Anxiety sensitivity, conscious awareness and selective attentional biases in children

Fearful Temperament and the Risk for Child and Adolescent Anxiety: The Role of Attention Biases and Effortful Control

Fearful temperament represents one of the most robust predictors of child and adolescent anxiety; however, not all children with fearful temperament unvaryingly develop anxiety. Diverse processes resulting from the interplay between automatic processing (i.e., attention bias) and controlled processing (i.e., effortful control) drive the trajectories toward more adaptive or maladaptive directions. In this review, we examine the associations between fearful temperament, attention bias, and anxiety, as well as the moderating effect of effortful control. Based on the reviewed literature, we propose a two-mechanism developmental model of attention bias that underlies the association between fearful temperament and anxiety. We propose that the sub-components of effortful control (i.e., attentional control and inhibitory control) play different roles depending on individuals' temperaments, initial automatic biases, and goal priorities. Our model may help resolve some of the mixed findings and conflicts in the current literature. It may also advance our knowledge regarding the cognitive mechanisms linking fearful temperament and anxiety, as well as facilitate the continuing efforts in identifying and intervening with children who are at risk. Finally, we conclude the review with a discussion on the existing limitations and then propose questions for future research.

Anxiety and Attentional Bias in Children with Specific Learning Disorders

Children with specific learning disorders (SLDs) face a unique set of socio-emotional challenges as a result of their academic difficulties. Although a higher prevalence of anxiety in children with SLD is often reported, there is currently no research on cognitive mechanisms underlying this anxiety. One way to elucidate these mechanisms is to investigate attentional bias to threatening stimuli using a dot-probe paradigm. Our study compared children ages 9-16 with SLD (n = 48) to typically-developing (TD) controls (n = 33) on their attentional biases to stimuli related to general threats, reading, and stereotypes of SLD. We found a significant threat bias away from reading-related stimuli in the SLD, but not TD group. This attentional bias was not observed with the general threat and stereotype stimuli. Further, children with SLD reported greater anxiety compared to TD children. These results suggest that children with SLD experience greater anxiety, which may partially stem from reading specifically. The finding of avoidance rather than vigilance to reading stimuli indicates the use of more top-down attentional control. This work has important implications for therapeutic approaches to anxiety in children with SLD and highlights the need for attention to socio-emotional difficulties in this population. Future research is needed to further investigate the cognitive aspects of socio-emotional difficulties in children with SLD, as well as how this may impact academic outcomes.

What drives prioritized visual processing? A motivational relevance account

Emotion is fundamental to our being, and an essential aspect guiding behavior when rapid responding is required. This includes whether we approach or avoid a stimulus, and the accompanying physiological responses. A common tenet is that threat-related content drives stimulus processing and biases visual attention, so that rapid responding can be initiated. In this paper, it will be argued instead that prioritization of threatening stimuli should be encompassed within a motivational relevance framework. To more fully understand what is, or is not, prioritized for visual processing one must, however, additionally consider: (i) stimulus ambiguity and perceptual saliency; (ii) task demands, including both perceptual load and cognitive load; and (iii) endogenous/affective states of the individual. Combined with motivational relevance, this then leads to a multifactorial approach to understanding the drivers of prioritized visual processing. This accords with current recognition that the brain basis allowing for visual prioritization is also multifactorial, including transient, dynamic and overlapping networks. Taken together, the paper provides a reconceptualization of how "emotional" information prioritizes visual processing.

The Serotonin Transporter Promoter Variant, Stress, and Attentional Biases in Middle Childhood

Although evidence suggests that 5-HTTLPR variants may shape risk for depression, the influence is likely complex, and involves effects on endophenotypes. We examined associations between 5-HTTLPR and biases in attention to affective stimuli in a sample of girls and a sample of both boys and girls. Children with at least one short (S) variant of the 5-HTTLPR polymorphism had lower positive attentional bias scores in both samples. This association was qualified by an interaction with stress in one sample, such that links between the S allele and decreased positive attentional bias was significant only when life stress was elevated. This difference in findings between the two samples was explained by sex differences in samples; the GXE interaction was significant only in boys. Findings are discussed in the context of sex differences in GXE.

Modulation of Inhibitory Processing by Posttraumatic Stress Symptoms and Anxiety in a Subclinical Sample of Children

In adults, pathologies of anxiety such as posttraumatic stress symptoms (PTSS) involve deficits in information processing that may reflect hypervigilance and deficient inhibitory control, specifically for negative information. However, little is known about inhibitory processing in children, particularly regarding the inhibition of emotional information. This study investigated whether children with PTSS or anxiety show impairments in executive control in an inhibition task. A total of 45 children (M age = 9.2 year, SD = 0.7, range: 8-11) completed an inhibition task involving emotional-happy, angry, and fearful-and neutral stimuli and clinical scales for PTSS and anxiety. The results indicated that the percentage of correct answers was modulated by PTSS status, particularly in the happiness task. PTSS and anxiety altered the inhibition of fearful information in children. These data suggest different types of inhibitory deficits depending on clinical symptoms, and implications are discussed.

Anxiety sensitivity is associated with attentional bias for pain-related information in healthy children and adolescents

This investigation explored the association between anxiety sensitivity and attentional bias for threatening information in children and adolescents ( N = 40). Participants completed a pictorial version of the visual-probe task, featuring pain-related, health-threat and general-threat images presented for 500 and 1250 ms. Regression analyses revealed significant associations between anxiety sensitivity and attentional bias towards pain-related images presented for 500 ms and between state anxiety and attentional bias towards general-threat images presented for 1250 ms. These results suggest that in children and adolescents, anxiety sensitivity is associated with attentional bias for negative information of personal relevance.

Parental depression and child cognitive vulnerability predict children's cortisol reactivity

Risk for depression is expressed across multiple levels of analysis. For example, parental depression and cognitive vulnerability are known markers of depression risk, but no study has examined their interactive effects on children's cortisol reactivity, a likely mediator of early depression risk. We examined relations across these different levels of vulnerability using cross-sectional and longitudinal methods in two community samples of children. Children were assessed for cognitive vulnerability using self-reports (Study 1; n = 244) and tasks tapping memory and attentional bias (Study 2; n = 205), and their parents were assessed for depression history using structured clinical interviews. In both samples, children participated in standardized stress tasks and cortisol reactivity was assessed. Cross-sectionally and longitudinally, parental depression history and child cognitive vulnerability interacted to predict children's cortisol reactivity; associations between parent depression and elevated child cortisol activity were found when children also showed elevated depressotypic attributions as well as attentional and memory biases. Findings indicate that models of children's emerging depression risk may benefit from the examination of the interactive effects of multiple sources of vulnerability across levels of analysis.

Attentional bias to respiratory- and anxiety-related threat in children with asthma

This study investigated attentional biases in children with asthma. The study aimed at testing whether children with asthma are vigilant to asthma and/or anxiety cues. Thirty-six children (18 with asthma and 18 healthy controls) aged 9-12 completed a computerised dot probe task designed to measure attentional bias to three different categories of words: asthma, anxiety symptom and general negative emotion. Main caregiver anxiety was also assessed, as was frequency of inhaler use for those with asthma. Children with asthma showed an attentional bias towards asthma words but not anxiety or general negative emotion words. Children without asthma showed no significant attentional biases to any word categories. Caregiver anxiety was correlated with asthma word attentional bias in the asthma group. The findings indicate that attentional bias is present in children with asthma. Further research is required to ascertain if this exacerbates or maintains health-related problems.

Perturbed threat monitoring following a traumatic event predicts risk for post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is a chronic and difficult to treat psychiatric disorder. Objective, performance-based diagnostic markers that uniquely index risk for PTSD above and beyond subjective self-report markers could inform attempts to improve prevention and early intervention. We evaluated the predictive value of threat-related attention bias measured immediately after a potentially traumatic event, as a risk marker for PTSD at a 3-month follow-up. We measured the predictive contribution of attentional threat bias above and beyond that of the more established marker of risk for PTSD, self-reported psychological dissociation.

METHOD

Dissociation symptoms and threat-related attention bias were measured in 577 motor vehicle accident (MVA) survivors (mean age = 35.02 years, 356 males) within 24 h of admission to an emergency department (ED) of a large urban hospital. PTSD symptoms were assessed at a 3-month follow-up using the Clinician-Administered PTSD Scale (CAPS).

RESULTS

Self-reported dissociation symptoms significantly accounted for 16% of the variance in PTSD at follow-up, and attention bias toward threat significantly accounted for an additional 4% of the variance in PTSD.

CONCLUSIONS

Threat-related attention bias can be reliably measured in the context of a hospital ED and significantly predicts risk for later PTSD. Possible mechanisms underlying the association between threat bias following a potentially traumatic event and risk for PTSD are discussed. The potential application of an attention bias modification treatment (ABMT) tailored to reduce risk for PTSD is suggested.

Genetic variations in COMT and DRD2 modulate attentional bias for affective facial expressions

Studies have revealed that catechol-O-methyltransferase (COMT) and dopaminegic receptor2 (DRD2) modulate human attention bias for palatable food or tobacco. However, the existing evidence about the modulations of COMT and DRD2 on attentional bias for facial expressions was still limited. In the study, 650 college students were genotyped with regard to COMT Val158Met and DRD2 TaqI A polymorphisms, and the attentional bias for facial expressions was assessed using the spatial cueing task. The results indicated that COMT Val158Met underpinned the individual difference in attentional bias for negative emotional expressions (P = 0.03) and the Met carriers showed more engagement bias for negative expressions than the Val/Val homozygote. On the contrary, DRD2 TaqIA underpinned the individual difference in attentional bias for positive expressions (P = 0.003) and individuals with TT genotype showed much more engagement bias for positive expressions than the individuals with CC genotype. Moreover, the two genes exerted significant interactions on the engagements for negative and positive expressions (P = 0.046, P = 0.005). These findings suggest that the individual differences in the attentional bias for emotional expressions are partially underpinned by the genetic polymorphisms in COMT and DRD2.

Investigating the genetic and environmental bases of biases in threat recognition and avoidance in children with anxiety problems

Background

Adults with anxiety show biased categorization and avoidance of threats. Such biases may emerge through complex interplay between genetics and environments, occurring early in life. Research on threat biases in children has focuses on a restricted range of biases, with insufficient focus on genetic and environmental origins. Here, we explore differences between children with and without anxiety problems in under-studied areas of threat bias. We focused both on associations with anxious phenotype and the underlying gene-environmental correlates for two specific processes: the categorisation of threat faces and avoidance learning.

Method

Two-hundred and fifty 10-year old MZ and DZ twin pairs (500 individuals) completed tasks assessing accuracy in the labelling of threatening facial expressions and in the acquisition of avoidant responses to a card associated with a masked threatening face. To assess whether participants met criteria for an anxiety disorder, parents of twins completed a self-guided computerized version of the Development and Well-being Assessment (DAWBA). Comparison of MZ and DZ twin correlations using model-fitting were used to compute estimates of genetic, shared and non-shared environmental effects.

Results

Of the 500 twins assessed, 25 (5%) met diagnostic criteria for a current anxiety disorder. Children with anxiety disorders were more accurate in their ability to recognize disgust faces than those without anxiety disorders, but were commensurate on identifying other threatening face emotions (angry, fearful, sad). Children with anxiety disorders but also more strongly avoided selecting a conditioned stimulus than non-anxious children. While recognition of socially threatening faces was moderately heritable, avoidant responses were heavily influenced by the non-shared environment.

Conclusion

These data add to other findings on threat biases in anxious children. Specifically, we found biases in the labelling of some negative-valence faces and in the acquisition of avoidant responses. While non-shared environmental effects explained all of the variance on threat avoidance, some of this may be due to measurement error.

Attentional bias in adolescents with panic disorder: changes over an 8-day intensive treatment program

BACKGROUND

The present study evaluated attentional bias in adolescents diagnosed with panic disorder. Although a large body of research exists in the area of attentional bias in adults, this feature of panic disorder is not well understood in adolescents.

METHOD

Twenty-five adolescents, aged 12-17, with a panic disorder diagnosis were included in the study. An emotional Stroop task was utilized to assess whether: (1) adolescents with panic disorder exhibit an attentional bias to panic-relevant stimuli; (2) this bias diminishes after completing a course of CBT; and (3) a specific attentional bias towards disorder-relevant stimuli exists.

RESULTS

An attentional bias to panic-relevant stimuli was found at pre-treatment but was no longer present following an intensive CBT intervention. Contrary to some findings in the adult literature, no significant differences were found between panic-relevant versus other threatening stimuli.

CONCLUSIONS

These results suggest that adolescents with panic disorder, similar to adults, do exhibit an attentional bias towards panic-relevant stimuli, and treatment seems to normalize this cognitive process.

The time-course of threat processing in children: a temporal dissociation between selective attention and behavioral interference

Although selective attention to threatening information is an adaptive mechanism, exaggerated attention to threat may be related to anxiety disorders. However, studies examining threat processing in children have obtained mixed findings. In the present study, the time-course of attentional bias for threat and behavioral interference was analyzed in a community sample of 8-18-year-old children (N=33) using a pictorial dot probe task. Threatening and neutral stimuli were shown during 17 ms (masked), 500 ms, and 1250 ms. Results provide preliminary evidence of an automatic attentional bias for threat at 17 ms that persists during later, more controlled stages of information processing (500 and 1250 ms). Furthermore, participants showed a delayed response to threat-containing trials relative to neutral trials in the 500 and 1250 ms condition, which may indicate interference by threat. Together, these results suggest that an attentional bias for threat precedes behavioral interference in children. Furthermore, results indicate that performance in daily life can be temporarily interrupted by the processing of threatening information. In addition, results of earlier studies into selective attention in children using tasks based on behavioral responses may have been confounded by interference effects of threat. For future studies, we recommend to take behavioral interference into account.

Attentional bias towards angry faces in childhood anxiety disorders

OBJECTIVE

To examine attentional bias towards angry and happy faces in 8-12 year old children with anxiety disorders (n=29) and non-anxious controls (n=24).

METHOD

Children completed a visual-probe task in which pairs of angry/neutral and happy/neutral faces were displayed for 500ms and were replaced by a visual probe in the spatial location of one of the faces.

RESULTS

Children with more severe anxiety showed an attentional bias towards angry relative to neutral faces, compared with anxious children who had milder anxiety and non-anxious control children, both of whom did not show an attentional bias for angry faces. Unexpectedly, all groups showed an attentional bias towards happy faces relative to neutral ones.

CONCLUSIONS

Anxiety symptom severity increases attention to threat stimuli in anxious children. This association may be due to differing threat appraisal processes or emotion regulation strategies.

The time-course of attentional bias in anxious children and adolescents

This study examined the time-course of attentional bias in anxious and non-anxious children and adolescents aged 7-17 years using eye movement as an index of selective attention. Participants completed two eye-tracking tasks in which they viewed happy-neutral and negative-neutral face pairs for 3000 and 500 ms, respectively. When face pairs were presented for 3000 ms eye movement data showed no evidence of an attentional bias at any stage of attentional processing. When face pairs were presented for 500 ms a bias in initial orienting occurred; anxious adolescents directed their first fixation away from negative faces and anxious children directed their first fixation away from happy faces. Results suggest that childhood anxiety is characterized by a bias in initial orienting, with no bias in sustained attention, although only for briefly presented faces.

Negative affectivity, effortful control, and attention to threat-relevant stimuli

There is increasing recognition of temperamental influences on risk for psychopathology. Whereas the link between the broad temperament construct of negative affectivity (NA) and problems associated with anxiety and depression is now well-established, the mechanisms through which this link operate are not well understood. One possibility involves interactions between reactive and effortful components of temperament, as well as cognitive factors, like attentional biases to threat stimuli. This study tested a predicted relation between high levels of NA, low levels of effortful control (EC), and an attentional bias toward threat in children. A sample of 104 4th through 12th graders, selected from a larger screening sample because they reported high or low levels of trait NA and EC, completed a dot probe detection task. Results indicated that EC moderated the relation between NA and attentional bias; only children with low levels of EC and high levels of NA showed an attentional bias to threat stimuli. This pattern was not moderated by grade level or age.

Role of attention in the regulation of fear and anxiety

Emotion regulation makes use of specific aspects of attention and executive functions that are critical for the development of adaptive social functioning, and perturbations in these processes can result in maladaptive behavior and psychopathology. Both involuntary and voluntary attention processes have been examined at both the behavioral and the neural levels and are implicated in the maintenance of fearful or anxious behaviors. However, relatively little is known about how these attention processes come to influence emotional behavior across development. The current review summarizes the extant literature on the links between voluntary and involuntary attention processes and the role that these attention processes have in the etiology, maintenance, and regulation of anxious behavior.

Plasticity in attention: implications for stress response in children

Attention bias has been suggested as an etiological and maintaining factor in anxiety. However, empirical evidence establishing this causal association is scarce and has been provided only in adults. In this preliminary study, we tested whether an induction of attentional bias can cause changes in vulnerability to stress in children reporting normal anxiety levels. Twenty-six 7-12 year-old children were randomly assigned to two groups. One group was exposed to a training condition designed to induce an attentional bias away from threat. The other group was exposed to a training condition designed to induce an attentional bias toward threat. Children who were trained to attend to threat developed attentional vigilance to threat-related information. The training procedure was ineffective with children who were trained to avoid threat, and their attention remained unbiased. Children from both training groups reported elevated depression scores following stress-induction. However, only the children who were trained to attend to threat subsequently reported elevations in anxiety. The findings suggest that biased attentional responses to threat, among children, can exert a specific influence on the tendency to experience anxiety in the face of stress.