Cool Little Kids might sound like a range of quirky children’s clothes but, in Australia, it is the name given to an ambitious program aimed at intervening early with childhood anxiety and depression. The program is being evaluated using a population-level randomized trial – a trial of all children in the group, not just those singled out as being at risk – which will test whether systematically screening preschool children and providing assistance to those at risk for emotional difficulties is effective.

The lead researchers have recently published the study protocol, which gives the academic and policy world a better sense of what the trial aims to discover and the methods it will use. The program has already been subject to two smaller, relatively contained efficacy trials with promising results. The “real world” approach taken in this trial will see all children in the preschool system in four government areas across Melbourne screened for early signs of a disorder.

More than 95% of children in Australia attend preschool in the year before they begin primary school and the researchers estimate that approximately 16% will exhibit early risks for clinical disorder. The biggest risk factor is “temperamental inhibition” – fearfulness and a tendency to withdraw from new situations – though harsh or overprotective parenting is also thought to play a role. Parents’ own emotional difficulties are also considered.

Parents of children who screen positively will be eligible to be take part in the study. They will be randomly allocated to receive either the Cool Little Kids parenting intervention or services as usual within their school and community. The manualized intervention includes six group sessions of 90 minutes each delivered by trained early childhood professionals to a group of approximately 12 parents. The six sessions are spaced over a 12-week period to allow time for practice and reflection.

The program provides instruction and support to parents both to manage their own worries and distress and to help their children to develop appropriate coping skills. The workbook given to parents “details instructions in exposing children to their specific triggers for emotional distress… supplemented with extensive examples and detailed exercises.” Parents are encouraged to apply the strategies to their own concerns before they introduce the techniques with their children.

The randomized trial will test whether the intervention results in a reduced likelihood of symptoms of anxiety and depression, and whether it results reduced diagnoses of a disorder at one and two years post-baseline, when the children are approximately 5-6 and 6-7 years of age. The researchers also expect that parents who participate in the program will show lower scores on harsh and overprotective parenting and fewer internalizing problems of their own. A clinician blind to the group allocation will conduct the interviews with the parents.

The trial will also include a process evaluation, monitoring the fidelity of program implementation, as well as an economic evaluation to examine whether the intervention provides value for money to government, families and society at large. Finding effective ways to prevent these disorders is a major public health priority, since by 2030 anxiety and depression are expected to be second only to HIV/AIDS in the number of years of healthy life lost – a measure called the “global burden of disease.”

Recruitment to the study is taking place in early 2011 and Prevention Action will bring you the latest on the trial’s progress and findings as they are published.

Source:
Bayer, J.K., Rapee, R.M., Hiscock, H., Ukoumunne, O.C., Mihalopoulos, C., Clifford, S., & Wake, M. (2011). Study Protocol: The Cool Little Kids randomised controlled trial: Population-level early prevention for anxiety disorders, BMC Public Health, 11:11, www.biomedcentral.com/1471-2458/11/11.