Cool Little Kids: Effectiveness of an early intervention program for anxiety-prone toddlers in the Netherlands
Angstproblemen komen veel voor en kunnen langdurig invloed hebben op verschillende leefgebieden. Al op peuterleeftijd zijn er bij angstgevoelige kinderen signalen zichtbaar, bijvoorbeeld in de vorm van teruggetrokken en verlegen gedrag. In een eerder door ZonMw gesubsidieerd onderzoeksproject bleek dat deze angstgevoelige peuters en kleuters opgespoord kunnen worden met een vragenlijst. Een preventieve interventie is echter nog niet beschikbaar in Nederland.
In dit onderzoeksproject gaat hoofdonderzoeker dr. L.J. Vreeke van de Universiteit Utrecht samen met de GGD Amsterdam, Prezens, Het Kabouterhuis, Stichting Angst Dwang Fobie en het Trimbos onderzoeken of met een korte training voor ouders, genaamd Cool Little Kids (CLK), voorkomen kan worden dat deze angstgevoelige peuters daadwerkelijk angstproblemen ontwikkelen. Daarnaast wordt onderzocht of de training kosteneffectief is.
Eerste aanwijzingen voor effectiviteit van de interventie Cool Little Kids.
Samenvatting van de aanvraag
Anxiety disorders affect approximately 20% of all individuals before the age of 16 (e.g., Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015), which makes these among the most common forms of psychopathology among children. The high prevalence, negative outcomes and the continuity of anxiety problems emphasize the importance of early, effective interventions. Clear markers exist to detect toddlers at risk of developing anxiety disorders. One of those markers in children is behavioral inhibition, a temperament characteristic expressed as showing shy behavior in unknown and challenging situations, and with unknown people (e.g., Clauss & Blackford, 2012; Kagan, Snidman, & Gibbons, 1989). This temperament characteristic can play an important role in identifying children with an increased risk of anxiety problems that could benefit from an intervention. A previously-funded ZonMw project (project number 15700.1010) found that the Behavioral Inhibition Questionnaire – Short Form (BIQ-SF) is a valid and reliable Dutch screening measure to identify children at risk of developing anxiety problems (Vreeke et al., 2012). However, a preventive intervention for these very young anxiety-prone children is not yet available in the Netherlands. A promising early intervention for these anxiety-prone toddlers is the Australian Cool Little Kids (CLK; Rapee et al., 2005). This brief parenting program provides psycho-education to parents about the nature and development of, and risks for anxiety disorders. Parents are also taught practical ways to reduce child anxiety through graded exposure, contingency management, reduction of overprotective behaviors, and management of their own fears and worries. Previous studies of the CLK program in anxious Australian preschoolers have yielded positive results (Bayer et al., 2011; Kennedy et al., 2009; Morgan et al., 2017; Rapee et al., 2005; 2010; Rapee, 2013). The past year, the CLK program has successfully been tested in a pilot study in Amsterdam with four pilot groups. In this pilot study, Utrecht University, two mental health care organizations (Medisch Orthopedagogisch Centrum ‘t Kabouterhuis and Prezens) and the Public Health Service Amsterdam participated. A process evaluation by the GGD Amsterdam showed that CLK is a feasible intervention, and that trainers and parents evaluated the program positively (Koldijk, 2019). Further, the evaluation yielded recommendations to perfect implementation strategies. In the proposed study, an interdisciplinary project group aims to evaluate the (cost)effectiveness of this parenting program in reducing the severity of anxiety problems in children aged 2 - 6 years in Amsterdam, The Netherlands. In addition, we will examine the mediating role of parental anxiety and overprotective parenting on intervention outcomes and to examine treatment integrity and parents' satisfaction. To do so, inhibited children between the ages of 2 and 6 years and their parents will be recruited by a PhD student in collaboration with the Public Health Service of Amsterdam (GGD Amsterdam) and the participating mental health organizations. Children identified as inhibited based on the BIQ-SF screening questionnaire from the previous ZonMw study will be randomly allocated to either 1) the Cool Little Kids parent intervention program or 2) a monitoring condition, consisting of an active control group. Clinical psychologists or prevention workers from MOC ‘t Kabouterhuis and Prezens will be responsible for delivering the CLK program to parents. To assess the effects of the intervention, parents will complete questionnaires and will be interviewed with a clinical interview regarding their children’s anxiety symptoms as well as on their own anxieties and their parenting behaviors. To examine cost-effectiveness, a quality of life questionnaire and a cost-diary will be filled out by parents. In addition, children themselves will be asked to complete an easy and age-appropriate self-report interview measuring anxiety, using animal images to communicate how they are feeling in given situations. Lastly, their primary caretaker at daycare or teachers will complete questionnaires on the children’s anxious behaviors in the daycare or school setting.