BACKGROUND: Social reticence in early childhood is characterized by shy and anxiously avoidant behavior, and it confers risk for pediatric anxiety disorders later in development. Aberrant threat processing may play a critical role in this association between early reticent behavior and later psychopathology. The goal of this longitudinal study is to characterize developmental trajectories of neural mechanisms underlying threat processing and relate these trajectories to associations between early-childhood social reticence and adolescent anxiety.METHODS: In this 16-year longitudinal study, social reticence was assessed from 2 to 7 years of age; anxiety symptoms and neural mechanisms during the dot-probe task were assessed at 10, 13, and 16 years of age. The sample included 144 participants: 71 children provided data at age 10 (43 girls, mean(age) = 10.62), 85 at age 13 (46 girls, mean(age) = 13.25), and 74 at age 16 (36 girls, mean(age) = 16.27).RESULTS: A significant interaction manifested among social reticence, anxiety symptoms, and time, on functional connectivity between the left amygdala and the left dorsolateral prefrontal cortex, voxelwise p < .001, clusterwise familywise error p < .05. Children with high social reticence showed a negative association between amygdala- dorsolateral prefrontal cortex connectivity and anxiety symptoms with age, compared to children with low social reticence, suggesting distinct neurodevelopmental pathways to anxiety.CONCLUSIONS: These findings were present across all conditions, suggesting task-general effects in potential threat processing. Additionally, the timing of these neurodevelopmental pathways differed for children with high versus low social reticence, which could affect the timing of effective preventive interventions.

Attention to emotional signals conveyed by others is critical for gleaning information about potential social partners and the larger social context. Children appear to detect social threats (e.g., angry faces) faster than non-threatening social signals (e.g., neutral faces). However, methods that rely on behavioral responses alone are limited in identifying different attentional processes involved in threat detection or responding. To address this question, we used a visual search paradigm to assess behavioral (i.e., reaction time to select a target image) and attentional (i.e., eye-tracking fixations, saccadic shifts, and dwell time) responses in children (ages 7-10 years old, N = 42) and adults (ages 18-23 years old, N = 46). In doing so, we compared behavioral responding and attentional detection and engagement with threatening (i.e., angry and fearful faces) and non-threatening (i.e., happy faces) social signals. Overall, children and adults were faster to detect social threats (i.e., angry faces), but spent a smaller proportion of time dwelling on them and had slower behavioral responses. Findings underscore the importance of combining different measures to parse differences between processing versus responding to social signals across development. RESEARCH HIGHLIGHTS: Children and adults are slower to select angry faces when measured by time to mouse-click but faster to detect angry faces when measured by time to first eye fixation. The use of eye-tracking addresses some limitations of prior visual search tasks with children that rely on behavioral responses alone. Results suggest shorter time to first fixation, but subsequently, shorter duration of dwell on social threat in children and adults.

Aberrant decision-making characterizes various pediatric psychopathologies; however, deliberative choice strategies have not been investigated. A transdiagnostic sample of 95 youths completed a child-friendly sequential sampling paradigm. Participants searched for the best offer by sampling a finite list of offers. Participants’ willingness to explore was measured as the number of offers sampled, and ideal task performance was modeled using a Markov decision-process model. As in previous findings in adults, youths explored more offers when lists were long compared with short, yet participants generally sampled fewer offers relative to model-estimated ideal performance. Searching deeper into the list was associated with choosing better price options. Analyses examining the main and interactive effects of transdiagnostic anxiety and irritability symptoms indicated a negative correlation between anxiety and task performance ( p = .01, η p2 = .08). Findings suggest the need for more research on exploratory decision impairments in youths with anxiety symptoms.

Social reticence during early childhood predicts the development of anxiety disorders, typically emerging during adolescence. Not all socially reticent children develop anxiety; thus, it is essential to determine which factors moderate this relation. Here, we focused on the neurodevelopmental processes underlying threat bias as a potential moderator.

Most research examining the impact of early parental depression on the developing child has focused on the nature of parenting practices observed in depressed adults. Maternal elaborative reminiscing, or the extent to which mothers elaboratively discuss past shared experiences with their children, has a considerable influence on children’s emotional and social development and is understudied within the context of maternal depression. The current study is the first to examine whether maternal elaborative reminiscing in middle childhood mediates the association between exposure to maternal depressive symptoms in infancy and later internalizing and externalizing problems. The study included 206 mother–child dyads recruited from the community who participated in a prospective longitudinal study. Maternal depressive symptoms were assessed when offspring were 6-months old. At 5-years old, dyads were observed during a free play task to measure sensitive and harsh-intrusive parenting and during a reminiscing task to measure maternal elaboration. Teacher-reported internalizing and externalizing problems were collected at age 7. A saturated path model revealed that maternal elaborative reminiscing, but not sensitive or harsh-intrusive parenting, fully mediated the association between maternal depression in infancy and externalizing, but not internalizing, problems. Reduced maternal elaboration during parent–child reminiscing constitutes one way in which risk from early maternal depression is associated with later externalizing problems.

Attentional control theory suggests that high cognitive demands impair the flexible deployment of attention control in anxious adults, particularly when paired with external threats. Extending this work to pediatric anxiety, we report two studies utilising eye tracking (Study 1) and functional magnetic resonance imaging (Study 2). Both studies use a visual search paradigm to examine anxiety-related differences in the impact of threat on attentional control at varying levels of task difficulty. In Study 1, youth ages 8-18 years (N = 109), completed the paradigm during eye tracking. Results indicated that youth with more severe anxiety took longer to fixate on and identify the target, specifically on difficult trials, compared to youth with less anxiety. However, no anxiety-related effects of emotional distraction (faces) emerged. In Study 2, a separate cohort of 8-18-year-olds (N = 72) completed a similar paradigm during fMRI. Behaviourally, youth with more severe anxiety were slower to respond on searches following non-threatening, compared to threatening, distractors, but this effect did not vary by task difficulty. The same interaction emerged in the neuroimaging analysis in the superior parietal lobule and precentral gyrus-more severe anxiety was associated with greater brain response following non-threatening distractors. Theoretical implications of these inconsistent findings are discussed.

In light of the growing interest in, and need for, the telehealth delivery of health care, additional research is needed on the acceptability and effectiveness of these types of interventions. This study examined the acceptability, feasibility, and preliminary effectiveness of an adapted telehealth-delivered group cognitive-behavioral therapy (CBT) intervention for adults with social anxiety disorder (SAD). This report describes the adaptation and subsequent implementation of an 8-week telehealth-delivered group treatment designed to reduce symptoms of SAD. Specific adaptations for delivering treatment during the COVID-19 pandemic and the subsequent enactment of social distancing measures are discussed. Posttreatment data indicated that the intervention was feasible to implement in an outpatient mental health clinic, acceptable to participants, and associated with reduction in symptoms of social anxiety, general anxiety, depression, and stress.

Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Here, we propose an enhanced ABMT to target the attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth. This enhanced ABMT integrates the modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. These two training elements (modified dot-probe and visual search) are embedded in an engaging game to foster motivation and adherence. Our goal is to determine the efficacy of the enhanced ABMT in the context of CBT. Further, we aim to replicate two previous findings: (a) aberrant amygdala connectivity being the neurobiological correlate of the attentional bias towards threat at baseline; and (b) amygdala connectivity being a mediator of the ABMT effect. We will also explore moderators of treatment response (age, sex, depressive symptoms and irritability) on a behavioral and neuronal level. One hundred and twenty youth (8–17 years old) with a primary anxiety disorder diagnosis all receive CBT and are randomized to nine weeks of either active or control ABMT and symptom improvement will be compared between the two study arms. We will also recruit 60 healthy comparison youth, who along with eligible anxious youth, will be assessed with the dot-probe task during fMRI (anxious youth: before and after training; healthy volunteers: second measurement twelve weeks after initial assessment). The present study will contribute to the literature by (1) potentially replicating that aberrant amygdala connectivity mediates the attentional bias towards threat in anxious youth; (2) determining the efficacy of enhanced ABMT; and (3) advancing our understanding of the mechanisms underlying ABMT. Clinicaltrials.gov: NCT03283930 Trial registration date: September 14th 2017. The trial registration took place retrospectively. Data acquisition started February 1st 2017.

Abstract Background Anxiety symptoms gradually emerge during childhood and adolescence. Individual differences in behavioral inhibition (BI), an early-childhood temperament, may shape developmental paths through which these symptoms arise. Cross-sectional research suggests that level of early-childhood BI moderates associations between later anxiety symptoms and threat-related amygdala–prefrontal cortex (PFC) circuitry function. However, no study has characterized these associations longitudinally. Here, we tested whether level of early-childhood BI predicts distinct evolving associations between amygdala–PFC function and anxiety symptoms across development. Methods Eighty-seven children previously assessed for BI level in early childhood provided data at ages 10 and/or 13 years, consisting of assessments of anxiety and an fMRI-based dot-probe task (including threat, happy, and neutral stimuli). Using linear-mixed-effects models, we investigated longitudinal changes in associations between anxiety symptoms and threat-related amygdala–PFC connectivity, as a function of early-childhood BI. Results In children with a history of high early-childhood BI, anxiety symptoms became, with age, more negatively associated with right amygdala–left dorsolateral-PFC connectivity when attention was to be maintained on threat. In contrast, with age, low-BI children showed an increasingly positive anxiety–connectivity association during the same task condition. Behaviorally, at age 10, anxiety symptoms did not relate to fluctuations in attention bias (attention bias variability, ABV) in either group; by age 13, low-BI children showed a negative anxiety–ABV association, whereas high-BI children showed a positive anxiety–ABV association. Conclusions Early-childhood BI levels predict distinct neurodevelopmental pathways to pediatric anxiety symptoms. These pathways involve distinct relations among brain function, behavior, and anxiety symptoms, which may inform diagnosis and treatment.

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a measure widely used to assess childhood anxiety based on parent and child report. However, while the SCARED is a reliable, valid, and sensitive measure to screen for pediatric anxiety disorders, informant discrepancy can pose clinical and research challenges. The present study assesses informant discrepancy, measurement invariance, test–retest reliability, and external validity of the SCARED in 1092 anxious and healthy parent–child dyads. Our findings indicate that discrepancy does not vary systematically by the various clinical, demographic, and familial variables examined. There was support for strict measurement invariance, strong test–retest reliability, and adequate external validity with a clinician-rated measure of anxiety. These findings further support the utility of the SCARED in clinical and research settings, but low parent–child agreement highlights the need for further investigation of factors contributing to SCARED informant discrepancy.

Anxiety symptoms evolve as children approach adolescence. Individual differences in behavioral inhibition (BI), an early-life fearful temperament, may define distinct developmental paths through which anxiety symptoms arise. Prior cross-sectional research suggests that level of early-life BI moderates how later anxiety symptoms relate to attention and associated amygdala-prefrontal cortex (PFC) circuitry function. However, no study has examined longitudinal changes in these functions as they relate to anxiety, in children who manifested different BI levels. We tested whether levels of early-life BI predict distinct associations between anxiety symptoms and amygdala-PFC function across development.

Impairments in decision making are often associated with various types of pediatric psychopathology. Such perturbations may impact one’s ability to resolve explore-exploit dilemmas, i.e., choosing to pursue a known reward (exploitation) versus a lesser-known option (exploration). The explore-exploit dilemma has begun to be mapped using both behavioral paradigms and neuroimaging data. However, exploratory decision-making strategies have not yet been studied in a clinical pediatric sample group using the present reward choice task. The present study aims to use an explore-exploit paradigm to examine group differences in information-seeking behavior.

The Screen for Child Anxiety Related Disorders (SCARED) is a questionnaire measure widely used to assess childhood anxiety based on parent and child report. However, although SCARED is a reliable, valid, and sensitive measure to screen for pediatric anxiety disorders, informant discrepancy can pose clinical and research challenges. Preliminary research suggests partial threshold invariance among respondents but uses moderate sample sizes. By examining measurement invariance of the SCARED between parent–child dyads and between age-groups, the present study aims to explore psychometric factors that may influence informant discrepancies.