autism spectrum disorders who were referred through their parents, community health centers, mental health professionals, or medical practitioners.

Location/Institution: Annie’s Center and Macquarie University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the effectiveness of a treatment intervention for children with co-morbid anxiety and highly functioning autism spectrum disorders based on the Cool Kids model. Participants were randomized to one of four 12-session intervention groups or a waitlist control for a period of 7 months. Parents and children participated pre- and post-treatment in completing the Anxiety Disorders Interview Schedule (ADIS-CP) and the self-reported Revised Children’s Manifest Anxiety Scale (RCMAS), Spence Children’s Anxiety Scale (SCAS), Children’s Automatic Thoughts Scale (CATS), and the Strengths and Difficulties Questionnaire (SDQ). Results indicated that the active treatment condition produced significant change in the dependent variables in contrast to the waitlist control condition. Major limitations included relatively small sample size and diagnostic status was not formally assessed. Limitations include relatively small sample size and diagnostic status was not formally assessed. 

Length of postintervention follow-up: None.

Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulous, N. (2009). Cognitive behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 533-544. doi:10.1097/CHI.0b013e31819c2401

Type of Study: Randomized controlled trial
Number of Participants: 112

Population:

  • Age — 7-16 years
  • Race/Ethnicity — 89% Caucasian and 11% Asian
  • Gender — 64 Males and 48 Females
  • Status — Participants were parents and children with a principal anxiety disorder not including depressive symptoms.

Location/Institution: Center for Emotional Health, Department of Psychology, Macquarie University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children were randomly assigned to either Cool Kids or a control condition (group support and attention [GSA]). Parents and children participated in completing the Anxiety Disorders Interview Schedule (ADIS-CP) and the self-reported Spence Children’s Anxiety Scale (SCAS) and Strengths and Difficulties Questionnaire (SDQ) at pre- and post-intervention and at 3-month follow-up. Results indicated that Cool Kids was significantly more efficacious compared with the GSA condition. At post-treatment and follow-up, a significantly greater proportion of children in the Cool Kids condition no longer met criteria for any anxiety diagnoses, compared with the children in the GSA condition. Limitations include a significant lack of congruence between parent and child reports.

Length of postintervention follow-up: 3 months.

Hudson, J. L., Newall, C., Rapee, R. M., Lyneham, H. J., Schniering, C. C., Wuthrich, V. M., ... Gar, N. S. (2014). The impact of brief parental anxiety management on child anxiety treatment outcomes: A controlled trial. Journal of Clinical Child & Adolescent Psychology, 43(3), 370-380. doi:10.1080/15374416.2013.807734

Type of Study: Randomized controlled trial
Number of Participants: 209

Population:

  • Age — 6-13 years
  • Race/Ethnicity — 90% Caucasian
  • Gender — 104 Female
  • Status — Participants were children meeting criteria for a principal diagnosis of an anxiety disorder.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The current trial examined whether the addition of a brief parental anxiety management (BPAM) program to the Cool Kids family cognitive behavioral therapy was more efficacious than Cool Kids alone in treating childhood anxiety disorders. Children with a principal anxiety disorder were randomly allocated to Cool Kids with a five-session program of BPAM or Cool Kids. Measures utilized include the Anxiety Disorder Interview Schedule for Children—Child and Parent version (ADIS-IV-C/P), the Spence Children’s Anxiety Scale, and Protocol Adherence Checklist–Modified. Results indicated that the addition of BPAM to Cool Kids did not significantly improve outcomes for the child or the parent compared to the Cool Kids group at posttreatment or at follow-up. Overall, however, children with nonanxious parents were more likely to be diagnosis free for any anxiety disorder compared to children with anxious parents at posttreatment and follow-up. BPAM did not produce greater reductions in parental anxiety. Limitations include concerns about the generalizability of the study due to the limited racial/ethnic diversity and the lack of a no treatment or waitlist control group to further examine to decline in parental anxiety over time.

Length of postintervention follow-up: 6 months.

Chavira, D. A., Drahota, A., Garland, A. F., Roesch, S., Garcia, M., & Stein, M. B. (2014). Feasibility of two modes of treatment delivery for child anxiety in primary care. Behaviour Research and Therapy, 60, 60-66. doi:10.1016/j.brat.2014.06.010

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

  • Age — Children: 8-13 years (Mean=9.75), Parents: 41-43 years (Mean=41.69)
  • Race/Ethnicity — Children: 72.9% Caucasian, 10.4% Latino, and 16.67% Multicultural; Parents: Not specified
  • Gender — Children: 56.3% Female, Parents: Not specified
  • Status — Participants were children and their parents recruited from primary care clinics.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the study was to evaluate the feasibility of the Cool Kids program for children with anxiety in primary care. Participants were randomly allocated to Cool Kids, (face-to-face Cognitive-Behavioral Therapy [CBT]), or Cool Kids outreach therapist-supported, parent-implemented CBT intervention. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Screen for Anxiety and Related Disorders (SCARED), Clinical Global Impression Scale - Improvement (CGI-I), Children’s Global Assessment Scale (C-GAS), Parent Consumer Satisfaction Scale, and the Barriers to Treatment Participation Scales. Results showed that both modalities are feasible in primary care and associated with treatment gains. Limitations include small sample size, generalizability due to ethnicity and education level of participants, lack of no treatment control group, and length of follow-up.

Length of postintervention follow-up: 3 months.

Arendt, K., Thastum, M., & Hougaard, E. (2016). Efficacy of a Danish version of the Cool Kids program: a randomized wait‐list controlled trial. Acta Psychiatrica Scandinavica, 133(2), 109-121. doi:10.1111/acps.12448

Type of Study: Randomized controlled trial
Number of Participants: 109

Population:

  • Age — 7-16 years (Mean=11.78 years)
  • Race/Ethnicity — Not specified
  • Gender — 57% Female
  • Status — Participants were children and adolescents with a primary diagnosis of anxiety.

Location/Institution: Department of Psychology and Behavioural Sciences, Aarhus University, Denmark

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the study was to evaluate the efficacy of a Danish version of the Cool Kids program for anxiety disorders among children and adolescents. Participants were randomly allocated to the Cool Teens (CBT) or a wait list (WL). Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Spence Children’s Anxiety Scale (SCAS), Spence Children’s Anxiety Scale – Parent Version (SCAS-P), Child Anxiety Life Interference Scale (CALIS), Mood and Feelings Questionnaire (S-MFQ), Becks Youth Inventories (BYI), Experience of Service Questionnaire (ESQ), Children’s Automatic Thought Scale (CATS), Self-Efficacy Questionnaire for Children (SEQ), Depression Anxiety Stress Scales (DASS) for parents, Rearing Behavior Questionnaire (RBQ), Clinical Global Impression – Improvement Scale (CGI-I) and Children’s Global Assessment Scale (C-GAS). Results showed that the Danish version of the Cool Kids program was efficacious with 48.2% free of all anxiety diagnoses at posttreatment, compared with 5.7% in the WL condition, and large effect sizes on self-report measures of child anxiety symptoms rated by child, mother, and father. Children and adolescents in the Cool Kids group improved further from posttreatment to 3-month follow-up and this improvement was maintained at 12-month follow-up. Participants with a primary diagnosis of social phobia (SoP) showed less improvement compared with other anxiety diagnoses. Limitations include inclusion of three graduate students in each group which may limit the generalizability of the current study, treatment was compared to wait list and not to an active control condition, and the 12-month follow-up analyses excluded 12 participants due to their inclusion in another study on individualized treatment of nonresponders.

Length of postintervention follow-up: 3 and 12 months (intervention only).

Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2017). Comparison of stepped care delivery against a single, empirically validated cognitive-behavioral therapy program for youth with anxiety: a randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 841-848.

Type of Study: Randomized controlled trial
Number of Participants: 281

Population:

  • Age — 6-17 years
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were youth with anxiety disorders

Location/Institution: Macquarie University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of this study was to evaluate the efficacy of cognitive behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework, compared to Cool Kids. Youth with anxiety disorders were randomly allocated to receive either Cool Kids or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV, the Parent and Child versions (ADIS-IV-CP), the Spence Children’s Anxiety Scale (SCAS) and the Spence Children’s Anxiety Scale – Parent Version (SCAS-P). Results showed that interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with Cool Kids (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. Limitations include concerns about generalizability, as the study was conducted in a university clinic and subjects were relatively wealthy, well educated, and of limited ethnic diversity. Also, the movement between steps was an arbitrary decision, and not determined by diagnostic status of questionnaire scores, which may have affected the results.

Length of postintervention follow-up: Unclear - 12 months post-baseline, but treatment length varied. Cool Kids took approximately 12 weeks, while stepped care took up to 12 months to complete.

Additional References

Hudson, J. L., Lyneham, H. J., & Rapee, R. M. (2008). Social anxiety. In A. R. Eisen (Ed.), Treating childhood behavioral and emotional problems: A step-by-step, evidence-based approach (pp. 53-102). New York: Guilford.

Lyneham, H. J., & Rapee, R. M. (2005). Evaluation and treatment of anxiety disorders in the general pediatric population: A clinician's guide. Child and Adolescent Psychiatric Clinics of North America, 14(4), 845-862.

Contact Information

Ronald M. Rapee, PhD
Agency/Affiliation: Centre for Emotional Health, Macquarie University
Website: www.centreforemotionalhealth.com.au/pages/cool-kids-program.aspx
Email:

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: June 2018

Date Program Originally Loaded onto CEBC: April 2011