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Empirical evidence addressing the effectiveness of anxiety prevention programs is limited. Gaps identified in this literature provide a lifetime of opportunity for prevention scientists. This commentary extends the discussion of anxiety prevention to issues relevant for designing preventive interventions for youth. Three specific questions are discussed: a) Which “at-risk” youth should be targeted? b) When developmentally might preventive interventions have the greatest impact? and c) What specific intervention strategies might be most effective? Key components of the Child Anxiety Prevention Study are presented to illustrate one approach to designing a child anxiety prevention program.