Association between attention bias to threat and anxiety symptoms in children and adolescents

Abstract

Background: Considerable research links threat-related attention biases to anxiety symptoms in adults, whereas extant findings on threat biases in youth are limited and mixed. Inconsistent findings may arise due to substantial methodological variability and limited sample sizes, emphasizing the need for systematic research on large samples. The aim of this report is to examine the association between threat bias and pediatric anxiety symptoms using standardized measures in a large, international, multi-site youth sample.

Methods: A total of 1,291 children and adolescents from seven research sites worldwide completed standardized attention bias assessment task (dot-probe task) and child anxiety symptoms measure (Screen for Child Anxiety Related Emotional Disorders). Using a dimensional approach to symptomatology, we conducted regression analyses predicting overall, and disorder-specific, anxiety symptoms severity, based on threat bias scores.

Results: Threat bias correlated positively with overall anxiety symptoms severity (ß = 0.078, P = .004). Furthermore, threat bias was positively associated specifically with social anxiety (ß = 0.072, P = .008) and school phobia (ß = 0.076, P = .006) symptoms severity, but not with panic, generalized anxiety, or separation anxiety symptoms. These associations were not moderated by age or gender.

Conclusions: These findings indicate associations between threat bias and pediatric anxiety symptoms, and suggest that vigilance to external threats manifests more prominently in symptoms of social anxiety and school phobia, regardless of age and gender. These findings point to the role of attention bias to threat in anxiety, with implications for translational clinical research. The significance of applying standardized methods in multi-site collaborations for overcoming challenges inherent to clinical research is discussed.

Keywords: GAD/generalized anxiety disorder; SAD/social anxiety disorder/social phobia; anxiety/anxiety disorders; biological markers; child/adolescent; computer/internet technology; international; phobia/phobic disorders; separation anxiety.

FIGURE 1

Sequence of events in a single dot-probe task trial; in this case, an angry–neutral trial in which the probe replaces the angry face (angry trial) Note: ms = millisecond.

FIGURE 2

Scatterplots depicting the unique association between age, gender and threat bias, and total SCARED scores, based on the regression model predicting the latter variable. In each plot, SCARED scores are presented as residuals, controlling for the effects of the other predictors. Note: SCARED= Screen for childhood Anxiety Relational Disorders.