Drawing and visual art interventions for anxiety in children aged 5-12: a systematic review and meta-analysis of randomised controlled trials.

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.