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Effective Health Care Program

Anxiety in Children

Subtitle for Anxiety in Children

Systematic Review



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Purpose of Review

To evaluate the comparative effectiveness and harms of psychotherapy and medications for childhood anxiety disorders (panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, and separation anxiety).

Key Messages

  • Cognitive behavioral therapy reduces anxiety symptoms based on child, parent, and clinician reports, improves functioning, and leads to clinical response.
  • Medications (selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors) are also effective in reducing anxiety symptoms but not based on all three reporters (child, parent, and clinician) and are more likely to cause short-term adverse events. Long-term adverse events require further study.
  • Cognitive behavioral therapy reduced primary anxiety symptoms and improved function more than fluoxetine and increased remission more than sertraline.
  • The combination of medications and cognitive behavioral therapy is more effective than either treatment alone, but the benefits and risks of each need to be considered.
  • Future research should address treatment of children who have other psychiatric conditions in addition to anxiety, evaluate the effectiveness of the components of cognitive behavioral therapy, compare drugs head to head, and study the long-term adverse effects of medications.


Wang Z, Whiteside S, Sim L, Farah W, Morrow A, Alsawas M, Barrionuevo Moreno P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Gunjal S, Larrea Mantilla L, Ponce Ponte O, LeBlanc A, Prokop LJ, Murad MH. Anxiety in Children. Comparative Effectiveness Review No. 192. (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I.) AHRQ Publication No. 17-EHC023-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2017. DOI: