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. https://doi.org/10.1080/00049530008255379

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 95

Population:

• Age — 7-16 years
• Race/Ethnicity — 100% Caucasian
• Gender — 56 Female and 39 Male
• 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the outcomes from a nine-session group treatment [now called Cool Kids Anxiety Program]. Participants were either part of Cool Kids Anxiety Program or a wait list control group. Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-CP), the Revised Children’s Manifest Anxiety Scale (RCMAS), the Fear Survey Schedule – Revised (FSSC-R), the Child Behavior Checklist (CBCL), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS). Results indicate 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, control groups, and lack of generalizability due to ethnicity.

Length of controlled 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. https://doi.org/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 basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the value of modifying an empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Participants were randomly allocated to standard group treatment [now called Cool Kids Anxiety Program], waitlist, or a bibliotherapy version of treatment for childhood anxiety. Measures utilized include the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), the Spence Children’s Anxiety Scale (SCAS), the Children’s Automatic Thoughts Scale (CATS), and the parent version of the SCAS and the Child Behavior Checklist (CBCL). Results indicate that in general, parent bibliotherapy demonstrated benefit for children relative to waitlist, but was not as efficacious as standard 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. Limitations include the sample came from a traditional, specialist anxiety clinic, lack of generalizability due to ethnicity, and length of follow-up. 

Length of controlled postintervention follow-up: 3 months.

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. https://doi.org/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 Male and 48 Female
• 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether a specific cognitive-behavioral treatment package (CBT) [now called Cool Kids Anxiety Program] was more efficacious in treating childhood anxiety disorders than a nonspecific support package [group support and attention (GSA)]. Participants were randomly allocated to either the CBT or the GSA control condition. Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-CP), the self-reported Spence Children’s Anxiety Scale (SCAS), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that CBT was significantly more efficacious compared with the GSA condition: 68.6% of children in the CBT condition did not meet diagnostic criteria for their principal anxiety diagnosis at 6-month follow-up compared with 45.5% of the children in the GSA condition. The results of the child- and parent-completed measures indicated that mothers of CBT children reported significantly greater treatment gains than mothers of GSA children, and children reported similar improvements across conditions. Limitations include a significant lack of congruence between parent and child reports, lack of generalizability due to ethnicity, and length of follow up

Length of controlled postintervention follow-up: 3 months.

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. https://doi.org/10.1007/s12310-012-9088-7

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

• Age — Children: 8-13 years(Mean=9.63-9.77 years); Parents: Mean=40-43 years
• Race/Ethnicity — Not specified
• Gender — Children: Home-based: 43% Male, School-based: 37% Male, and Waitlist: 29% Male; Parents: Not specified
• Status — Participants were parents and their children in grades 2 through 6.

Location/Institution: 11 schools located within metropolitan, Sydney, Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the feasibility of delivering an early intervention program for the management of child anxiety [now called Cool Kids Anxiety Program] in either a school- or home setting, relative to a waitlist-control condition. Participants were randomly allocated to the following three conditions: school-based treatment, home-based treatment, and monitoring only. Measures utilized include the Spence Children’s Anxiety Scale (SCAS), the Children’s Automatic Thoughts Scale (CATS), the Spence Children’s Anxiety Scale-parent version (SCASp), the Child Anxiety Life Interference Scale (CALIS), the Depression, Anxiety Stress Scales (DASS), the Barriers to Treatment Participation Scale, the School Anxiety Scale (SAS), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that children participating in the active conditions; home-based and school-based interventions showed significantly greater reductions in anxiety and anxiety-related interference in daily life, compared to the waitlist-control group according to parents’ reports. In contrast, reports from children and teachers failed to show significant group differences on measures of anxiety. Limitations include lack of independent assessment, parents not blind to child’s study condition, and high attrition rate.

Length of controlled postintervention follow-up: 1 year.

Hudson, J. L., Newall, C., Rapee, R. M., Lyneham, H. J., Schniering, C. C., Wuthrich, V. M., Schneider, S., Seeley-Wait, E., Edwards, S., & 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. https://doi.org/10.1080/15374416.2013.807734

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

Population:

• Age — Children: 6-13 years; Mothers: Mean=41.1-42.6 years; Fathers: Mean=42.7-45.0 years
• Race/Ethnicity — Children: 90% Caucasian; Parents: Not specified
• Gender — Children: 104 Female; Parents: Not specified
• Status — Participants were children meeting criteria for a principal diagnosis of an anxiety disorder.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether the addition of a brief parental anxiety management (BPAM) program to family cognitive behavioral therapy (CBT) [now called Cool Kids Anxiety Program] was more efficacious than CBT alone in treating childhood anxiety disorders. Children were randomly allocated to CBT with a five-session program of BPAM or CBT alone. 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 indicate that the addition of BPAM to CBT did not significantly improve outcomes for the child, or the parent compared to the CBT alone 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, the reliance on self-report questionnaire measures to determine parental anxiety, and the lack of a no treatment or waitlist control group.

Length of controlled 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. https://doi.org/10.1016/j.brat.2014.06.010

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

Population:

• Age — Children: FF: Mean=9.75 years and TSB: Mean=9.75 years; Parents: FF: Mean=41.69 years and TSB: Mean=42.31 years
• Race/Ethnicity — Children: FF: 83% Caucasian, 13% Multicultural, and 8% Latino; TSB: 63% Caucasian, 21% Multicultural, and 13% Latino; Parents: Not specified
• Gender — Children: FF: 58% Female and TSB: 54% Female; Parents: Not specified
• Status — Participants were children and their parents recruited from primary care clinics.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility of the cognitive behavior therapy (CBT) [now called Cool Kids Anxiety Program] for children with anxiety in primary care. Participants were randomly assigned to receive either CBT delivered by a child anxiety specialist in the primary care clinic (FF), or implemented by the parent with therapist support by telephone (TSB). Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Screen for Anxiety and Related Disorders (SCARED), the Clinical Global Impression Scale - Improvement (CGI-I), Children’s Global Assessment Scale (C-GAS), the Parent Consumer Satisfaction Scale, and the Barriers to Treatment Participation Scales. Results indicate that according to the CGI-I, 58.3%-75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from “primary anxiety disorder” and “all anxiety disorders” as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Limitations include small sample size, lack of generalizability due to ethnicity and education level of participants, lack of no treatment control group, and length of follow-up..

Length of controlled 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. https://doi.org/10.1111/acps.12448

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

Population:

• Age — 7-16 years, GCBT: Mean=11.82 years and Wait-List: Mean=11.73 years
• Race/Ethnicity — Not specified
• Gender — GCBT: 56% Female and Wait-List: 59% Female
• Status — Participants were children and adolescents with a primary anxiety disorder diagnosis.

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

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of a Danish version of the Cool Kids [now called Cool Kids Anxiety Program] program for anxiety disorders among children and adolescents. Participants were randomly allocated to Cool Kids 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 the Children’s Global Assessment Scale (C-GAS). Results indicate 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 were found. 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 student therapists in each group which may limit the generalizability of the current study, treatment was compared to WL 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 non-responders

Length of controlled 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. https://doi.org/10.1016/j.jaac.2017.08.001

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

Population:

• Age — 6-17 years; Empirically validated treatment: Mean=9.10 years; SC: Mean=9.42 years
• Race/Ethnicity — Not specified
• Gender — Empirically validated treatment: 57% Female; SC: 49% Female
• Status — Participants were youth with anxiety disorders.

Location/Institution: Macquarie University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework (SC), compared to an empirically validated treatment [now called Cool Kids Anxiety Program]. Participants were randomly allocated to receive either the empirically validated treatment, or SC involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. 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 indicate that interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver SC (774 minutes) compared with the empirically validated treatment (897 minutes). Within SC, 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.

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

Johnsen, D. B., Arendt, K., & Thastum, M. (2019). The efficacy of manualized Cognitive Behavior Therapy conducted by student-therapists treating Danish youths with anxiety using a benchmark comparison. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 7(1), 68–80. https://doi.org/10.21307/sjcapp-2019-010

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 110

Population:

• Age — ST: Mean=10.18 years; PT: Mean=11.82 years
• Race/Ethnicity — 100% Danish
• Gender — ST: 59% Male; PT: 45% Male
• Status — Participants were youths and their parents, seeking help regarding youth anxiety.

Location/Institution: A university clinic in Denmark

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effects of student therapists (ST) treating youths, using a group-based CBT program [now called Cool Kids Anxiety Program]. Second, the study compared these results with outcomes achieved by professional therapists (PT). Participants were part of either the ST or PT groups. Measures utilized include the Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions (ADIS-C/P), the Spence Children’s Anxiety Scale (SCAS), the SCAS parent version (SCAS-P), the Child Anxiety Life Interference Scale (CALIS), and the Experience of Service Questionnaire (ESQ). Results indicate that there was a significant reduction of both self-reported and clinician rated measures of youth anxiety over time in the ST group, with small to large effect sizes. No significant differences of improvements in self-report measures were found between the ST and the PT groups. There was no significant difference in remission rates for participants’ primary anxiety disorder between the ST and the PT at post-treatment or at three-month follow-up. There was a significant difference regarding number of youths free of all anxiety disorder between the ST and PT group at post-treatment. This difference was not significant at three-month follow-up. Limitations include lack of randomization, lack of a control group, no analysis on program adherence or therapist competencies were conducted, the study was underpowered to detect significant effects between groups, and length of follow-up.

Length of controlled postintervention follow-up: 3 months.

The following studies were not included in rating Cool Kids Anxiety Program on the Scientific Rating Scale...

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. https://doi.org/10.1007/s10803-006-0318-4

The purpose of the study was to examine the effectiveness of a treatment intervention for children with co-morbid anxiety and highly functioning autism spectrum disorders based on the Cool Kids Anxiety Program 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 pretreatment and posttreatment 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 indicate 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. Note: The study in this article was not used to rate Cool Kids Anxiety Program due to the program being an adaptation in the study.