Drawing and visual art interventions for anxiety in children aged 5-12: a systematic review and meta-analysis of randomised controlled trials
In brief
Art therapy cuts procedural anxiety in kids by roughly three standard deviations
A meta-analysis of eight randomized trials (816 children) found that drawing- and visual-art activities dramatically lowered short-term anxiety in medical or procedure settings, with an effect size near -2.7 standard deviations. However, results were highly variable and only apply to acute clinical contexts, so the benefit cannot yet be assumed in schools or other settings.
- Journal
- BMJ paediatrics open (Q1)
- Published
- 16 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yu Jia, Shaojie Zhang, Diying Liao
- PMID
- 42749358
- DOI
- 10.1136/bmjpo-2026-004752
Why clinicians should know about it
- Picked for Complementary and Alternative Medicine (top studies of the week, 20 September 2026): Ranked by evidence level and journal quartile
- Picked for Rehabilitation (top studies of the week, 20 September 2026): Systematic review of art interventions for pediatric anxiety
- Picked for Pediatrics and Child Health (top studies of the week, 20 September 2026): Art interventions reduce anxiety in medical settings
Abstract
OBJECTIVE: To evaluate the effects of drawing- and visual art-based interventions on anxiety in children aged 5-12 years and to examine variation across comparator structures and settings. METHODS: PubMed, Web of Science, Cochrane Library, ERIC, DOAJ and China National Knowledge Infrastructure were searched for randomised controlled trials (RCTs). Postintervention anxiety was the primary outcome and was pooled as standardised mean differences. Trials using non-art or usual-care comparators and those using active art comparators were synthesised separately. Risk of bias was assessed using RoB 2. RESULTS: 10 RCTs involving 816 children were included. The primary meta-analysis included eight trials with non-art or usual-care comparators conducted in medical or procedure-related contexts. Drawing- and visual art-based interventions were associated with lower short-term anxiety compared with these controls (SMD=-2.70, 95% CI -3.73 to -1.68; I²=96%). Leave-one-out sensitivity analyses and exclusion of studies at high risk of bias did not materially change the direction of the effect although heterogeneity remained substantial. Two school-based trials used active art-based comparators and were synthesised separately. CONCLUSION: Drawing- and visual art-based interventions may reduce short-term anxiety mainly in acute medical or procedure-related contexts. Because heterogeneity was substantial and school-based evidence used different comparator structures, the current evidence does not support a single generalisable effect across paediatric settings. PROSPERO REGISTRATION NUMBER: CRD420261288781.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.