Effectiveness of Stay Cool Kids (Alles Kidzzz): An indicated preventive intervention for externalizing problem behavior in school age children.

Externalizing problem behavior in school-aged children has an estimated frequency of 2 to 16%. Stable externalizing behavior places these children at risk for future difficulties and diagnosable psychopathology. Therefore, preventive interventions designed to alter the developmental trajectory towards more serious behavior problems should occur before transition from elementary to higher school, since this is a developmental risk point. The aim of this trial is to test the effectiveness of the individual school-based preventive social cogntive training 'Stay Cool Kids (Alles Kidzzz)', to reduce externalizing behavior problems and to enhance cognitive behavioral skills. The sample consists of 48 schools, with 264 fourth-grade children displaying externalizing behavior (TRF T-score > 60), randomly assigned to the intervention or no-intervention control condition. Moderators and mediators of the intervention will be examined.

N/A

1. Pretest;

2. Post test;

3. Half year follow-up;

4. One year follow-up.

Stay Cool Kids:

1. Individual, tailor-made intervention;

2. School-based;

3. Social-cognitive basis;

4. Targeted.



The Stay Cool Kids training is a social cognitive intervention that focuses on reciprocal relations between cognitions, emotions, and behavior of the child. The training is designed to reduce aggressive behavior in highly aggressive children at elementary schools. The long term goal is to prevent the development of disruptive behavior disorders. Trainers worked individually, in 8 weekly sessions of 45 minutes, with the target child. Children were seen during the school day from January until March. The trainer met with parents and teachers before the start of the training, during a mid term evaluation, and at the end of the training.

The training consisted of 2 phases. In the first phase, trainers investigated child’s specific needs and competences. The first session starts with a general introduction, which is the same for all children. Next, trainers were able to choose two from six exercises, which were best suited for the individual child, for the second and third session. After the third session, an individual analysis of child’s competences was made and discussed with parents and teachers during a midterm evaluation, resulting in an individual intervention plan. For the intervention plan trainers chose five from nine program components, which were most appropriate for the individual child’s needs, as described in the trainer manual. Before phase 2 (session 4 -8) started, a contract between the trainer and child was signed, in which the training program is described. Exercises focused on 1) self-perception (less negative, realistic self-perception), 2) social cognitions (attribution of benign intent in ambiguous situations, accurate representation of other children emotions), 3) anger management (emotion-regulations strategies, e.g., ‘stop-think-act’), and 4) aggressive behavior (generation of less aggressive responses to social provocations). Parents and teachers receive information after each training session about what is done during the training. Also, they are asked to practice together with the child its newly learned skills.



The children in the control condition did not receive any intervention or received care as usual (e.g., remedial teaching, universal remediation programs) within their school.