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Six decades of preventing and treating childhood anxiety disorders: a systematic review and meta-analysis to inform policy and practice
  1. Christine Schwartz,
  2. Jenny Lou Barican,
  3. Donna Yung,
  4. Yufei Zheng,
  5. Charlotte Waddell
  1. Children’s Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Charlotte Waddell, Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC V6B 5K3, Canada; charlotte_waddell{at}


Question Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?

Methods We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria—evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type.

Findings For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06).

Conclusions CBT is effective for preventing and treating childhood anxiety—across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors All authors played a role in developing the idea for this review and all approved the final version. CS interpreted the data and wrote the manuscript with extensive input from CW. JLB and DY conducted the literature searches, extracted relevant data and contributed to the manuscript. YZ led the meta-analyses and contributed to the manuscript. All authors approved the final version.

  • Funding The British Columbia Ministry of Children and Family Development supported this work (grant number SL00444S01, dated 11 April 2011, modified 1 April 2019).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on reasonable request from the corresponding author until 31 March 2022.

  • Patient consent for publication Not required.

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