1
|
Byrne ME, Kirschner S, Harrewijn A, Abend R, Lazarov A, Liuzzi L, Kircanski K, Haller SP, Bar-Haim Y, Pine DS. Eye-tracking measurement of attention bias to social threat among youth: A replication and extension study. JOURNAL OF MOOD AND ANXIETY DISORDERS 2024; 8:100075. [PMID: 39007026 PMCID: PMC11238819 DOI: 10.1016/j.xjmad.2024.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Attentional bias to social threat cues has been linked to heightened anxiety and irritability in youth. Yet, inconsistent methodology has limited replication and led to mixed findings. The current study aims to 1) replicate and extend two previous pediatric studies demonstrating a relationship between negative affectivity and attentional bias to social threat and 2) examine the test-retest reliability of an eye-tracking paradigm among a subsample of youth. Attention allocation to negative versus non-negative emotional faces was measured using a free-viewing eye-tracking task among youth (N=185 total, 60% female, M age=13.10 years, SD age=2.77) with three face-pair conditions: happy-angry, neutral-disgust, sad-happy. Replicating procedures of two previous studies, linear mixed-effects models compared attention bias between children with anxiety disorders and healthy controls. Bifactor analysis was used to parse shared versus unique facets of general negative affectivity (i.e., anxiety, irritability), which were then examined in relation to attention bias. Test-retest reliability of the bias-index was estimated among a subsample of youth (N=36). No significant differences in attention allocation or bias emerged between anxiety and healthy control groups. While general negative affectivity across the sample was not associated with attention bias, there was a positive relationship for anxiety and irritability on duration of attention allocation toward negative faces. Test-retest reliability for attention bias was moderate (r=0.50, p<.01). While anxiety-related findings from the two previous studies were not replicated, the relationship between attention bias and facets of negative affect suggests a potential target for treatment. Evidence for test-retest reliability encourages future use of the eye-tracking task for researchers.
Collapse
Affiliation(s)
- Meghan E Byrne
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Sara Kirschner
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Anita Harrewijn
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
| | - Rany Abend
- Baruch Ivcher School of Psychology, Reichman University, 8 Ha'Universita St., Herzliya 4610101, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Lucrezia Liuzzi
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Katharina Kircanski
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Simone P Haller
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel
| | - Daniel S Pine
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, 20892, USA
| |
Collapse
|
2
|
Ortiz C, Fastman M. A novel independence intervention to treat child anxiety: A nonconcurrent multiple baseline evaluation. J Anxiety Disord 2024; 105:102893. [PMID: 38901131 DOI: 10.1016/j.janxdis.2024.102893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge, 2023). Exposure-based cognitive-behavioral therapy is the gold standard in the treatment of anxious children (Hofmann et al. (2012)). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child anxiety composed of independence activities (IAs), which are child-directed, fun, unstructured, developmentally challenging tasks performed without parents' help. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy. Despite this dissimilarity, IAs target putative mechanisms involved in the development and maintenance of child anxiety (e.g., parental accommodation and overinvolvement, child avoidance, unhelpful thinking styles). Using a nonconcurrent multiple baseline design, this five-session treatment provided preliminary evidence of high treatment acceptability from children and parents. Medium to large improvements were reported in child anxiety and avoidance, parent and child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness. Results may suggest a new treatment paradigm, which is desperately needed, given unabated increases in child and adolescent anxiety despite vast resources being directed toward the problem.
Collapse
Affiliation(s)
- Camilo Ortiz
- Department of Psychology, Long Island University-Post, USA.
| | | |
Collapse
|
3
|
Eskola E, Kataja EL, Hyönä J, Nolvi S, Häikiö T, Carter AS, Karlsson H, Karlsson L, Korja R. Higher attention bias for fear at 8 months of age is associated with better socioemotional competencies during toddlerhood. Infant Behav Dev 2023; 71:101838. [PMID: 36996588 DOI: 10.1016/j.infbeh.2023.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND In previous studies, an attention bias for signals of fear and threat has been related to socioemotional problems, such as anxiety symptoms, and socioemotional competencies, such as altruistic behaviors in children, adolescents and adults. However, previous studies lack evidence about these relations among infants and toddlers. AIMS Our aim was to study the association between the individual variance in attention bias for faces and, specifically, fearful faces during infancy and socioemotional problems and competencies during toddlerhood. STUDY DESIGN AND SUBJECTS The study sample was comprised of 245 children (112 girls). We explored attentional face and fear biases at the age of 8 months using eye tracking and the face-distractor paradigm with neutral, happy and fearful faces and a scrambled-face control stimulus. Socioemotional problems and competencies were reported by parents with the Brief Infant and Toddler Social Emotional Assessment (BITSEA) when children were 24 months old. OUTCOME MEASURES AND RESULTS A higher attentional fear bias at 8 months of age was related to higher levels of socioemotional competence at 24 months of age (β = .18, p = .008), when infants' sex and temperamental affectivity, maternal age, education and depressive symptoms were controlled. We found no significant association between attentional face or fear bias and socioemotional problems. CONCLUSIONS We found that the heightened attention bias for fearful faces was related to positive outcomes in early socioemotional development. Longitudinal study designs are needed to explore the changes in the relation between the attention bias for fear or threat and socioemotional development during early childhood.
Collapse
|
4
|
Mullin BC, Holzman JBW, Pyle L, Perks EL, Chintaluru Y, Gulley LD, Haraden DA, Hankin BL. Relationships between attention to emotion and anxiety among a community sample of adolescents. Psychol Med 2022; 52:1548-1559. [PMID: 33641686 DOI: 10.1017/s0033291720003360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Attentional bias to threat has been implicated as a cognitive mechanism in anxiety disorders for youth. Yet, prior studies documenting this bias have largely relied on a method with questionable reliability (i.e. dot-probe task) and small samples, few of which included adolescents. The current study sought to address such limitations by examining relations between anxiety - both clinically diagnosed and dimensionally rated - and attentional bias to threat. METHODS The study included a community sample of adolescents and employed eye-tracking methodology intended to capture possible biases across the full range of both automatic (i.e. vigilance bias) and controlled attentional processes (i.e. avoidance bias, maintenance bias). We examined both dimensional anxiety (across the full sample; n = 215) and categorical anxiety in a subset case-control analysis (n = 100) as predictors of biases. RESULTS Findings indicated that participants with an anxiety disorder oriented more slowly to angry faces than matched controls. Results did not suggest a greater likelihood of initial orienting to angry faces among our participants with anxiety disorders or those with higher dimensional ratings of anxiety. Greater anxiety severity was associated with greater dwell time to neutral faces. CONCLUSIONS This is the largest study to date examining eye-tracking metrics of attention to threat among healthy and anxious youth. Findings did not support the notion that anxiety is characterized by heightened vigilance or avoidance/maintenance of attention to threat. All effects detected were extremely small. Links between attention to threat and anxiety among adolescents may be subtle and highly dependent on experimental task dimensions.
Collapse
Affiliation(s)
- Benjamin C Mullin
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Jacob B W Holzman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, School of Public Health, Aurora, CO, USA
| | - Emmaly L Perks
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Lauren D Gulley
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Dustin A Haraden
- Department of Psychology, University of Illinois, Urbana-Champaign, IL, USA
| | - Benjamin L Hankin
- Department of Psychology, University of Illinois, Urbana-Champaign, IL, USA
| |
Collapse
|
5
|
Aktar E. Intergenerational Transmission of Anxious Information Processing Biases: An Updated Conceptual Model. Clin Child Fam Psychol Rev 2022; 25:182-203. [PMID: 35218453 PMCID: PMC8948131 DOI: 10.1007/s10567-022-00390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
Anxiety disorders are globally one of the most prevalent and disabling forms of psychopathology in adults and children. Having a parent with an anxiety disorder multiplies the risk of anxiety disorders in the offspring, although the specific mechanisms and processes that play a role in this intergenerational transmission remain largely unknown. According to information processing theories, threat-related biases in cognitive processing are a causal mechanism in the development and maintenance of anxiety. These theories propose that individuals with anxiety are more likely to cognitively process novel stimuli in their environment as threatening. Creswell and colleagues proposed a theoretical model that highlighted the role of these cognitive biases as a mechanism in the intergenerational transmission of anxiety (Creswell et al., in Hadwin, Field (eds) Information processing biases and anxiety: a developmental perspective, Wiley, pp 279-295, 2010). This model postulated significant associations between (1) parents' and children's threat-related cognitive biases (2) parents' threat-related cognitive biases in their own and their child's environment, (3) parents' threat-related cognitive biases and parenting behaviors that convey anxiety risk to the offspring (e.g., modeling of fear, and verbal threat information transmission), and (4) parenting behaviors and child threat-related biases. This theoretical review collated the recent empirical work testing these four core hypotheses of the model. Building on the reviewed empirical work, an updated conceptual model focusing on threat-related attention and interpretation is proposed. This updated model incorporates the links between cognition and anxiety in parents and children and addresses the potential bidirectional nature of parent-child influences.
Collapse
Affiliation(s)
- Evin Aktar
- Department of Psychology, Clinical Psychology Unit, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
| |
Collapse
|
6
|
Fearful Temperament and the Risk for Child and Adolescent Anxiety: The Role of Attention Biases and Effortful Control. Clin Child Fam Psychol Rev 2021; 23:205-228. [PMID: 31728796 DOI: 10.1007/s10567-019-00306-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
Collapse
|
7
|
Jenness JL, Lambert HK, Bitrán D, Blossom JB, Nook EC, Sasse SF, Somerville LH, McLaughlin KA. Developmental Variation in the Associations of Attention Bias to Emotion with Internalizing and Externalizing Psychopathology. Res Child Adolesc Psychopathol 2021; 49:711-726. [PMID: 33534093 PMCID: PMC8102336 DOI: 10.1007/s10802-020-00751-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
Attention biases to emotion are associated with symptoms of internalizing and externalizing psychopathology in children and adolescents. It is unknown whether attention biases to emotion and their associations with different symptoms of psychopathology vary across development from early childhood through young adulthood. We examine this age-related variation in the current study. Participants (N = 190; ages: 4-25) completed survey-based psychopathology symptom measures and a dot-probe task to assess attention bias to happy, sad, and angry relative to neutral faces. We tested whether linear or non-linear (e.g., spline-based models) associations best characterized age-related variation in attention to emotion. We additionally examined whether attention biases were associated with depression, anxiety, and externalizing symptoms and whether these associations varied by age. No age-related differences in attention biases were found for any of the emotional faces. Attention biases were associated with psychopathology symptoms, but only when examining moderation by age. Biased attention to angry faces was associated with greater symptoms of anxiety and depression in adolescents and young adults, but not children. Similarly, biased attention to happy faces was associated with externalizing symptoms in adolescents and young adults, but not in children. In contrast, biased attention to happy faces was associated with greater anxiety symptoms in children, but not in adolescents or young adults. Biased attention toward social threat and reward becomes more strongly coupled with internalizing and externalizing symptoms, respectively, during the transition to adolescence. These findings could inform when interventions such as attention bias modification training may be most effective.
Collapse
Affiliation(s)
- Jessica L Jenness
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US.
| | - Hilary K Lambert
- Department of Psychology, University of Washington, Seattle, WA, US
| | - Debbie Bitrán
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, US
| | - Jennifer B Blossom
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US
- Department of Psychology, University of Maine at Farmington, Farmington, ME, US
| | - Erik C Nook
- Department of Psychology, Harvard University, Cambridge, MA, US
| | | | | | | |
Collapse
|
8
|
Vallorani A, Fu X, Morales S, LoBue V, Buss KA, Pérez-Edgar K. Variable- and person-centered approaches to affect-biased attention in infancy reveal unique relations with infant negative affect and maternal anxiety. Sci Rep 2021; 11:1719. [PMID: 33462275 PMCID: PMC7814017 DOI: 10.1038/s41598-021-81119-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/22/2020] [Indexed: 12/27/2022] Open
Abstract
Affect-biased attention is an automatic process that prioritizes emotionally or motivationally salient stimuli. Several models of affect-biased attention and its development suggest that it comprises an individual's ability to both engage with and disengage from emotional stimuli. Researchers typically rely on singular tasks to measure affect-biased attention, which may lead to inconsistent results across studies. Here we examined affect-biased attention across three tasks in a unique sample of 193 infants, using both variable-centered (factor analysis; FA) and person-centered (latent profile analysis; LPA) approaches. Using exploratory FA, we found evidence for two factors of affect-biased attention: an Engagement factor and a Disengagement factor, where greater maternal anxiety was related to less engagement with faces. Using LPA, we found two groups of infants with different patterns of affect-biased attention: a Vigilant group and an Avoidant group. A significant interaction noted that infants higher in negative affect who also had more anxious mothers were most likely to be in the Vigilant group. Overall, these results suggest that both FA and LPA are viable approaches for studying distinct questions related to the development of affect-biased attention, and set the stage for future longitudinal work examining the role of infant negative affect and maternal anxiety in the emergence of affect-biased attention.
Collapse
Affiliation(s)
- Alicia Vallorani
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Xiaoxue Fu
- University of South Carolina, Columbia, SC, USA
| | | | | | - Kristin A Buss
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA
| |
Collapse
|
9
|
Stuijfzand S, Stuijfzand B, Reynolds S, Dodd H. Anxiety-Related Attention Bias in Four- to Eight-Year-Olds: An Eye-Tracking Study. Behav Sci (Basel) 2020; 10:bs10120194. [PMID: 33348888 PMCID: PMC7766356 DOI: 10.3390/bs10120194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Background: There is evidence of an attention bias–anxiety relationship in children, but lack of appropriate methods has limited the number of studies with children younger than eight years old. This study used eye tracking as a measure of overt attention in young children. The aim of this study was to assess anxiety-related attention bias in children aged four to eight years. Age was considered a moderator, and the influence of effortful control was investigated. (2) Method: A community sample of 104 children was shown pairs of happy–neutral and angry–neutral faces. Growth curve analyses were used to examine patterns of gaze over time. (3) Results: Analyses revealed moderation by age and anxiety, with distinct patterns of anxiety-related biases seen in different age groups in the angry–neutral face trials. Effortful control did not account for age-related effects. (4) Conclusions: The results support a moderation model of the development of anxiety in children.
Collapse
Affiliation(s)
- Suzannah Stuijfzand
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
| | | | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AH, UK; (S.S.); (S.R.)
- Correspondence:
| |
Collapse
|
10
|
Abend R, Bajaj MA, Matsumoto C, Yetter M, Harrewijn A, Cardinale EM, Kircanski K, Lebowitz ER, Silverman WK, Bar-Haim Y, Lazarov A, Leibenluft E, Brotman M, Pine DS. Converging Multi-modal Evidence for Implicit Threat-Related Bias in Pediatric Anxiety Disorders. Res Child Adolesc Psychopathol 2020; 49:227-240. [PMID: 33095373 DOI: 10.1007/s10802-020-00712-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 01/08/2023]
Abstract
This report examines the relationship between pediatric anxiety disorders and implicit bias evoked by threats. To do so, the report uses two tasks that assess implicit bias to negative-valence faces, the first by eye-gaze and the second by measuring body-movement parameters. The report contrasts task performance in 51 treatment-seeking, medication-free pediatric patients with anxiety disorders and 36 healthy peers. Among these youth, 53 completed an eye-gaze task, 74 completed a body-movement task, and 40 completed both tasks. On the eye-gaze task, patients displayed longer gaze duration on negative relative to non-negative valence faces than healthy peers, F(1, 174) = 8.27, p = .005. In contrast, on the body-movement task, patients displayed a greater tendency to behaviorally avoid negative-valence faces than healthy peers, F(1, 72) = 4.68, p = .033. Finally, implicit bias measures on the two tasks were correlated, r(38) = .31, p = .049. In sum, we found an association between pediatric anxiety disorders and implicit threat bias on two tasks, one measuring eye-gaze and the other measuring whole-body movements. Converging evidence for implicit threat bias encourages future research using multiple tasks in anxiety.
Collapse
Affiliation(s)
- Rany Abend
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA.
| | - Mira A Bajaj
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Chika Matsumoto
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Marissa Yetter
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Anita Harrewijn
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Elise M Cardinale
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | | | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Melissa Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Bldg 15K, MSC-2670, Bethesda, MD, 20892, USA
| |
Collapse
|
11
|
Davies PT, Thompson MJ, Hentges RF, Coe JL, Sturge-Apple ML. Children's attentional biases to emotions as sources of variability in their vulnerability to interparental conflict. Dev Psychol 2020; 56:1343-1359. [PMID: 32478529 DOI: 10.1037/dev0000994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Little is known about the role children's processing of emotions plays in altering children's vulnerability to interparental conflict. To address this gap, the present study examined whether the mediational cascade involving children's exposure to interparental conflict, their insecure responses to interparental conflict, and their psychological problems varied as a function of children's preexisting biases to attend to angry, fearful, sad, and happy expressions. Participants included 243 children (M age = 4.60 years) and their parents assessed at 3 annual measurement occasions. Moderated-mediation analyses within a cross-lagged autoregressive design indicated that the indirect paths among interparental conflict, emotional insecurity, and psychological problems were significant for children who exhibited greater attentional biases toward angry and fearful emotions. Greater attention to anger and fear specifically moderated the first link in the mediational path. Interparental conflict was a significantly stronger predictor of emotional insecurity for children who attended to angry and fearful cues longer. Consistent with environmental sensitivity theories, children with attentional biases to angry and fearful emotions exhibited disproportionately higher levels of emotional insecurity following exposure to heightened interparental conflict but also lower levels of emotional insecurity after experiencing minimal interparental conflict. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
12
|
Dennis-Tiwary TA, Roy AK, Denefrio S, Myruski S. Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research. Clin Psychol Sci 2019; 7:879-899. [PMID: 33758680 DOI: 10.1177/2167702619838474] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The anxiety-related attention bias (AB) has been studied for several decades as a clinically-relevant output of the dynamic and complex threat detection-response system. Despite research enthusiasm for the construct of AB, current theories and measurement approaches cannot adequately account for the growing body of mixed, contradictory, and null findings. Drawing on clinical, neuroscience, and animal models, we argue that the apparent complexity and contradictions in the empirical literature can be attributed to the field's failure to clearly conceptualize AB heterogeneity and the dearth of studies in AB that consider additional cognitive mechanisms in anxiety, particularly disruptions in threat-safety discrimination and cognitive control. We review existing research and propose a working model of AB heterogeneity positing that AB may be best conceptualized as multiple subtypes of dysregulated processing of and attention to threat anchored in individual differences in threat-safety discrimination and cognitive control. We review evidence for this working model and discuss how it can be used to advance knowledge of AB mechanisms and inform personalized prevention and intervention approaches.
Collapse
Affiliation(s)
- Tracy A Dennis-Tiwary
- Hunter College, The City University of New York, Department of Psychology, New York, NY.,The Graduate Center, The City University of New York, Department of Psychology, New York, NY
| | - Amy Krain Roy
- Fordham University, Department of Psychology, Bronx, NY.,New York University Langone School of Medicine, Department of Child and Adolescent Psychiatry, New York, NY
| | - Samantha Denefrio
- The Graduate Center, The City University of New York, Department of Psychology, New York, NY.,Hunter College, The City University of New York, Department of Psychology, New York, NY
| | - Sarah Myruski
- Hunter College, The City University of New York, Department of Psychology, New York, NY
| |
Collapse
|
13
|
Aktar E, Van Bockstaele B, Pérez‐Edgar K, Wiers RW, Bögels SM. Intergenerational transmission of attentional bias and anxiety. Dev Sci 2019; 22:e12772. [PMID: 30428152 PMCID: PMC6590262 DOI: 10.1111/desc.12772] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 09/29/2018] [Accepted: 11/02/2018] [Indexed: 12/02/2022]
Abstract
Earlier evidence has revealed a bi-directional causal relationship between anxiety and attention biases in adults and children. This study investigated the prospective and concurrent relations between anxiety and attentional bias in a sample of 89 families (mothers, fathers, and first-born children). Parents' and children's attentional bias was measured when children were 7.5 years old, using both a visual probe task and visual search task with angry versus happy facial expressions. Generalized and social anxiety symptoms in parents and children were measured when children were 4.5 and 7.5 years old. Anxiety in parents and children was prospectively (but not concurrently) related to their respective attentional biases to threat: All participants showed a larger attentional bias to threat in the visual search (but not in the visual probe) task if they were more anxious at the 4.5 (but not at the 7.5) year measurement. Moreover, parents' anxiety levels were prospectively predictive of the visual search attentional bias of their children after controlling for child anxiety. More anxiety in mothers at 4.5 years was related to a faster detection of angry among happy faces, while more anxiety in fathers predicted a faster detection of happy among angry faces in children at 7.5 years. We found no direct association between parental and child attentional biases. Our study contributes to the recently emerging literature on attentional biases as a potential mechanism in the intergenerational transmission of anxiety by showing that parents' anxiety rather than parents' attentional bias contributes to the intergenerational transmission of risk for child anxiety.
Collapse
Affiliation(s)
- Evin Aktar
- Institute of Psychology, Clinical Psychology UnitLeiden UniversityLeidenthe Netherlands
- Department of Child Development and EducationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Bram Van Bockstaele
- Department of Child Development and EducationUniversity of AmsterdamAmsterdamthe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Koraly Pérez‐Edgar
- Department of PsychologyChild Study CenterThe Pennsylvania State UniversityPennsylvania
| | - Reinout W. Wiers
- Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| | - Susan M. Bögels
- Department of Child Development and EducationUniversity of AmsterdamAmsterdamthe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamthe Netherlands
| |
Collapse
|
14
|
Associations Between Attentional Bias and Interpretation Bias and Change in School Concerns and Anxiety Symptoms During the Transition from Primary to Secondary School. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1521-1532. [PMID: 30891678 PMCID: PMC6647860 DOI: 10.1007/s10802-019-00528-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The transition from primary to secondary school is often associated with a period of heightened anxiety and worry. For most children, any feelings of anxiety subside relatively quickly but for a small minority, emotional difficulties can continue into the first year of secondary school and beyond. This study recruited 109 children and measured their anxiety symptoms and school concerns toward the end of primary school and again at the end of their first term of secondary school. We investigated for the first time whether pre-transition measures of attentional and interpretation bias, and the magnitude of change in attentional bias toward and away from threat stimuli were associated with pre- and post-transition measures of anxiety and school concerns, and the change in these measures over time. Over 50% of the current sample exceeded clinical levels of anxiety at pre-transition. However, anxiety symptoms and school concerns had significantly reduced by post-transition. Higher levels of pre-transition anxiety or school concerns, and a greater magnitude of change in attentional bias towards threat stimuli predicted a larger reduction in anxiety symptoms and school concerns across the transition period. A greater interpretation bias toward threat was associated with higher pre-transition anxiety symptoms and school concerns but not post-transition scores, or the change in these scores. While many children experience heightened anxiety prior to school transition, this appears to be largely temporary and self-resolves. Nonetheless, the current findings highlight the importance of monitoring children's anxiety and concerns, and related cognitive processes during this important transition period.
Collapse
|
15
|
Fu X, Pérez-Edgar K. Threat-related Attention Bias in Socioemotional Development: A Critical Review and Methodological Considerations. DEVELOPMENTAL REVIEW 2019; 51:31-57. [PMID: 32205901 PMCID: PMC7088448 DOI: 10.1016/j.dr.2018.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cross-sectional evidence suggests that attention bias to threat is linked to anxiety disorders and anxiety vulnerability in both children and adults. However, there is a lack of developmental evidence regarding the causal mechanisms through which attention bias to threat might convey risks for socioemotional problems, such as anxiety. Gaining insights into this question demands longitudinal research to track the complex interplay between threat-related attention and socioemotional functioning. Developing and implementing reliable and valid assessments tools is essential to this line of work. This review presents theoretical accounts and empirical evidence from behavioral, eye-tracking, and neural assessments of attention to discuss our current understanding of the development of normative threat-related attention in infancy, as well as maladaptive threat-related attention patterns that may be associated with the development of anxiety. This review highlights the importance of measuring threat-related attention using multiple attention paradigms at multiple levels of analysis. In order to understand if and how threat-related attention bias in real-life, social interactive contexts can predict socioemotional development outcomes, this review proposes that future research cannot solely rely on screen-based paradigms but needs to extend the assessment of threat-related attention to naturalistic settings. Mobile eye-tracking technology provides an effective tool for capturing threat-related attention processes in vivo as children navigate fear-eliciting environments and may help us uncover more proximal bio-psycho-behavioral markers of anxiety.
Collapse
Affiliation(s)
- Xiaoxue Fu
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
- Center for Biobehavioral Health, Nationwide Children’s Hospital, United States
- Department of Pediatrics, The Ohio State University, United States
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| |
Collapse
|
16
|
Conejero Á, Rueda MR. Infant temperament and family socio-economic status in relation to the emergence of attention regulation. Sci Rep 2018; 8:11232. [PMID: 30046121 PMCID: PMC6060120 DOI: 10.1038/s41598-018-28831-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/29/2018] [Indexed: 11/27/2022] Open
Abstract
Attention regulation refers to the ability to control attention according to goals and intentions. Disengagement of attention is one of the first mechanisms of attention regulation that emerges in infancy, involving attention control and flexibility. Disengaging attention from emotional stimuli (such as threat-related cues) is of particular interest given its implication for self-regulation. A second mechanism of attention control is the ability to flexibly switch attention according to changing conditions. In our study, we investigated 9 to 12-month-olds’ disengagement and flexibility of attention, and examined the contribution of both temperament and socioeconomic status (SES) to individual differences in the emergence of these attention regulation skills at the end of the first year of life. Our results show that both difficulty to disengage from fearful faces and poorer attention flexibility were associated with higher levels of temperamental Negative Affectivity (NA). Additionally, attention flexibility moderated the effect of NA on disengagement from fearful faces. Infants with higher NA and poorer attention flexibility showed the greatest difficulty to disengage. Low SES was also associated with poorer attention flexibility, association that was mediated by infants’ NA. These results suggest that attention flexibility together with temperament and environmental factors are key to understand individual differences in attention regulation from threat-related stimuli as early as from infancy. Our findings also stress the importance of interactions between environmental and constitutional factors for understanding individual differences in the emergence of attention regulation.
Collapse
Affiliation(s)
- Ángela Conejero
- Department Psicología Experimental, Universidad de Granada, Granada, Spain.,Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain
| | - M Rosario Rueda
- Department Psicología Experimental, Universidad de Granada, Granada, Spain. .,Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain.
| |
Collapse
|
17
|
The dot-probe task to measure emotional attention: A suitable measure in comparative studies? Psychon Bull Rev 2018; 24:1686-1717. [PMID: 28092078 DOI: 10.3758/s13423-016-1224-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For social animals, attending to and recognizing the emotional expressions of other individuals is of crucial importance for their survival and likely has a deep evolutionary origin. Gaining insight into how emotional expressions evolved as adaptations over the course of evolution can be achieved by making direct cross-species comparisons. To that extent, experimental paradigms that are suitable for investigating emotional processing across species need to be developed and evaluated. The emotional dot-probe task, which measures attention allocation toward emotional stimuli, has this potential. The task is implicit, and subjects need minimal training to perform the task successfully. Findings in nonhuman primates, although scarce, show that they, like humans, have an attentional bias toward emotional stimuli. However, the wide literature on human studies has shown that different factors can have important moderating effects on the results. Due to the large heterogeneity of this literature, these moderating effects often remain unnoticed. We here review this literature and show that subject characteristics and differences in experimental designs affect the results of the dot-probe task. We conclude with specific recommendations regarding these issues that are particularly relevant to take into consideration when applying this paradigm to study animals.
Collapse
|
18
|
Routledge KM, Williams LM, Harris AWF, Schofield PR, Clark CR, Gatt JM. Genetic correlations between wellbeing, depression and anxiety symptoms and behavioral responses to the emotional faces task in healthy twins. Psychiatry Res 2018; 264:385-393. [PMID: 29677622 DOI: 10.1016/j.psychres.2018.03.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
Abstract
Currently there is a very limited understanding of how mental wellbeing versus anxiety and depression symptoms are associated with emotion processing behaviour. For the first time, we examined these associations using a behavioural emotion task of positive and negative facial expressions in 1668 healthy adult twins. Linear mixed model results suggested faster reaction times to happy facial expressions was associated with higher wellbeing scores, and slower reaction times with higher depression and anxiety scores. Multivariate twin modelling identified a significant genetic correlation between depression and anxiety symptoms and reaction time to happy facial expressions, in the absence of any significant correlations with wellbeing. We also found a significant negative phenotypic relationship between depression and anxiety symptoms and accuracy for identifying neutral emotions, although the genetic or environment correlations were not significant in the multivariate model. Overall, the phenotypic relationships between speed of identifying happy facial expressions and wellbeing on the one hand, versus depression and anxiety symptoms on the other, were in opposing directions. Twin modelling revealed a small common genetic correlation between response to happy faces and depression and anxiety symptoms alone, suggesting that wellbeing and depression and anxiety symptoms show largely independent relationships with emotion processing at the behavioral level.
Collapse
Affiliation(s)
- Kylie M Routledge
- The Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW 2145, Australia.
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, CA 94305-5717, USA.
| | - Anthony W F Harris
- The Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW 2145, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia.
| | - Peter R Schofield
- Neuroscience Research Australia, Barker St, Randwick, Sydney, NSW 2031 Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - C Richard Clark
- School of Psychology, Flinders University, Bedford Park, SA 5042, Australia.
| | - Justine M Gatt
- Neuroscience Research Australia, Barker St, Randwick, Sydney, NSW 2031 Australia; School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
| |
Collapse
|
19
|
O'Malley KR, Waters AM. Attention avoidance of the threat conditioned stimulus during extinction increases physiological arousal generalisation and retention. Behav Res Ther 2018; 104:51-61. [DOI: 10.1016/j.brat.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 11/26/2022]
|
20
|
Morales S, Brown KM, Taber-Thomas BC, LoBue V, Buss KA, Pérez-Edgar KE. Maternal anxiety predicts attentional bias towards threat in infancy. Emotion 2017; 17:874-883. [PMID: 28206795 PMCID: PMC5519443 DOI: 10.1037/emo0000275] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although cognitive theories of psychopathology suggest that attention bias toward threat plays a role in the etiology and maintenance of anxiety, there is relatively little evidence regarding individual differences in the earliest development of attention bias toward threat. The current study examines attention bias toward threat during its potential first emergence by evaluating the relations between attention bias and known risk factors of anxiety (i.e., temperamental negative affect and maternal anxiety). We measured attention bias to emotional faces in infants (N = 98; 57 male) ages 4 to 24 months during an attention disengagement eye-tracking paradigm. We hypothesized that (a) there would be an attentional bias toward threat in the full sample of infants, replicating previous studies; (b) attentional bias toward threat would be positively related to maternal anxiety; and (c) attention bias toward threat would be positively related to temperamental negative affect. Finally, (d) we explored the potential interaction between temperament and maternal anxiety in predicting attention bias toward threat. We found that attention bias to the affective faces did not change with age, and that bias was not related to temperament. However, attention bias to threat, but not attention bias to happy faces, was positively related to maternal anxiety, such that higher maternal anxiety predicted a larger attention bias for all infants. These findings provide support for attention bias as a putative early mechanism by which early markers of risk are associated with socioemotional development. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Kayla M Brown
- Department of Psychology, The Pennsylvania State Universit
| | | | | | - Kristin A Buss
- Department of Psychology, The Pennsylvania State Universit
| | | |
Collapse
|
21
|
Mathews BL, Koehn AJ, Abtahi MM, Kerns KA. Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review. Clin Child Fam Psychol Rev 2017; 19:162-84. [PMID: 27072682 DOI: 10.1007/s10567-016-0204-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.
Collapse
Affiliation(s)
| | - Amanda J Koehn
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
| | | | - Kathryn A Kerns
- Kent State University, 600 Hilltop Dr., Kent Hall, Kent, OH, 4424, USA
| |
Collapse
|
22
|
Lau JYF, Waters AM. Annual Research Review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression. J Child Psychol Psychiatry 2017; 58:387-407. [PMID: 27966780 DOI: 10.1111/jcpp.12653] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Anxiety and depression occurring during childhood and adolescence are common and costly. While early-emerging anxiety and depression can arise through a complex interplay of 'distal' factors such as genetic and environmental influences, temperamental characteristics and brain circuitry, the more proximal mechanisms that transfer risks on symptoms are poorly delineated. Information-processing biases, which differentiate youth with and without anxiety and/or depression, could act as proximal mechanisms that mediate more distal risks on symptoms. This article reviews the literature on information-processing biases, their associations with anxiety and depression symptoms in youth and with other distal risk factors, to provide direction for further research. METHODS Based on strategic searches of the literature, we consider how youth with and without anxiety and/or depression vary in how they deploy attention to social-affective stimuli, discriminate between threat and safety cues, retain memories of negative events and appraise ambiguous information. We discuss how these information-processing biases are similarly or differentially expressed on anxiety and depression and whether these biases are linked to genetic and environmental factors, temperamental characteristics and patterns of brain circuitry functioning implicated in anxiety and depression. FINDINGS Biases in attention and appraisal characterise both youth anxiety and depression but with some differences in how these are expressed for each symptom type. Difficulties in threat-safety cue discrimination characterise anxiety and are understudied in depression, while biases in the retrieval of negative and overgeneral memories have been observed in depression but are understudied in anxiety. Information-processing biases have been studied in relation to some distal factors but not systematically, so relationships remain inconclusive. CONCLUSIONS Biases in attention, threat-safety cue discrimination, memory and appraisal may characterise anxiety and/or depression risk. We discuss future research directions that can more systematically test whether these biases act as proximal mechanisms that mediate other distal risk factors.
Collapse
Affiliation(s)
- Jennifer Y F Lau
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Gold Coast, Qld, Australia
| |
Collapse
|
23
|
Savage JE, Sawyers C, Roberson-Nay R, Hettema JM. The genetics of anxiety-related negative valence system traits. Am J Med Genet B Neuropsychiatr Genet 2017; 174:156-177. [PMID: 27196537 PMCID: PMC5349709 DOI: 10.1002/ajmg.b.32459] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/05/2016] [Indexed: 01/11/2023]
Abstract
NIMH's Research Domain Criteria (RDoC) domain of negative valence systems (NVS) captures constructs of negative affect such as fear and distress traditionally subsumed under the various internalizing disorders. Through its aims to capture dimensional measures that cut across diagnostic categories and are linked to underlying neurobiological systems, a large number of phenotypic constructs have been proposed as potential research targets. Since "genes" represent a central "unit of analysis" in the RDoC matrix, it is important for studies going forward to apply what is known about the genetics of these phenotypes as well as fill in the gaps of existing knowledge. This article reviews the extant genetic epidemiological data (twin studies, heritability) and molecular genetic association findings for a broad range of putative NVS phenotypic measures. We find that scant genetic epidemiological data is available for experimentally derived measures such as attentional bias, peripheral physiology, or brain-based measures of threat response. The molecular genetic basis of NVS phenotypes is in its infancy, since most studies have focused on a small number of candidate genes selected for putative association to anxiety disorders (ADs). Thus, more research is required to provide a firm understanding of the genetic aspects of anxiety-related NVS constructs. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jeanne E. Savage
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Chelsea Sawyers
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Roxann Roberson-Nay
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | - John M. Hettema
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
24
|
Sylvester CM, Hudziak JJ, Gaffrey MS, Barch DM, Luby JL. Stimulus-Driven Attention, Threat Bias, and Sad Bias in Youth with a History of an Anxiety Disorder or Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:219-31. [PMID: 25702927 DOI: 10.1007/s10802-015-9988-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Attention biases towards threatening and sad stimuli are associated with pediatric anxiety and depression, respectively. The basic cognitive mechanisms associated with attention biases in youth, however, remain unclear. Here, we tested the hypothesis that threat bias (selective attention for threatening versus neutral stimuli) but not sad bias relies on stimulus-driven attention. We collected measures of stimulus-driven attention, threat bias, sad bias, and current clinical symptoms in youth with a history of an anxiety disorder and/or depression (ANX/DEP; n = 40) as well as healthy controls (HC; n = 33). Stimulus-driven attention was measured with a non-emotional spatial orienting task, while threat bias and sad bias were measured at a short time interval (150 ms) with a spatial orienting task using emotional faces and at a longer time interval (500 ms) using a dot-probe task. In ANX/DEP but not HC, early attention bias towards threat was negatively correlated with later attention bias to threat, suggesting that early threat vigilance was associated with later threat avoidance. Across all subjects, stimulus-driven orienting was not correlated with early threat bias but was negatively correlated with later threat bias, indicating that rapid stimulus-driven orienting is linked to later threat avoidance. No parallel relationships were detected for sad bias. Current symptoms of depression but not anxiety were related to decreased stimulus-driven attention. Together, these results are consistent with the hypothesis that threat bias but not sad bias relies on stimulus-driven attention. These results inform the design of attention bias modification programs that aim to reverse threat biases and reduce symptoms associated with pediatric anxiety and depression.
Collapse
Affiliation(s)
- Chad M Sylvester
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8511, St. Louis, MO, 63110, USA.
| | - James J Hudziak
- Department of Psychiatry, University of Vermont College of Medicine, 1 South Prospect, UHC St. Joseph's Room 3213, Burlington, VT, 05401, USA
| | - Michael S Gaffrey
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8511, St. Louis, MO, 63110, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8511, St. Louis, MO, 63110, USA.,Department of Psychology, Washington University School of Medicine, One Brookings Drive, Campus Box 1125, St. Louis, MO, 63130, USA.,Department of Radiology, Washington University School of Medicine, One Brookings Drive, Campus Box 1125, St. Louis, MO, 63130, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8511, St. Louis, MO, 63110, USA
| |
Collapse
|
25
|
Morales S, Fu X, Pérez-Edgar KE. A developmental neuroscience perspective on affect-biased attention. Dev Cogn Neurosci 2016; 21:26-41. [PMID: 27606972 PMCID: PMC5067218 DOI: 10.1016/j.dcn.2016.08.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 01/09/2023] Open
Abstract
There is growing interest regarding the impact of affect-biased attention on psychopathology. However, most of the research to date lacks a developmental approach. In the present review, we examine the role affect-biased attention plays in shaping socioemotional trajectories within a developmental neuroscience framework. We propose that affect-biased attention, particularly if stable and entrenched, acts as a developmental tether that helps sustain early socioemotional and behavioral profiles over time, placing some individuals on maladaptive developmental trajectories. Although most of the evidence is found in the anxiety literature, we suggest that these relations may operate across multiple domains of interest, including positive affect, externalizing behaviors, drug use, and eating behaviors. We also review the general mechanisms and neural correlates of affect-biased attention, as well as the current evidence for the co-development of attention and affect. Based on the reviewed literature, we propose a model that may help us better understand the nuances of affect-biased attention across development. The model may serve as a strong foundation for ongoing attempts to identify neurocognitive mechanisms and intervene with individuals at risk. Finally, we discuss open issues for future research that may help bridge existing gaps in the literature.
Collapse
Affiliation(s)
- Santiago Morales
- The Pennsylvania State University, Department of Psychology, 140 Moore Building, University Park, PA 16802, United States.
| | - Xiaoxue Fu
- The Pennsylvania State University, Department of Psychology, 140 Moore Building, University Park, PA 16802, United States
| | - Koraly E Pérez-Edgar
- The Pennsylvania State University, Department of Psychology, 140 Moore Building, University Park, PA 16802, United States
| |
Collapse
|
26
|
Humphreys KL, Kircanski K, Colich NL, Gotlib IH. Attentional avoidance of fearful facial expressions following early life stress is associated with impaired social functioning. J Child Psychol Psychiatry 2016; 57:1174-82. [PMID: 27457566 PMCID: PMC5030156 DOI: 10.1111/jcpp.12607] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early life stress is associated with poorer social functioning. Attentional biases in response to threat-related cues, linked to both early experience and psychopathology, may explain this association. To date, however, no study has examined attentional biases to fearful facial expressions as a function of early life stress or examined these biases as a potential mediator of the relation between early life stress and social problems. METHODS In a sample of 154 children (ages 9-13 years) we examined the associations among interpersonal early life stressors (i.e., birth through age 6 years), attentional biases to emotional facial expressions using a dot-probe task, and social functioning on the Child Behavior Checklist. RESULTS High levels of early life stress were associated with both greater levels of social problems and an attentional bias away from fearful facial expressions, even after accounting for stressors occurring in later childhood. No biases were found for happy or sad facial expressions as a function of early life stress. Finally, attentional biases to fearful faces mediated the association between early life stress and social problems. CONCLUSIONS Attentional avoidance of fearful facial expressions, evidenced by a bias away from these stimuli, may be a developmental response to early adversity and link the experience of early life stress to poorer social functioning.
Collapse
Affiliation(s)
| | | | | | - Ian H. Gotlib
- Department of Psychology; Stanford University; Stanford CA USA
| |
Collapse
|
27
|
Montagner R, Mogg K, Bradley BP, Pine DS, Czykiel MS, Miguel EC, Rohde LA, Manfro GG, Salum GA. Attentional bias to threat in children at-risk for emotional disorders: role of gender and type of maternal emotional disorder. Eur Child Adolesc Psychiatry 2016; 25:735-42. [PMID: 26547923 DOI: 10.1007/s00787-015-0792-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
Previous studies suggested that threat biases underlie familial risk for emotional disorders in children. However, major questions remain concerning the moderating role of the offspring gender and the type of parental emotional disorder on this association. This study addresses these questions in a large sample of boys and girls. Participants were 6-12 years old (at screening) typically developing children participating in the High Risk Cohort Study for Psychiatric Disorders (n = 1280; 606 girls, 674 boys). Children were stratified according to maternal emotional disorder (none; mood disorder; anxiety disorder; comorbid anxiety/mood disorder) and gender. Attention biases were assessed using a dot-probe paradigm with threat, happy and neutral faces. A significant gender-by-parental emotional disorder interaction predicted threat bias, independent of anxiety and depression symptoms in children. Daughters of mothers with an emotional disorder showed increased attention to threat compared with daughters of disorder-free mothers, irrespective of the type of maternal emotion disorder. In contrast, attention bias to threat in boys only occurred in mothers with a non-comorbid mood disorder. No group differences were found for biases for happy-face cues. Gender and type of maternal emotional disorder predict attention bias in disorder-free children. This highlights the need for longitudinal research to clarify whether this pattern of threat-attention bias in children relates to the risk of developing anxiety and mood disorders later in life.
Collapse
Affiliation(s)
- Rachel Montagner
- Hospital de Clınicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2350, Room 2202, Porto Alegre, 90035-003, Brazil.
| | | | | | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - Marcelo S Czykiel
- Hospital de Clınicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2350, Room 2202, Porto Alegre, 90035-003, Brazil
| | - Euripedes Constantino Miguel
- São Paulo University, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD, CNPq), São Paulo, Brazil
| | - Luis A Rohde
- Hospital de Clınicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2350, Room 2202, Porto Alegre, 90035-003, Brazil.,São Paulo University, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD, CNPq), São Paulo, Brazil
| | - Gisele G Manfro
- Hospital de Clınicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2350, Room 2202, Porto Alegre, 90035-003, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD, CNPq), São Paulo, Brazil
| | - Giovanni A Salum
- Hospital de Clınicas de Porto Alegre, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2350, Room 2202, Porto Alegre, 90035-003, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD, CNPq), São Paulo, Brazil
| |
Collapse
|
28
|
Morales S, Taber-Thomas BC, Pérez-Edgar KE. Patterns of attention to threat across tasks in behaviorally inhibited children at risk for anxiety. Dev Sci 2016; 20. [PMID: 26786586 DOI: 10.1111/desc.12391] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
Although attention bias towards threat has been causally implicated in the development and maintenance of fear and anxiety, the expected associations do not appear consistently. Reliance on a single task to capture attention bias, in this case overwhelmingly the dot-probe task, may contribute to this inconsistency. Comparing across attentional bias measures could help capture patterns of behavior that have implications for anxiety. This study examines the patterns of attentional bias across two related measures in a sample of children at temperamental risk for anxiety. Children (Meanage = 10.19 ± 0.96) characterized as behaviorally inhibited (N = 50) or non-inhibited (N = 64) via parent-report completed the dot-probe and affective Posner tasks to measure attentional bias to threat. Parent-report diagnostic interviews assessed children's social anxiety. Behavioral inhibition was not associated with performance in the dot-probe task, but was associated with increased attentional bias to threat in the affective Posner task. Cross-task convergence was dependent on temperament, such that attention bias across the two tasks was only related in behaviorally inhibited children. Finally, children who were consistently biased across tasks (showing high or low attentional bias scores in both tasks, rather than high in one but low in the other) had higher levels of anxiety. Convergence across attention bias measures may be dependent on individuals' predispositions (e.g. temperament). Moreover, convergence of attention bias across measures may be a stronger marker of information processing patterns that shape socioemotional outcomes than performance in a single task.
Collapse
Affiliation(s)
- Santiago Morales
- Department of Psychology, The Pennsylvania State University, USA
| | | | | |
Collapse
|
29
|
Gibb BE, McGeary JE, Beevers CG. Attentional biases to emotional stimuli: Key components of the RDoC constructs of sustained threat and loss. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:65-80. [PMID: 26369836 PMCID: PMC5664953 DOI: 10.1002/ajmg.b.32383] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 11/10/2022]
Abstract
Biased attention to emotional stimuli plays a key role in the RDoC constructs of Sustained Threat and Loss. In this article, we review approaches to assessing these biases, their links with psychopathology, and the underlying neural influences. We then review evidence from twin and candidate gene studies regarding genetic influences on attentional biases. We also discuss the impact of developmental and environmental influences and end with a number of suggestions for future research in this area.
Collapse
Affiliation(s)
| | - John E. McGeary
- Providence Veterans Affairs Medical Center
- Division of Behavioral Genetics, Rhode Island Hospital
- Department of Psychiatry and Human Behavior, Brown University
| | | |
Collapse
|
30
|
A Critical Review of Attentional Threat Bias and Its Role in the Treatment of Pediatric Anxiety Disorders. J Cogn Psychother 2015; 29:171-184. [PMID: 32755946 DOI: 10.1891/0889-8391.29.3.171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Threat bias, or exaggerated selective attention to threat, is considered a key neurocognitive factor in the etiology and maintenance of pediatric anxiety disorders. However, upon closer examination of the literature, there is greater heterogeneity in threat-related attentional biases than typically acknowledged. This is likely impacting progress that can be made in terms of interventions focused on modifying this bias and reducing anxiety, namely attention bias modification training. We suggest that the field may need to "take a step back" from developing interventions and focus research efforts on improving the methodology of studying attention bias itself, particularly in a developmental context. We summarize a neurocognitive model that addresses the issue of heterogeneity by broadly incorporating biases toward and away from threat, linking this variation to key neurodevelopmental factors, and providing a basis for future research aimed at improving the utility of threat bias measures and interventions in clinical practice.
Collapse
|
31
|
Waters AM, Kershaw R. Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children. Behav Res Ther 2015; 64:56-65. [DOI: 10.1016/j.brat.2014.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 11/04/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
|
32
|
Brown HM, Eley TC, Broeren S, Macleod C, Rinck M, Hadwin JA, Lester KJ. Psychometric properties of reaction time based experimental paradigms measuring anxiety-related information-processing biases in children. J Anxiety Disord 2014; 28:97-107. [PMID: 24486916 DOI: 10.1016/j.janxdis.2013.11.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/29/2013] [Accepted: 11/16/2013] [Indexed: 10/26/2022]
Abstract
Theoretical frameworks highlight the importance of threat-related information-processing biases for understanding the emergence of anxiety in childhood. The psychometric properties of several tasks measuring these biases and their associations with anxiety were examined in an unselected sample of 9-year-old children (N=155). In each task, threat bias was assessed using bias scores reflecting task performance on threat versus non-threat conditions. Reliability was assessed using split-half and test-retest correlations of mean reaction times (RTs), accuracy and bias indices. Convergence between measures was also examined. Mean RTs showed substantial split-half and test-retest correlations. Bias score reliability coefficients were near zero and non-significant, suggesting poor reliability in children of this age. Additionally, associations between bias scores and anxiety were weak and inconsistent and performance between tasks showed little convergence. Bias scores from RT based paradigms in the current study lacked adequate psychometric properties for measuring individual differences in anxiety-related information-processing in children.
Collapse
Affiliation(s)
- H M Brown
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, United Kingdom
| | - T C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, United Kingdom
| | - S Broeren
- Department of Public Health, Erasmus Medical Centre, Rotterdam, Netherlands
| | - C Macleod
- Centre for the Advancement of Research on Emotion, University of Western Australia, Australia
| | - M Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - J A Hadwin
- Department of Psychology, University of Southampton, United Kingdom
| | - K J Lester
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London, United Kingdom.
| |
Collapse
|
33
|
Strawn JR, Wehry AM, Chu WJ, Adler CM, Eliassen JC, Cerullo MA, Strakowski SM, Delbello MP. Neuroanatomic abnormalities in adolescents with generalized anxiety disorder: a voxel-based morphometry study. Depress Anxiety 2013; 30:842-8. [PMID: 23495075 DOI: 10.1002/da.22089] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 01/02/2013] [Accepted: 02/09/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite recent data implicating functional abnormalities in the neurocircuitry underlying emotional processing in pediatric anxiety disorders, little is known regarding neurostructural abnormalities within these systems. METHODS Using voxel-based morphometry, gray and white matter volumes were compared in 15 medication-free adolescents with generalized anxiety disorder (GAD; and no comorbid major depressive disorder) and 28 age- and sex-matched healthy comparison subjects. RESULTS Compared to healthy adolescents, youth with GAD had larger gray matter volumes in the right precuneus and right precentral gyrus and decreased gray matter volumes in the left orbital gyrus and posterior cingulate. White matter volumes were decreased in the left medial and superior frontal gyrus and were increased in the left inferior temporal gyrus in youth with GAD relative to healthy subjects. CONCLUSIONS Adolescents with GAD, who are early in the course of their illness, exhibit abnormalities in neural structures that subserve threat appraisal, modulation of fear responses, attachment, and mentalization.
Collapse
Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45267, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Samango-Sprouse CA, Stapleton E, Sadeghin T, Gropman AL. Is it all the X: familial learning dysfunction and the impact of behavioral aspects of the phenotypic presentation of XXY? AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:27-34. [PMID: 23359595 DOI: 10.1002/ajmg.c.31353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The behavioral phenotype of children with XXY has not been extensively studied until recently and this research has been confounded by insufficient study populations and ascertainment biases. The aim of the study was to expand the behavioral aspect of the XXY phenotype as well as investigate the role of existing familial learning disabilities (FLD) on behavioral problems. Behavioral phenotype of XXY includes social anxiety, ADHD, social communication, and atypical peer interactions. The Child Behavior Checklist (CBCL), Social Responsiveness Scale (SRS), and Gilliam Autism Rating Scale (GARS) were completed by the parents of 54 boys with XXY who had not received hormonal replacement prior to participation. Our findings suggest fewer behavioral deficits and lower severity in the general 47,XXY population than previously published and found significant differences between the groups with a positive FLD on the behavioral assessments. Findings demonstrate that boys with FLD exhibit an increased incidence and severity of behavioral problems. Our study expands on the findings of Samango-Sprouse et al. [Samango-Sprouse et al. (2012b) J Intellect Disabil Res] and the significant influence that FLD has on not only neurodevelopment, but also behavioral deficits. Our study suggests that part of the XXY phenotypic profile may be modulated by FLD. Further study is underway to examine the interaction between the many salient factors effecting behavioral and neurodevelopmental progression in XXY and variant forms. © 2013 Wiley Periodicals, Inc.
Collapse
|