Abstract
Objective: Anxiety disorders of childhood are prevalent, debilitating conditions that do not always respond to existing treatments. Attentional biases towards threatening stimuli have been reported in anxious children and hypothesized to interfere with treatment response. Therefore, we examined such biases in children with anxiety disorders in relation to cognitive behavioral therapy (CBT) outcomes. Method: Thirty-eight children diagnosed with anxiety disorders in a specialized clinic (21 girls and 17 boys; age = 10.50 ± 1.11 years) and 36 unaffected community controls (19 girls and 17 boys; age = 10.20 ± 1.07 years) participated. Participants completed standardized questionnaire measures of anxiety and a probe position task (PPT) with facial cues. This task often reveals a response slowing effect related to threatening faces in vulnerable individuals. Children with anxiety disorders repeated these measures after completing CBT. Results: Groups did not differ in performance on the PPT, but angry/calm incongruent difference scores were significantly associated with self-reports of social anxiety and state anxiety. When controlling for pre-CBT anxiety levels, incongruent difference scores involving angry faces predicted post-CBT anxiety disorders index scores on the Multidimensional Anxiety Scale for Children. PPT scores did not change significantly with CBT. Conclusions: Attentional bias towards threat on the PPT task may predict response to CBT and appears linked to social anxiety. Interventions to ameliorate this bias merit further study, as they might improve treatment outcomes for anxious, especially socially anxious, children.
Highlights
Childhood anxiety disorders are prevalent, debilitating, and associated with adverse long term outcomes [1,2]
Groups did not differ in performance on the probe position task (PPT), but angry/calm incongruent difference scores were significantly associated with self-reports of social anxiety and state anxiety
PPT difference scores related to threat attention were correlated with self-reported social anxiety and, in anxious children, were predictive of response to cognitive behavioral therapy (CBT) on the Anxiety Disorders Index of the Multidimensional Anxiety Scale for Children (MASC)
Summary
Childhood anxiety disorders are prevalent, debilitating, and associated with adverse long term outcomes [1,2]. Perez-Edgar and colleagues [14] found that behaviorally inhibited preschoolers (vulnerable to social anxiety) showed more stable forms of social withdrawal if they oriented towards threats in a dot-probe task than if they did not Complicating these diagnostic specificity findings, is the high degree of comorbidity found among anxiety disorders in prepubertal children [1]. Legerstee and colleagues [16] found that difficulty disengaging from threatening pictures on a dot probe (implicit) task was associated with treatment nonresponse to CBT. They linked normalization of this bias to child response to “stepped care CBT” (an unusually intensive child- and parentfocused intervention) [17]. Waters and colleagues [18] found that threat interpretation bias on stories (an explicit task) responded to a standard child CBT protocol, but bias on a visual probe task (an implicit task) persisted
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