Threat-biased attention in childhood anxiety: A cognitive-affective developmental model

Abstract

• Threat-biased attention is inconsistent in clinical and developmental literatures. • Threat-biased attention in childhood anxiety is a matter of relative magnitude. • Executive function and emotion regulation may relate to persistent threat biases. • Unique risk profiles are proposed for the development of anxiety in children. Threat-biased attention presents a paradox among clinical and developmental literatures: while biased attention toward threat has been implicated in childhood anxiety vulnerability, a parallel developmental literature highlights the early emergence of this bias as a normative pattern of attention associated with positive socioemotional outcomes. To bridge between these two literatures, evidence is reviewed across diverse domains (threat-biased attention, temperamental vulnerability, executive function, emotion regulation). An integrative developmental framework is proposed to elucidate how threat-biased attention may progress from a normative response to a more robust and persistent attentional bias associated with childhood anxiety. Deficits in developing executive function (inhibition and attentional control) and emotion regulation are proposed as reciprocal pathways to the perpetuation of this bias and the development of anxiety. Temperamental vulnerability is also considered as a risk factor. This model is most relevant for vigilant models of threat bias and may not account for threat-biases with diverse presentations (e.g., attention bias away from threat). Further, the current model is derived from studies highly reliant on behavioural reaction time and would benefit from validation across more diverse methods and paradigms for studying attentional bias. This model may help identify unique risk profiles for anxiety in children (e.g., deficits in either domain of executive function or emotion regulation with the other domain relatively intact). With further validation, these profiles may have clinical utility in informing the development of treatments that are tailored to address specific affected pathways – allowing for greater specificity in intervention selection.