Hyperbolic trade-off: The importance of balancing trial and subject sample sizes in neuroimaging

Here we investigate the crucial role of trials in task-based neuroimaging from the perspectives of statistical efficiency and condition-level generalizability. Big data initiatives have gained popularity for leveraging a large sample of subjects to study a wide range of effect magnitudes in the brain. On the other hand, most task-based FMRI designs feature a relatively small number of subjects, so that resulting parameter estimates may be associated with compromised precision. Nevertheless, little attention has been given to another important dimension of experimental design, which can equally boost a study's statistical efficiency: the trial sample size. The common practice of condition-level modeling implicitly assumes no cross-trial variability. Here, we systematically explore the different factors that impact effect uncertainty, drawing on evidence from hierarchical modeling, simulations and an FMRI dataset of 42 subjects who completed a large number of trials of cognitive control task. We find that, due to an approximately symmetic hyperbola-relationship between trial and subject sample sizes in the presence of relatively large cross-trial variability, 1) trial sample size has nearly the same impact as subject sample size on statistical efficiency; 2) increasing both the number of trials and subjects improves statistical efficiency more effectively than focusing on subjects alone; 3) trial sample size can be leveraged alongside subject sample size to improve the cost-effectiveness of an experimental design; 4) for small trial sample sizes, trial-level modeling, rather than condition-level modeling through summary statistics, may be necessary to accurately assess the standard error of an effect estimate. We close by making practical suggestions for improving experimental designs across neuroimaging and behavioral studies.

Phasic Versus Tonic Irritability: Differential Associations With Attention-Deficit/Hyperactivity Disorder Symptoms

OBJECTIVE

Irritability is a multifaceted construct in pediatric psychopathology. It has been conceptualized as having a phasic dimension and a tonic dimension. Disruptive mood dysregulation disorder is defined by the presence of both dimensions. Severe irritability, or disruptive mood dysregulation disorder, is highly comorbid with attention-deficit/hyperactivity disorder (ADHD). However, it is unknown whether the presence of ADHD modulates the expression of phasic and tonic irritability.

METHOD

A data-driven, latent variable approach was used to examine irritability and ADHD symptoms in a transdiagnostic pediatric sample (N = 489) with primary disruptive mood dysregulation disorder, ADHD, subclinical irritability symptoms, or no diagnosis. Using latent profile analyses, we identified 4 classes: high levels of both irritability and ADHD symptoms, high levels of irritability and moderate levels of ADHD symptoms, moderate levels of irritability and high levels of ADHD symptoms, and low levels of both irritability and ADHD symptoms. Confirmatory factor analysis operationalized phasic irritability and tonic irritability.

RESULTS

As expected, the 2 latent classes characterized by high overall irritability exhibited the highest levels of both phasic and tonic irritability. However, between these 2 high irritability classes, highly comorbid ADHD symptoms were associated with significantly greater phasic irritability than were moderately comorbid ADHD symptoms. In contrast, the 2 high irritability groups did not differ on levels of tonic irritability.

CONCLUSION

These findings suggest that phasic, but not tonic, irritability has a significant association with ADHD symptoms and that phasic and tonic might be distinct, though highly related, irritability dimensions. Future research should investigate potential mechanisms underlying this differential association.

Location-dependent threat and associated neural abnormalities in clinical anxiety

Anxiety disorders are characterized by maladaptive defensive responses to distal or uncertain threats. Elucidating neural mechanisms of anxiety is essential to understand the development and maintenance of anxiety disorders. In fMRI, patients with pathological anxiety (ANX, n = 23) and healthy controls (HC, n = 28) completed a contextual threat learning paradigm in which they picked flowers in a virtual environment comprising a danger zone in which flowers were paired with shock and a safe zone (no shock). ANX compared with HC showed 1) decreased ventromedial prefrontal cortex and anterior hippocampus activation during the task, particularly in the safe zone, 2) increased insula and dorsomedial prefrontal cortex activation during the task, particularly in the danger zone, and 3) increased amygdala and midbrain/periaqueductal gray activation in the danger zone prior to potential shock delivery. Findings suggest that ANX engage brain areas differently to modulate context-appropriate emotional responses when learning to discriminate cues within an environment.

Suarez-Jimenez and colleagues use a shock and safe zone experiment with fMRI imaging to examine how pathological anxiety disorders are manifested in the brain. Their findings suggest that safe and dangerous zones within the experiment alter activation in different brain regions.

Recent advances in understanding neural correlates of anxiety disorders in children and adolescents

PURPOSE OF REVIEW

Anxiety disorders are some of the most common psychiatric diagnoses in children and adolescents, but attempts to improve outcome prediction and treatment have stalled. This review highlights recent findings on neural indices related to fear and anxiety that provide novel directions for attempts to create such improvements.

RECENT FINDINGS

Stimuli capable of provoking fear engage many brain regions, including the amygdala, medial prefrontal cortex, hippocampus, and bed nucleus of the stria terminalis. Studies in rodents suggest that sustained, low-level threats are particularly likely to engage the bed nucleus of the stria terminalis, which appears to malfunction in anxiety disorders. However, anxiety disorders, like most mental illnesses, appear less likely to arise from alterations in isolated brain regions than in distributed brain circuitry. Findings from large-scale studies of brain connectivity may reveal signs of such broadly distributed dysfunction, though available studies report small effect sizes. Finally, we review novel approaches with promise for using such large-scale data to detect clinically relevant, broadly distributed circuitry dysfunction.

SUMMARY

Recent work maps neural circuitry related to fear and anxiety. This circuitry may malfunction in anxiety disorders. Integrating findings from animal studies, big datasets, and novel analytical approaches may generate clinically relevant insights based on this recent work.

Intimate Partner Violence Exposure and Childhood Psychopathology: Associations with Discriminating Fearful and Angry Faces in Young Children

Purpose

Childhood exposure to traumatic violence may shape how children respond to threatening faces and increase risk for psychopathology. Maltreated children may exhibit altered processing of threatening faces; however, the effects of witnessing intimate partner violence (IPV) on children's discrimination of facial expressions is under-studied. Emotional face processing differentially relates to psychopathology, with some evidence suggesting improved detection of angry faces in children with fear-related anxiety symptoms, whereas externalizing symptoms are associated with poorer detection of fearful faces and perhaps emotional faces broadly.

Method

In this cross-sectional study, we examined discrimination of threatening emotional faces (angry, fearful) in relation to experiences of probable abuse and witnessing of physical IPV, as well as psychopathology. Children (N = 137, mean age = 5.01 years, SD = 0.81) completed a "face in the crowd task" designed to examine discrimination of angry and fearful faces. Children either searched for an angry face among fearful distractor faces or a fearful face among angry distractors. Probable child abuse, witnessed IPV, and symptoms were assessed in semi-structured maternal interviews.

Results

Children who witnessed violence showed poorer accuracy when fearful faces were the target; however, effects for probable abuse were non-significant. Greater fear-related anxiety symptoms were associated with poorer accuracy for fearful faces. Externalizing symptoms were associated with poorer overall accuracy.

Conclusions

Findings suggest that IPV and fear-related anxiety symptoms were associated with difficulty detecting fearful faces when angry distractors were present, consistent with prior research. Implications of violence- and symptom-associated deficits in emotional face processing are discussed.

Social relevance modulates multivariate neural representations of threat generalization in children and adults

Few studies have examined threat generalization across development and no developmental studies have compared the generalization of social versus nonsocial threat, making it difficult to identify contextual factors that contribute to threat learning across development. The present study assessed youth and adults' multivoxel neural representations of social versus nonsocial threat stimuli. Twenty adults (M_age  = 25.7 ± 4.9) and 16 youth (M_age  = 14.1 ± 1.7) completed two conditioning and extinction recall paradigms: one social and one nonsocial paradigm. Three weeks after conditioning, participants underwent a functional magnetic resonance imaging extinction recall task that presented the extinguished threat cue (CS+), a safety cue (CS-), and generalization stimuli (GS) consisting of CS-/CS+ blends. Across age groups, neural activity patterns and self-reported fear and memory ratings followed a linear generalization gradient for social threat stimuli and a quadratic generalization gradient for nonsocial threat stimuli, indicating enhanced threat/safety discrimination for social relative to nonsocial threat stimuli. The amygdala and ventromedial prefrontal cortex displayed the greatest neural pattern differentiation between the CS+ and GS/CS-, reinforcing their role in threat learning and extinction recall. Contrary to predictions, age did not influence threat representations. These findings highlight the importance of the social relevance of threat on generalization across development.

Return of fear following extinction in youth: An event-related potential study

The ability to learn to differentiate safety from danger matures gradually, particularly when such learning occurs over an extended time period. And yet, most research on fear learning examines the early phases of such learning and mainly in adults. The current study examined fear conditioning and extinction, as well as one form of extended learning, return of fear (ROF). Thirty-three typically developing children (age range: 7-14 years) completed fear conditioning and extinction; self-reports and psychophysiological indices were measured at this point. Two weeks later, children completed a ROF test (n = 23), and event-related potentials (ERPs) were recorded. Results indicated successful fear acquisition and extinction. Moreover, participants reported greater fear of the conditioned stimulus (CS+) than the safety stimulus (CS-) in the ROF test 2 weeks later. In electrophysiology data, ROF manifested as a larger late positive potential (LPP) response to the CS+ than the CS-. Finally, these differences in LPP responses were positively correlated with poorer extinction, as indicated by the GSR responses 2 weeks earlier. This is the first ERP study to demonstrate ROF in children. The LPP measure may index an interplay between inhibitory and excitatory brain-related processes underlying the long-term effects of fear learning.

Trial and error: A hierarchical modeling approach to test-retest reliability

The concept of test-retest reliability indexes the consistency of a measurement across time. High reliability is critical for any scientific study, but specifically for the study of individual differences. Evidence of poor reliability of commonly used behavioral and functional neuroimaging tasks is mounting. Reports on low reliability of task-based fMRI have called into question the adequacy of using even the most common, well-characterized cognitive tasks with robust population-level effects, to measure individual differences. Here, we lay out a hierarchical framework that estimates reliability as a correlation divorced from trial-level variability, and show that reliability tends to be underestimated under the conventional intraclass correlation framework through summary statistics based on condition-level modeling. In addition, we examine how reliability estimation between the two statistical frameworks diverges and assess how different factors (e.g., trial and subject sample sizes, relative magnitude of cross-trial variability) impact reliability estimates. As empirical data indicate that cross-trial variability is large in most tasks, this work highlights that a large number of trials (e.g., greater than 100) may be required to achieve precise reliability estimates. We reference the tools TRR and 3dLMEr for the community to apply trial-level models to behavior and neuroimaging data and discuss how to make these new measurements most useful for future studies.

Behavioral inhibition and dual mechanisms of anxiety risk: Disentangling neural correlates of proactive and reactive control

Background:

Behavioral inhibition (BI) is a temperament style characterized by heightened reactivity and negative affect in response to novel people and situations, and it predicts anxiety problems later in life. However, not all BI children develop anxiety problems, and mounting evidence suggests that how one manages their cognitive resources (cognitive control) influences anxiety risk. The present study tests whether more (proactive control) or less (reactive control) planful cognitive strategies moderate relations between early BI and later anxiety.

Methods:

Participants included 112 adolescents (55% female; M_age = 15.4 years) whose temperament was assessed during toddlerhood. In adolescence, participants completed an AX Continuous Performance Test while electroencephalography was recorded to disentangle neural activity related to proactive (cue-locked P3b) and reactive (probe-locked N2) control.

Results:

Greater BI was associated with greater total anxiety scores only among adolescents with smaller ΔP3bs and larger ΔN2s—a pattern consistent with decreased reliance on proactive strategies and increased reliance on reactive strategies. Additionally, a larger ΔP3b was associated with greater total anxiety scores; however, this effect was largely explained by the fact that females tended to have larger ΔP3bs and greater anxiety than males.

Conclusions:

Early BI relates to risk for later anxiety specifically among adolescents who rely less on proactive strategies and more on reactive control strategies. Thus, cognitive control strategy moderates the association between developmental context (i.e., temperament) and later anxiety. The present study is the first to characterize how proactive and reactive control uniquely relate to pathways toward anxiety risk.

A Developmental Pathway From Early Behavioral Inhibition to Young Adults' Anxiety During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has brought unprecedented changes to young adults' lives, resulting in mental health difficulties for many; however, some individuals are particularly prone to heightened anxiety. Little is known about the early life predictors of anxiety during the pandemic. We examined a developmental pathway from behavioral inhibition (BI), a temperament characterized by fearful responses toward novelty, to changes in young adults' anxiety during the initial period of the pandemic. We hypothesized that a stable pattern of BI across early childhood would predict greater adolescent worry dysregulation, which in turn would predict increases in young adult anxiety during a stressful phase of the pandemic.

METHOD

Participants (N = 291; 54% female) were followed from toddlerhood to young adulthood. BI was observed at ages 2 and 3 years. Social wariness was observed at age 7 years. Participants rated their worry dysregulation in adolescence (age 15) and anxiety in young adulthood (age 18) at 2 assessments during the COVID-19 pandemic, 1 month apart.

RESULTS

A significant moderated mediation, in which a stable pattern of BI from toddlerhood to childhood, as compared to the absence of this pattern, predicted greater worry dysregulation in adolescence. Worry dysregulation predicted elevated young adult anxiety in the second assessment during COVID-19, even after accounting for the first assessment.

CONCLUSION

This study identifies a developmental pathway from toddlerhood BI to young adults' elevated anxiety during the COVID-19 pandemic. Findings have implications for early identification of individuals at risk for dysregulated worry and the prevention of anxiety during stressful life events in young adulthood.

Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group

The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.

Amygdala Functional Connectivity and Negative Reactive Temperament at Age 4 Months

OBJECTIVE

Infant amygdala connectivity correlates with maternal reports of infant temperament characterized by novelty-evoked distress and avoidance. However, no studies have examined how human infant amygdala connectivity relates to direct observations of novelty-evoked distress. This study examined the link between amygdala connectivity and infant novelty-evoked distress using direct observation of temperament.

METHOD

Novelty-evoked distress was assessed at 4 months of age (N = 90) using a standardized reactivity assessment and parent report. Within 3 weeks of assessment, resting-state functional magnetic resonance imaging was collected in a subset of infants (n = 34). Using a whole-brain voxelwise approach, amygdala connectivity associated with positive and negative affect during the reactivity assessment was examined. Regions where the association of amygdala connectivity with negative affect was higher than with positive affect were then examined. Associations between amygdala connectivity and parent report of temperament were also examined.

RESULTS

Greater amygdala-cingulate and amygdala-superior frontal gyrus connectivity was associated with lower positive affect during the reactivity assessment. Further, the association between amygdala-cingulate connectivity was greater for negative affect compared with positive affect. There were no significant associations between latency to approach novelty (as measured by parent report) and amygdala connectivity. Validation analyses conducted using a large independent longitudinal sample (N = 323) demonstrated that negative reactivity was associated with increased child-reported anxiety symptoms in adolescence.

CONCLUSION

These results provide novel insight into the developmental pathophysiology of novelty-evoked distress. This is consistent with research linking an altered cognitive control mechanism to temperamental risk for anxiety.

Whole-Brain Resting-State Functional Connectivity Patterns Associated With Pediatric Anxiety and Involuntary Attention Capture

BACKGROUND

Pediatric anxiety disorders are linked to dysfunction in multiple functional brain networks, as well as to alterations in the allocation of spatial attention. We used network-level analyses to characterize resting-state functional connectivity (rs-fc) alterations associated with 1) symptoms of anxiety and 2) alterations in stimulus-driven attention associated with pediatric anxiety disorders. We hypothesized that anxiety was related to altered connectivity of the frontoparietal, default mode, cingulo-opercular, and ventral attention networks and that anxiety-related connectivity alterations that include the ventral attention network would simultaneously be related to deviations in stimulus-driven attention.

METHODS

A sample of children (n = 61; mean = 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a clinical assay, an attention task, and rs-fc magnetic resonance imaging scans. Network-level analyses examined whole-brain rs-fc patterns associated with clinician-rated anxiety and with involuntary capture of attention. Post hoc analyses controlled for comorbid symptoms.

RESULTS

Elevated clinician-rated anxiety was associated with altered connectivity within the cingulo-opercular network, as well as between the cingulo-opercular network and the ventral attention, default mode, and visual networks. Connectivity between the ventral attention and cingulo-opercular networks was associated with variation in both anxiety and stimulus-driven attention.

CONCLUSIONS

Pediatric anxiety is related to aberrant connectivity patterns among several networks, most of which include the cingulo-opercular network. These results help clarify the within- and between-network interactions associated with pediatric anxiety and its association with altered attention, suggesting that specific network connections could be targeted to improve specific altered processes associated with anxiety.

Evolution, Emotion, and Episodic Engagement

Although rodent research provides important insights into neural correlates of human psychology, new cortical areas, connections, and cognitive abilities emerged during primate evolution, including human evolution. Comparison of human brains with those of nonhuman primates reveals two aspects of human brain evolution particularly relevant to emotional disorders: expansion of homotypical association areas and expansion of the hippocampus. Two uniquely human cognitive capacities link these phylogenetic developments with emotion: a subjective sense of participating in and reexperiencing remembered events and a limitless capacity to imagine details of future events. These abilities provided evolving humans with selective advantages, but they also created proclivities for emotional problems. The first capacity evokes the "reliving" of past events in the "here-and-now," accompanied by emotional responses that occurred during memory encoding. It contributes to risk for stress-related syndromes, such as posttraumatic stress disorder. The second capacity, an ability to imagine future events without temporal limitations, facilitates flexible, goal-related behavior by drawing on and creating a uniquely rich array of mental representations. It promotes goal achievement and reduces errors, but the mental construction of future events also contributes to developmental aspects of anxiety and mood disorders. With maturation of homotypical association areas, the concrete concerns of childhood expand to encompass the abstract apprehensions of adolescence and adulthood. These cognitive capacities and their dysfunction are amenable to a research agenda that melds experimental therapeutic interventions, cognitive neuropsychology, and developmental psychology in both humans and nonhuman primates.

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others' emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9-14 from a community sample (N = 601) completed a facial emotion labeling task. Children's symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = -0.12, p = 0.018), specifically happiness (β = -0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = -0.16, p = 0.003), specifically happiness (β = -0.15, p = 0.006) and fear (β = -0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.

Neonatal Brain Response to Deviant Auditory Stimuli and Relation to Maternal Trait Anxiety

OBJECTIVE

Excessive response to unexpected or "deviant" stimuli during infancy and early childhood represents an early risk marker for anxiety disorders. However, research has yet to delineate the specific brain regions underlying the neonatal response to deviant stimuli near birth and the relation to risk for anxiety disorders. The authors used task-based functional MRI (fMRI) to delineate the neonatal response to deviant stimuli and its relationship to maternal trait anxiety.

METHODS

The authors used fMRI to measure brain activity evoked by deviant auditory stimuli in 45 sleeping neonates (mean age, 27.8 days; 60% female; 64% African American). In 41 of the infants, neural response to deviant stimuli was examined in relation to maternal trait anxiety on the State-Trait Anxiety Inventory, a familial risk factor for offspring anxiety.

RESULTS

Neonates manifested a robust and widespread neural response to deviant stimuli that resembles patterns found previously in adults. Higher maternal trait anxiety was related to higher responses within multiple brain regions, including the left and right anterior insula, the ventrolateral prefrontal cortex, and multiple areas within the anterior cingulate cortex. These areas overlap with brain regions previously linked to anxiety disorders and other psychiatric illnesses in adults.

CONCLUSIONS

The neural architecture sensitive to deviant stimuli robustly functions in newborns. Excessive responsiveness of some circuitry components at birth may signal risk for anxiety and other psychiatric disorders.

A computational network perspective on pediatric anxiety symptoms

BACKGROUND

While taxonomy segregates anxiety symptoms into diagnoses, patients typically present with multiple diagnoses; this poses major challenges, particularly for youth, where mixed presentation is particularly common. Anxiety comorbidity could reflect multivariate, cross-domain interactions insufficiently emphasized in current taxonomy. We utilize network analytic approaches that model these interactions by characterizing pediatric anxiety as involving distinct, inter-connected, symptom domains. Quantifying this network structure could inform views of pediatric anxiety that shape clinical practice and research.

METHODS

Participants were 4964 youths (ages 5-17 years) from seven international sites. Participants completed standard symptom inventory assessing severity along distinct domains that follow pediatric anxiety diagnostic categories. We first applied network analytic tools to quantify the anxiety domain network structure. We then examined whether variation in the network structure related to age (3-year longitudinal assessments) and sex, key moderators of pediatric anxiety expression.

RESULTS

The anxiety network featured a highly inter-connected structure; all domains correlated positively but to varying degrees. Anxiety patients and healthy youth differed in severity but demonstrated a comparable network structure. We noted specific sex differences in the network structure; longitudinal data indicated additional structural changes during childhood. Generalized-anxiety and panic symptoms consistently emerged as central domains.

CONCLUSIONS

Pediatric anxiety manifests along multiple, inter-connected symptom domains. By quantifying cross-domain associations and related moderation effects, the current study might shape views on the diagnosis, treatment, and study of pediatric anxiety.

Neurocognitive Profiles in Adolescence Predict Subsequent Anxiety Trajectories During the COVID-19 Pandemic

Background

The COVID-19 pandemic has created increased stress and anxiety for many; however, some individuals are particularly prone to heightened anxiety. It is unclear if and how prestress neurocognitive factors moderate risk for anxiety during high-stress situations. Enhanced error monitoring and a cognitive control strategy of more instantaneous (reactive) control have both been independently related to anxiety. We examined if a specific neurocognitive profile characterized by heightened error monitoring and a more reactive cognitive control strategy in adolescence predicts young adults’ anxiety trajectories across 3 early months of the COVID-19 pandemic.

Methods

As part of a longitudinal study (N = 291), data were acquired in adolescence (13 years) on error monitoring (n = 124) and cognitive control strategy (n = 119). In young adulthood (18 years), anxiety was assessed three times during the COVID-19 pandemic (n = 162).

Results

On average, participants experienced greater anxiety in the first COVID-19 pandemic assessment, then anxiety decreased in the following months. Error monitoring and cognitive control strategy interacted to predict anxiety trajectories, such that among adolescents with an increased reliance on reactive control, error monitoring predicted greater anxiety in the first assessment but greater decreases the following months as stay-at-home orders were lifted and families adapted to the restrictions.

Conclusions

Results suggest that neurocognitive profiles in adolescence predict young adults’ anxiety responses during a highly stressful period, such as the initial months of the COVID-19 pandemic. Our findings have implications for the early identification of individuals at greater risk for anxiety.

Using a novel paradigm to examine observational fear-learning across development

BACKGROUND

Fear-learning through observing others begins early in life. Yet, most observational fear-learning research has focused on adults. The current study used a novel developmentally appropriate observational fear conditioning paradigm to examine differences in observational fear-learning among children, adolescents, and adults.

METHOD

Thirty-six typically developing children, 41 typically developing adolescents, and 40 adults underwent differential observational fear conditioning followed by a direct exposure test. Skin conductance response (SCR) and self-reported fear were measured.

RESULTS

Successful differential observational fear-learning was demonstrated in all three age groups as indexed by SCR, yet developmental differences emerged. Children showed overall higher physiological arousal during acquisition compared to adolescents and adults. Additionally, children reported less differential fear and were less successful at reporting the conditioned stimulus-unconditioned stimulus contingency compared to adolescents and adults. Finally, adolescents tended to overgeneralize their fear compared with adults.

CONCLUSIONS

This is the first study to compare observational fear-learning among children, adolescents, and adults. The novel task effectively induced observational fear-learning, particularly among adolescents and adults. Findings revealed developmental differences that have both theoretical and clinical implications.

Shared and Anxiety-Specific Pediatric Psychopathology Dimensions Manifest Distributed Neural Correlates

BACKGROUND

Imaging research has not yet delivered reliable psychiatric biomarkers. One challenge, particularly among youth, is high comorbidity. This challenge might be met through canonical correlation analysis designed to model mutual dependencies between symptom dimensions and neural measures. We mapped the multivariate associations that intrinsic functional connectivity manifests with pediatric symptoms of anxiety, irritability, and attention-deficit/hyperactivity disorder (ADHD) as common, impactful, co-occurring problems. We evaluate the replicability of such latent dimensions in an independent sample.

METHODS

We obtained ratings of anxiety, irritability, and ADHD, and 10 minutes of resting-state functional magnetic resonance imaging data, from two independent cohorts. Both cohorts (discovery: n = 182; replication: n = 326) included treatment-seeking youth with anxiety disorders, with disruptive mood dysregulation disorder, with ADHD, or without psychopathology. Functional connectivity was modeled as partial correlations among 216 brain areas. Using canonical correlation analysis and independent component analysis jointly we sought maximally correlated, maximally interpretable latent dimensions of brain connectivity and clinical symptoms.

RESULTS

We identified seven canonical variates in the discovery and five in the replication cohort. Of these canonical variates, three exhibited similarities across datasets: two variates consistently captured shared aspects of irritability, ADHD, and anxiety, while the third was specific to anxiety. Across cohorts, canonical variates did not relate to specific resting-state networks but comprised edges interconnecting established networks within and across both hemispheres.

CONCLUSIONS

Findings revealed two replicable types of clinical variates, one related to multiple symptom dimensions and a second relatively specific to anxiety. Both types involved a multitude of broadly distributed, weak brain connections as opposed to strong connections encompassing known resting-state networks.

Threat-anticipatory psychophysiological response is enhanced in youth with anxiety disorders and correlates with prefrontal cortex neuroanatomy

Background

Threat anticipation engages neural circuitry that has evolved to promote defensive behaviours; perturbations in this circuitry could generate excessive threat-anticipation response, a key characteristic of pathological anxiety. Research into such mechanisms in youth faces ethical and practical limitations. Here, we use thermal stimulation to elicit pain-anticipatory psychophysiological response and map its correlates to brain structure among youth with anxiety and healthy youth.

Methods

Youth with anxiety (n = 25) and healthy youth (n = 25) completed an instructed threat-anticipation task in which cues predicted nonpainful or painful thermal stimulation; we indexed psychophysiological response during the anticipation and experience of pain using skin conductance response. High-resolution brain-structure imaging data collected in another visit were available for 41 participants. Analyses tested whether the 2 groups differed in their psychophysiological cue-based pain-anticipatory and pain-experience responses. Analyses then mapped psychophysiological response magnitude to brain structure.

Results

Youth with anxiety showed enhanced psychophysiological response specifically during anticipation of painful stimulation (b = 0.52, p = 0.003). Across the sample, the magnitude of psychophysiological anticipatory response correlated negatively with the thickness of the dorsolateral prefrontal cortex (pFWE < 0.05); psychophysiological response to the thermal stimulation correlated positively with the thickness of the posterior insula (pFWE < 0.05).

Limitations

Limitations included the modest sample size and the cross-sectional design.

Conclusion

These findings show that threat-anticipatory psychophysiological response differentiates youth with anxiety from healthy youth, and they link brain structure to psychophysiological response during pain anticipation and experience. A focus on threat anticipation in research on anxiety could delineate relevant neural circuitry.

Anxiety disorders

Anxiety disorders form the most common group of mental disorders and generally start before or in early adulthood. Core features include excessive fear and anxiety or avoidance of perceived threats that are persistent and impairing. Anxiety disorders involve dysfunction in brain circuits that respond to danger. Risk for anxiety disorders is influenced by genetic factors, environmental factors, and their epigenetic relations. Anxiety disorders are often comorbid with one another and with other mental disorders, especially depression, as well as with somatic disorders. Such comorbidity generally signifies more severe symptoms, greater clinical burden, and greater treatment difficulty. Reducing the large burden of disease from anxiety disorders in individuals and worldwide can be best achieved by timely, accurate disease detection and adequate treatment administration, scaling up of treatments when needed. Evidence-based psychotherapy (particularly cognitive behavioural therapy) and psychoactive medications (particularly serotonergic compounds) are both effective, facilitating patients' choices in therapeutic decisions. Although promising, no enduring preventive measures are available, and, along with frequent therapy resistance, clinical needs remain unaddressed. Ongoing research efforts tackle these problems, and future efforts should seek individualised, more effective approaches for treatment with precision medicine.