Art-Based Interventions and Creative Problem-Solving in Anxious Children: A Scoping Review of Mechanistic Pathways

Abstract

Anxiety is among the most prevalent mental health conditions in childhood, often impairing adaptive coping and executive functioning. Art-based interventions have attracted growing clinical interest as non-verbal therapeutic modalities that may simultaneously reduce anxious symptomatology and enhance creative problem-solving capacities. Yet the precise psychological mechanisms linking these two outcomes remain poorly mapped in the literature. This scoping review systematically surveys peer-reviewed evidence on the mechanistic pathways through which structured art-based activities influence creative problem-solving in children aged 5 to 12 years with anxiety. Three candidate pathways are examined: symbolic externalisation, which disrupts rumination by creating cognitive distance from distress; autonomic regulation, whereby creative flow promotes parasympathetic activation and restores executive bandwidth; and agency restoration, through which open-ended artistic choice-making rebuilds self-efficacy and transfers to problem-solving contexts. Consistent with Arksey and O'Malley's framework, studies were eligible if they involved children aged 5 to 12 with clinically elevated or diagnosed anxiety, reported a structured art-based intervention, and measured problem-solving, cognitive flexibility, or related outcomes. Evidence from randomised controlled trials, controlled studies, and meta-analyses broadly supports each pathway, though mechanistic isolation remains rare. This review identifies critical gaps, including the absence of developmental-stage stratification, minimal longitudinal follow-up, and a lack of dismantling designs that test individual mechanisms. Recommendations for future research and clinical implementation are discussed.