Does Anxiety Enhance or Hinder Attentional and Impulse Control in Youth With ADHD? An ERP Analysis

Objective: Youth with ADHD and comorbid anxiety (ADHD+ANX) experience increased social and academic impairment compared with youth with ADHD without anxiety (ADHD). Group differences in attentional and impulse control may underlie this increased impairment. Examination of group differences using behavioral measures of attentional and impulse control has yielded inconsistent findings. This study explored group differences using event-related potentials (ERPs), which provide neural information concerning early information processing. Method: ERPs (early frontal positivity [EFP], N2) were collected while youth aged 11 to 17 with ADHD (n = 31) and ADHD+ANX (n = 35) completed a visual and an auditory computer task. Results: Compared with the ADHD group, the ADHD+ANX group exhibited larger N2 amplitudes to no-go stimuli and larger EFP amplitudes to target auditory stimuli, with variable attention allocation to nontarget stimuli. Conclusion: The addition of anxiety to ADHD appears to alter early attentional processing, which may be an important aspect of this comorbidity.

Altered relationship between prefrontal glutamate and activation during cognitive control in people with high trait anxiety

Trait anxiety can affect cognitive control resulting in ineffective and/or inefficient task performance. Moreover, previous functional Magnetic Resonance Imaging (fMRI) studies have reported altered dorsolateral prefrontal cortex (DLPFC) activity in anxious cohorts, particularly when executive control is required. Recently, it has been demonstrated that cortical glutamate levels can predict both functional activation during cognitive control, and anxiety levels. In the present study we sought to investigate the relationship between trait anxiety, prefrontal glutamate levels and functional activation in DLPFC during a cognitive control task. Thirty-nine participants assigned to either low trait anxiety (LTA) or high trait anxiety (HTA) groups underwent ¹H-Magnetic Resonance Spectroscopy (¹H-MRS) to measure levels of resting glutamate in the prefrontal cortex (PFC). Participants also completed fMRI during a Stroop task comprising congruent and incongruent colour word trials. The HTA group showed reduced task performance relative to the LTA group. In the LTA group, there was a positive association between PFC Glu levels and DLPFC activation during incongruent trials. This association was absent in the HTA group. Individual differences in trait anxiety affect the relationship between PFC glutamate levels and DLPFC activation, possibly contributing to ineffective task performance when cognitive control is required.

State anxiety impairs attentional control when other sources of control are minimal

Research suggests anxiety impairs attentional control; however, this effect has been unreliable. We argue that anxiety's impairment of attentional control is subtle, and can be obscured by other non-emotional sources of control. We demonstrate this by examining conflict adaptation, an enhancement in attentional control following a trial with high conflict between distracter and target stimuli. Participants completed a Stroop task featuring incongruent (e.g. RED in green font; high-conflict) and control (e.g. +++ in green font; low-conflict) trials. More state-anxious participants showed greater Stroop interference following control trials, but interference was uniformly low following incongruent trials. This suggests state anxiety can impair attention, but other sources of top-down control - such as conflict adaptation - can easily overcome this impairment. This is consistent with recent theories of anxious cognition and shows that anxiety researchers must attend to the dynamics and sources of attentional control.

Influence of anxiety on memory performance in temporal lobe epilepsy

This study examined the degree to which anxiety contributed to inconsistent material-specific memory difficulties among 243 patients with temporal lobe epilepsy from the Multisite Epilepsy Study. Visual memory performance on the Rey Complex Figure Test (RCFT) was poorer for those with high versus low levels of anxiety but was not found to be related to the TLE side. The verbal memory score on the California Verbal Learning Test (CVLT) was significantly lower for patients with left-sided TLE than for patients with right-sided TLE with low anxiety levels but equally impaired for those with high anxiety levels. These results suggest that we can place more confidence in the ability of verbal memory tests like the CVLT to lateralize to left-sided TLE for those with low anxiety levels, but that verbal memory will be less likely to produce lateralizing information for those with high anxiety levels. This suggests that more caution is needed when interpreting verbal memory tests for those with high anxiety levels. These results indicated that RCFT performance was significantly affected by anxiety and did not lateralize to either side, regardless of anxiety levels. This study adds to the existing literature which suggests that drawing-based visual memory tests do not lateralize among patients with TLE, regardless of anxiety levels.

Trait Anxiety Modulates the Neural Efficiency of Inhibitory Control

An impairment of attentional control in the face of threat-related distracters is well established for high-anxious individuals. Beyond that, it has been hypothesized that high trait anxiety more generally impairs the neural efficiency of cognitive processes requiring attentional control—even in the absence of threat-related stimuli. Here, we use fMRI to show that trait anxiety indeed modulates brain activation and functional connectivities between task-relevant brain regions in an affectively neutral Stroop task. In high-anxious individuals, dorsolateral pFC showed stronger task-related activation and reduced coupling with posterior lateral frontal regions, dorsal ACC, and a word-sensitive area in the left fusiform gyrus. These results support the assumption that a general (i.e., not threat-specific) impairment of attentional control leads to reduced neural processing efficiency in anxious individuals. The increased dorsolateral pFC activation is interpreted as an attempt to compensate for suboptimal connectivity within the cortical network subserving task performance.