Systematic review and classification of: Cool Kids
DOI:
https://doi.org/10.7557/25.7289Keywords:
Systematic review, Anxiety, Cool Kids, Cognitive behavioral therapyAbstract
Background: This paper is a systematic review of the effects of Cool Kids, a program with the main goal of helping children and young people aged 6-18 years to deal with anxiety and related difficulties. The program can be offered both individually and in group format, with approx. 10 meetings. The Cool Kids program is theoretically grounded in cognitive behavioral therapy, emphasizing psychoeducation, cognitive restructuring, exposure and parental inclusion. Training, approval of supervisors and approval as a Cool Kids therapist are offered free of charge by RKBU Vest. The program is currently offered in Norway in the municipal health service, the school health service and the specialist health service.
Methods: This review is based on a systematic literature search in the databases Embase, Medline, Psykinfo, NORART, Cochrane, Cristin, NORA, SCOPUS and SweMed. International databases on evidence have also been searched, as well as information about the intervention from the program provider. Results from literature searches and the other information obtained were reviewed to identify Nordic effect studies, international systematic reviews, and eventually other Norwegian studies of the intervention.
Results: The literature search resulted in 220 hits, of which a total of 9 articles were included, eight Nordic effect studies and a systematic review. Cool Kids is described in detail and is theoretically rooted in cognitive behavioral therapy, which has broad research support as a treatment for anxiety disorders. The studies of Cool Kids maintain good research methodological quality, with before, after, and follow-up measurements, relevant and valid and reliable measurement instruments, and a multi-informant perspective in the majority of the studies. The studies were conducted in both a clinical and indicated preventive setting. In the majority of the studies, there was a statistically significant difference between the intervention group (Cool Kids) and the comparison group. In a clinical and indicated preventive context, small to strong effects are generally shown. Follow-up studies show that the effect level is largely maintained over time.
Conclusion: Cool Kids is an evidence-based intervention that has a solid theoretical foundation. The program is well described. Results from Nordic effect studies indicate that the program can contribute to the reduction of anxiety and depressive symptoms compared with regular treatment and the effect has been shown to last over time for several main outcome measures. Cool Kids is classified at evidence level 5 - Measures with strong documentation of effect.
References
Angold, A., & Stephen, C. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Age (years), 6(11), 237–249.
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
Axelsdottir, B., Borren, I., Eidet, L. M., Dahlgren, A., Hammerstrøm, K., Bjørndal, A., Sund, A. M., & Morken, I. S. (2021). Kunnskapsoppsummering: effekt av tiltak for angstlidelser hos barn og unge RBUP; 2021. https://tiltakshandboka.no/no/tilstander/tilstandsgruppe-angstlidelser
Bakken, A. (2021). Ungdata. Nasjonale resultater. NOVA rapport 8/21.
Bakken, A. (2020). Ungdata. Ung i Distrikts-Norge. NOVA rapport 3/20.
Barican, J. L., Yung, D., Schwartz, C., Zheng, Y., Georgiades, K., & Waddell, C. (2022). Prevalence of childhood mental disorders in high-income countries: A systematic review and meta-analysis to inform policymaking. Evidence-Based Mental Health, 25(1), 36–44. https://doi.org/10.1136/ebmental-2021-300277
Bjåstad, J. F., Haugland, B. & Fjermestad, K. (2016). Cool Kids Etterlevelse og Kompetanse Skala (F-EKS). Upublisert skala til bruk i LIST prosjektet, Bergen, Norge
Breinholst, S., Walczak, M., Christiansen, B., & Esbjørn, B. (2021). A therapist-guided parent-delivered self-help group for anxiety disorders in children: An effectiveness study. Journal of Behavioral and Cognitive Therapy, 31(2), 105–113
Brown, A., Ford, T., Deighton, J., & Wolpert, M. (2014). Satisfaction in child and adolescent mental health services: Translating users’ feedback into measurement. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 434–446.
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour research and therapy, 43(3), 309–322.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Archives of General Psychiatry, 60(8), 837–844. https://doi.org/10.1001/archpsyc.60.8.837
Djurhuus, I. D., & Bikic, A. (2019). Is the cool kids programme working in outpatient psychiatric clinics? A danish naturalistic effectiveness study. Nordic Journal of Psychiatry, 73, 141–148
Flaten, K., & Heiervang, E. (2012). Program for forebygging av angst: Et pilotprosjekt gjennomført på 5. Klassetrinn. Specialpedagogikk, 10:12.
Folkehelseinstituttet. (2018). Folkehelserapporten. Psykiske plager og lidelser hos barn og unge https://www.fhi.no/nettpub/hin/psykisk-helse/psykisk-helse-hos-barn-og-unge/
Guy, W. (1976). ECDEU assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Public Health Service
Haugland, B. S. M., Raknes, S., Haaland, A. T., Wergeland, G. J. H., Bjaastad, J. F., Baste, V., Himle., J., Rapee, R., & Hoffart, A. (2017). School-based cognitive behavioural intervention for anxious youth: study protocol for a non-inferiority randomized controlled trial. Trials. Advance online publication. https://doi.org/10.1186/s13063-017-1831-9
Haugland, B. S. M., Haaland, Å. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., Raknes, S., Himle, J. A., Husabø, E., & Wergeland, G. J. (2020). Effectiveness of Brief and Standard School-Based Cognitive-Behavioral Interventions for Adolescents With Anxiety: A Randomized Noninferiority Study. Journal of the American Academy of Child & Adolescent Psychiatry.
Havinga, P. J., Maciejewski, D. F., Hartman, C. A., Hillegers, M. H. J., Schoevers, R. A., & Penninx, B. W. J. H. (2021). Prevention programmes for children of parents with a mood/anxiety disorder: Systematic review of existing programmes and meta-analysis of their efficacy https://doi.org/10.1111/bjc.12277 British Journal of Clinical Psychology, 60(2), 212–251. https://doi.org/10.1111/bjc.12277
Heiervang, E., Stormark, K. M., Lundervold, A.J., Heimann, M., Goodman, R., Posserud, M. B., Ullebo, A. K., Plessen, K. J., Bjelland, I., Lie, S. A. (2007). Psychiatric disorders in Norwegian 8-to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry, 46, 438–47.
Husabo, E. (2021a). Implementation of indicated anxiety prevention in schools. Doktorgradsavhandling. Universitetet i Bergen, Bergen.
Husabo, E., Haugland, B. S. M., McLeod, B. D., Ogden, T., Rapee, R. M., & Wergeland, G. J. (2020a). Does School-Based Recruitment for Anxiety Interventions Reach Youth Not Otherwise Identified? A Comparison Between a School-Based Sample and a Clinical Sample [Article]. School Mental Health. https://doi.org/10.1007/s12310-019-09357-7
Husabo, E., Haugland, B. S. M., McLeod, B. D., Baste, V., Haaland, Å. T., Bjaastad, J. F., Hoffart, A., Raknes, S., Fjermestad, K. W., Rapee, R. M., Ogden, T., & Wergeland, G. J. (2021b). Treatment Fidelity in Brief Versus Standard-Length School-Based Inter-ventions for Youth with Anxiety. School Mental Health. https://doi.org/10.1007/s12310-021-09458-2
Husabo, E., Haugland, B. S. M., Wergeland, G. J., & Maeland, S. (2020b). Providers’ Experiences with Delivering School-Based Targeted Prevention for Adolescents with Anxie-ty Symptoms: A Qualitative Study. School Mental Health, 12(4), 757–770. https://doi.org/10.1007/s12310-020-09382-x
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane database of systematic reviews(11).
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, 68–80.
Jónsson, H., Thastum, M., Arendt, K., & Juul–Sørensen, M. (2015). Group cognitive behavioural treatment of youth anxiety in community based clinical practice: Clinical significance and benchmarking against efficacy. Journal of Anxiety Disorders, 35, 9–18.
Kilburn, T. R., Sørensen, M. J., Thastum, M., Rapee, R. M., Rask, C. U., Arendt, K. B., Carlsen, A. H., & Thomsen, P. H. (2020). Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder: A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting. Journal of Autism and Developmental Disorders, 1–14.
Lundkvist-Houndoumadi, I., Thastum, M., & Hougaard, E. (2015). Effectiveness of an Individualized Case Formulation-Based CBT for Non-responding Youths with Anxiety Disorders. J Child Fam Stud. https://doi.org/10.1007/s10826-015-0225-4
Lydersen, S. (2019). Fremskrivning fra siste observasjon. Tidsskrift for Den norske legeforening, 9. https://doi.org/10.4045/tidsskr.19.0061
Lyneham, H. J., Sburlati, E. S., Abbott, M. J., Rapee, R. M., Hudson, J. L., Tolin, D. F., & Carlson, S. E. (2013). Psychometric properties of the child anxiety life interference scale (CALIS). Journal of Anxiety Disorders, 27(7), 711–719.
Martinussen, M., Reedtz, C., Eng, H., Neumer, S.-P., Patras, J., & Mørch, W.-T. (2019). Ungsinn. Tidsskrift for virksomme tiltak for barn og unge. Kriterier og prosedyrer for vurdering og klassifisering av tiltak. https://ungsinn.no/wp-content/uploads/2019/07/Ungsinn_kriterier_screen_2019-V2.1.pdf
Merikangas, K. R., He, J.-p., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/https://doi.org/10.1016/j.jaac.2010.05.017
Muris, P. (2001). A brief questionnaire for measuring self-efficacy in youths. Journal of Psychopathology and behavioral Assessment, 23(3), 145–149.
Mychailyszyn, M. P. (2017). “Cool” youth: A systematic review and comprehensive meta-analytic synthesis of data from the Cool Kids family of intervention programs. Canadian Psychology/psychologie canadienne, 58(2), 105.
Palitz, S. A., & Kendall, P. C. (2020). Anxiety Disorders in Children. In E. Bui, M. E. Charney, & A. W. Baker (Red.), Clinical Handbook of Anxiety Disorders: From Theory to Practice (pp. 141–156). Springer International Publishing. https://doi.org/10.1007/978-3-030-30687-8_7
Rapee, R. M., Lyneham, H. J., Schniering, C. A., Wuthrich, V., Abbott, M. A., Hudson, J. L., & Wignall, A. (2006). Cool kids: child & adolescent anxiety program. Centre for Emotional Health.
Rapee, R. M., Lau, E. X., & Kennedy, S. J. (2010). The Cool Little Kids Anxiety Prevention Program - Therapist Manual. Centre for Emotional Health, Macquarie University: Sydney. Manual, Norsk versjon 2013. Oslo; RBUP Øst og Sør, & Bergen; RBKU Vest.
Rapee, R. M., Wignall, A., Spence, S. H., Cobham, V., & Hudson, J. L. (2008). Helping your anxious child. A step by step guide for parents. (2 ed.). Oakland, CA: New Harbinger Publications, Inc.
Rapee, R. M., Wignall, A., Spence, S. H., Cobham, V. & Lyneham, H. (2016). Hjelp ditt engstelige barn: en foreldreveileder. Oslo: Gyldendal Akademisk.
Rasmussen, L. M. P., & Neumer, S. P. (2015). Måleegenskaper ved den norske versjonen av Anxiety Disorders Interview Schedule for DSM IV: Barneversjonen (ADIS for DSM IV: C). PsykTestBarn, 2:4.
Schniering, C. A., & Rapee, R. M. (2002). Development and validation of a measure of children’s automatic thoughts: the children’s automatic thoughts scale. Behaviour research and therapy, 40(9), 1091–1109.
Silverman, W., & Albano, A. (1996). The anxiety disorders interview schedule for children for DSM-IV: Child and parent versions. San Antonio, TX: Psychological Corporation. Silverman, WK, & Ollendick, TH (2005). Evidence-based assessment of anxiety and its disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937944.
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour research and therapy, 36(5), 545–566.
Stjerneklar, S., Hougaard, E., McLellan, L. F., & Thastum, M. (2019). A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders [Article]. PLoS ONE, 14(9), Article e0222485. https://doi.org/10.1371/journal.pone.0222485
Stjerneklar, S., Hougaard, E., & Thastum, M. (2019). Guided internet-based cognitive behavioral therapy for adolescent anxiety: Predictors of treatment response. Internet Interventions, 15, 116–125. https://doi.org/10.1016/j.invent.2019.01.003
Strawn, J. R., Lu, L., Peris, T. S., Levine, A., & Walkup, J. T. (2021). Research Review: Pediatric anxiety disorders – what have we learnt in the last 10 years? Journal of Child Psychology and Psychiatry, 62(2), 114–139. https://doi.org/https://doi.org/10.1111/jcpp.13262
Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: a systematic review of the literature. Psychotherapy and psychosomatics, 84(3), 167–176.
Wichstrøm, L., Berg-Nielsen, T. S., Angold, A., Egger, H. L., Solheim, E., & Sveen, T. H. (2012). Prevalence of psychiatric disorders in preschoolers [https://doi.org/10.1111/j.1469-7610.2011.02514.x]. Journal of Child Psychology and Psychiatry, 53(6), 695–705. https://doi.org/10.1111/j.1469-7610.2011.02514.x
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