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To present an updated review of recent studies into the effect of cognitive behavior therapy (CBT) for anxiety disorders in children and adolescents, ways to increase access to therapy, and predictors and moderators of therapy effect.The evidence base of CBT for anxiety disorders in children and adolescents continues to grow, demonstrating short and long-term efficacy and effectiveness. However, compared with active control conditions its effect appear to be modest; and a substantial percentage of youth do not show stable long-term remission. Standard CBT is often costly, with high noncompletion rates. New strategies to increase access to effective therapy for the large number of youth with anxiety disorders is therefore of priority. Additionally, there is a need for developing new ways to treat nonresponders, and to identify predictors and moderators of the effects of CBT.Although there is evidence for the efficacy and effectiveness of CBT for youth with anxiety disorders, there is doubt regarding its superiority over active control comparisons. Long-term outcome is uncertain, as a substantial percentage of youth remains impaired at follow-up. It is essential to develop more cost-efficient strategies to reach youth with anxiety disorders with effective treatments, and to identify early indicators for youth needing additional therapy.