Memory deficits in children with and at risk for anxiety disorders

Cognitive Functioning in Youth with Anxiety Disorders: A Systematic Review

Anxiety disorders are disorders involving cognition. Research on cognition in youth with anxiety can focus on cognitive content (e.g., self-talk) as well cognitive functioning. The present review examines domains of cognitive functioning (i.e., episodic memory, language, attention, executive functioning, motor skills, and visual functioning) in youth diagnosed with an anxiety disorder. A database search of Embase, PsycINFO, and PubMed yielded 28 studies that met inclusion criteria of youth aged 17 years or younger, a sample diagnosed with a principal anxiety disorder and a comparison sample of controls, a comparison between those samples, and use of a behavioral measure of neuropsychological performance. Findings did not identify any cognitive functioning strengths for anxious youth. Deficits were found in two domains (i.e., receptive language and motor skills) whereas no deficits were found in attention, visuospatial skills and one domain of executive functioning (i.e., inhibition). Most domains had mixed findings. Additional analysis indicated that anxiety disorders in youth are not associated with diminished IQ. Directions for future research are identified including (a) the prioritization of studies with larger, representative samples (b) the role of cognitive functioning as a predictor of anxiety treatment outcome (c) the examination of the effect of treatment on cognitive performance, and (d) the course of anxiety and potential impairment in cognitive functioning.

Baseline heart rate variability (HRV) and performance during a set-shifting visuospatial learning task: The moderating effect of trait negative affectivity (NA) on behavioral flexibility✰

Higher negative affectivity (NA) has an association with decreased executive function and cognitive control. Heart rate variability (HRV) may index cardiac vagal regulation differences in the autonomic nervous system (ANS) for both cognition and emotion. The current study investigates this association using a set-shifting variant of the Virtual Morris Water Task (VMWT) to study discrimination learning, spatial learning, reversal learning, and attentional set-shifting in a virtual environment. 73 participants completed affective questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory, Positive and Negative Affective Scale), a 5-minute baseline electrocardiogram, and the VMWT. Individuals who failed to complete the task exhibited significantly lower baseline RMSSD then those who completed the task. There was no direct effect between affective measures and task performance. Higher baseline HRV was predictive of better performance during set-shifting. Trait NA moderated the effect of baseline HRV, as well as trait positive affectivity (PA), on performance during the extradimensional shift condition. Increased behavioral flexibility performance was only predicted by higher HRV and PA in low NA individuals. High trait NA negates the positive effects of HRV and PA on behavioral flexibility.

Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth

BACKGROUND

The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology.

OBJECTIVE

Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning.

PARTICIPANTS AND SETTING

We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents.

METHODS

Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure).

RESULTS

Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02).

CONCLUSIONS

Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.

The effect of sleep medications on prospective and retrospective memory: a population-based study

Sleep medications, especially benzodiazepines, are known to cause motor and cognitive impairments as side-effects from their use. However, an evaluation of the effects of sleep medications in general on prospective and retrospective memory remains to be seen. Thus, the effects of the different types of sleep medicines were assessed using the total score and the 8 subscales of the Prospective and Retrospective Memory Questionnaire (PRMQ) in a representative sample from the Municipality of São Paulo. The effects of each type of medication on these same parameters were evaluated afterwards. Each analysis was performed controlling for different covariates to observe their degree of interference on the observed results. Impairment due to use of sleep aid medication was observed in 6 of the 8 subscales, as well in the overall score of the PRMQ when compared to non-users. Prospective subscales were particularly affected, even when controlling for highly interfering covariates such as depression and anxiety, and objective sleep variables related to sleep architecture and wakefulness in the night. Few effects were detected between the various types of medication even when controlling for covariates, suggesting that a sample with higher power is necessary to conduct a more detailed analysis. Using pharmacological aids to improve sleep may impair prospective and (to some extent) retrospective memory. Therefore, the relationship between sleep impairment, memory deficits and medication use must be considered by physicians.

Memory and language impairments are associated with anxiety disorder severity in childhood

Introduction Children with anxiety disorders have been suggested to possess deficits in verbal fluency, shifting and attention, with inconsistent results regarding working memory and its subcomponents. This study extends previous findings by analyzing the performance of children with anxiety disorders in a wide range of neuropsychological functions. Methods We evaluated 54 children with a primary diagnosis of an anxiety disorder according to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) using subtests of a neuropsychological battery. The severity of anxiety disorders was assessed using the Pediatric Anxiety Rating Scale (PARS). We calculated the frequency of neuropsychological impairments (-1.5 standard deviation of the normative sample). Comparisons between groups were performed based on the severity of anxiety symptoms, as well as in the presence of one vs. more diagnoses of anxiety disorder. Results We found higher impairment in visuospatial working memory (23.1%), semantic memory (27.8%), oral language (35.4%) and word writing (44.4%) in anxious children. Moreover, children with higher anxiety severity presented lower performance in visuospatial working memory, inferential processing, word reading, writing comprehension, copied writing, and semantic verbal fluency (d = 0.49 to 0.96 [Cohen's d]). The higher the number of anxiety diagnoses, the lower the performance in episodic memory and oral and written language (d = 0.56 to 0.77). Conclusion Our data suggested the presence of memory (visuospatial working memory and semantic memory) and language deficits (oral and writing) in some children with an anxiety disorder. Severity and number of anxiety diagnoses were associated with lower performance in memory and language domains in childhood.

Cognitive performance of youth with primary generalized anxiety disorder versus primary obsessive-compulsive disorder

BACKGROUND

Despite gains made in the study of childhood anxiety, differential diagnosis remains challenging because of indistinct boundaries between disorders and high comorbidity. This is certainly true for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) as they share multiple cognitive processes (e.g., rumination, intolerance of uncertainty, and increased attention to threat). Disentangling such cognitive characteristics and, subsequently, underlying mechanisms could serve to inform assessment and treatment practices, and improve prognoses.

METHODS

The current study sought to compare the cognitive performance (working memory, visuospatial memory, planning ability/efficiency, and cognitive flexibility), indexed by the Cambridge Neuropsychological Automated Battery (CANTAB) among three nonoverlapping groups of youth: (1) those diagnosed with OCD (n = 28), (2) those diagnosed with GAD, not OCD (n = 34), and (3) typically-developing controls (TDC) (n = 65).

RESULTS

Results showed that OCD and GAD youth demonstrated neurocognitive deficits in planning ability/efficiency, cognitive flexibility, and visual processing when compared to TDC, with potential diagnostic specificity such that youth with GAD or OCD had unique deficits compared to TDC and to one another. Specifically, youth with OCD demonstrated significantly impaired planning ability compared to youth in the GAD and TDS groups, whereas youth with GAD demonstrated greater cognitive inflexibility and delayed visual processing compared to youth in the OCD and TDC groups.

CONCLUSIONS

Future studies should expand upon these findings with more comprehensive assessment of cognitive functioning by including self- and parent-report forms, and neuroimaging to link behavioral findings with subjective ratings and neurocircuitry. Altogether, data can then inform future assessment and treatment targets.

Memory performance, oral comprehension and learning process between children with attention deficit hyperactivity disorder and children with anxiety disorder

ABSTRACT Purpose: to compare aspects of memory, learning and oral comprehension between children with Attention Deficit Hyperactivity Disorder (ADHD) and children with Anxiety Disorder (AD). Methods: thirty-two children (7-10 years) were divided into: G1 - children diagnosed with ADHD, and G2 - children diagnosed with AD. The children were not under drug treatment. The tests applied assessed working memory (phonological loop and visuospatial sketch), learning, episodic memory and oral comprehension. Results: both groups showed changes in working memory for visuospatial sketch and phonological loop (worse performance in pseudowords in the ADHD group and digit-reversed order for children with AD), and in oral comprehension. Group comparison showed a statistically significant difference regarding the most complex level of the oral comprehension test and the repetition of nonwords with three syllables. Both groups showed a suitable performance in learning ability, however, the group of children with ADHD suffered from backward interference, with no memory consolidation, showing low episodic memory performance. Conclusion: children with ADHD and anxiety disorder showed various altered cognitive skills, although group comparison revealed that children with ADHD exhibited worse cognitive performance.

Attention, memory, visuoconstructive, and executive task performance in adolescents with anxiety disorders: a case-control community study

Abstract Objective: The aim of the present study was to assess children and adolescents with mild and severe anxiety disorders for their performance in attention, verbal episodic memory, working memory, visuoconstructive skills, executive functions, and cognitive global functioning and conduct comparative analyses with the performance of children free from anxiety disorders. Methods: Our sample comprised 68 children and adolescents aged 10 to 17 years (41 with current diagnoses of anxiety disorders and 27 controls) selected from a larger cross-sectional community sample of adolescents. Children and adolescents with anxiety disorders were categorized into two groups on the basis of anxiety severity (mild or severe). All participants underwent a neuropsychological assessment battery to evaluate attention, verbal episodic memory, working memory, visuoconstructive skills, and executive and cognitive functions. Results: No differences were found in any neuropsychological tests, with the single exception that the group with mild anxiety had better performance on the Digit Span backward test compared to subjects with severe anxiety and to controls (p = 0.041; η2 = 0.11). Conclusions: Not only might anxiety disorders spare main cognitive functions during adolescence, they may even enhance certain working memory processes.

Phonemic verbal fluency is associated with pediatric anxiety disorders: evidence from a community study

BACKGROUND

Anxiety disorders typically begin in childhood and adolescence and predict risk for many problems throughout life. Although some neuropsychological correlates have been described, more research is needed, particularly in adolescents. This study compares neurocognitive characteristics of anxious adolescents with and without comorbidity to externalizing disorders to those of typically developing comparison (TDC) adolescents and adolescents with externalizing disorders alone.

METHODS

The study included 57 adolescents 12-18 years of age (TDC, n=23; anxiety, n=16; externalizing, n=11; comorbid, n=7). We used a neuropsychological battery to assess eight domains: Orientation, attention, visual perception, memory, arithmetic, language, praxis, and executive function.

RESULTS

Multivariate analysis of variance revealed a main effect of group in the neurocognitive domains evaluated (F8,48=2.32, p=0.034, ηp(2)=0.279). Post-hoc analysis revealed that executive functions score differed among groups, specifically in the task of verbal fluency (F[df=3]=5.01, p=0.004, ηp(2)=0.221), with both the anxious groups (anxiety and comorbid) presenting a lower score than the TDC and externalizing groups. This effect was independent of age, intelligence, and levels of education.

CONCLUSIONS

Verbal fluency is specifically impaired in adolescents with anxiety disorders. This extends results from neuroimaging research implicating prefrontal areas in pediatric anxiety disorder neurobiology, and has potential implications to new therapeutics.

Childhood cognitive ability and its relationship with anxiety and depression in adolescence

BACKGROUND

Childhood cognitive ability may have protective effects against internalizing symptoms in adolescence, although this may depend on the time of symptom assessment and child gender. Also, the effects of childhood stressors on adolescent internalizing symptoms may be moderated by childhood cognitive ability.

METHODS

The sample included 4405 individuals from the Canadian National Longitudinal Study of Children and Youth (NLSCY). Between ages 4-5 and 10-11, children completed a test of verbal ability and scholastic aptitude and a series of mathematics computation tests. Internalizing symptoms were assessed via self-reports at ages 12-13 and 14-15.

RESULTS

Greater cognitive ability was generally associated with decreased odds of internalizing symptoms at age 12-13. However, greater cognitive ability generally increased, or had no effect on, the odds of internalizing symptoms at age 14-15. Some of the effects of childhood cognitive ability varied with child gender. Also, childhood cognitive ability attenuated the effects of family dysfunction and chronic illness throughout childhood on subsequent internalizing symptoms.

LIMITATIONS

These data are largely subject to some degree of reporting bias, the tests of cognitive ability are limited and may not represent overall cognitive ability, and there may be intermediary variables that account for the relationship between childhood cognitive ability and adolescent internalizing symptoms.

CONCLUSION

Results suggest that programs attempting to increase early cognitive skills may be particularly beneficial for girls. Also, an increased focus on cognitive skills may attenuate the negative effects of some stressors on subsequent anxious and depressive symptoms, regardless of child gender.

Depressão materna e riscos para o comportamento e a saúde mental das crianças: uma revisão

A depressão materna tem sido considerada um fator de risco para a saúde mental das crianças. Objetivou-se identificar e analisar na literatura indexada artigos empíricos recentes (2005 a 2012), que abordaram as associações da depressão materna ao comportamento e à saúde mental de crianças, escolares. Procedeu-se a uma busca sistemática nas bases PubMed, PsycInfo e LILACS, por meio das palavras-chave "Maternal Depression or Depression" e "Risk Factors". Foram selecionados e analisados 68 artigos, 23 transversais e 45 longitudinais. Independentemente dos delineamentos adotados, a depressão materna mostrou-se associada à presença de dificuldades emocionais e comportamentais em geral, de manifestações depressivas e de ansiedade. Além da depressão materna, outras variáveis contextuais mostraram-se associadas às dificuldades das crianças. O reconhecimento da ação de múltiplas variáveis permitiu a verificação de indicadores diversos, o que pode favorecer o planejamento de intervenções.

Selective intentional forgetting in adolescents with social anxiety disorder

Anxiety in young adults has recently been linked to reduced capacities to inhibit the processing of non-affective perceptual distractors. However, no previous research has addressed the relationship between social anxiety disorder (SAD) and the ability to intentionally inhibit no longer relevant memories. In an experimental study with adolescents diagnosed with SAD and matched nonclinical controls, a selective directed forgetting procedure was used to assess the extent to which anxious individuals showed lower memory impairment for to-be-forgotten information than their non-anxious counterparts. The results revealed that while the nonclinical sample group demonstrated the ability to selectively forget when instructed, the anxious adolescents demonstrated good memory for to-be-forgotten material and therefore failed to forget. Interestingly, more severe SAD symptomatology inversely predicted a degree of forgetting. We conclude that the main difference between socially anxious and non-anxious participants is specifically related to the ability to intentionally forget and could reflect cognitive functioning that is associated with vulnerability to anxiety. Impairment of the ability to make unwanted memories less retrievable could prompt some individuals to initiate or maintain anxiety disorders. Future psychological treatments could benefit from including modules on memory control training.

Is test anxiety a peril for students with intellectual disabilities?

Test anxiety is one of the most confronting issues in modern times with the increase in the number of standardised and high-stakes testing. Research has established that there is a direct link between test anxiety and cognitive deficits. The aim of this study is to determine the test anxiety scores of the students with intellectual disabilities in South Australia. It also provided insights into the reasons for high-test anxiety in the participants under study. The Spielberger's Test Anxiety Questionnaire was administered on students with intellectual disabilities in stage 1. Interviews were conducted with participants with intellectual disabilities, parents and teachers in stage 2. Questionnaire findings revealed that the majority of the adolescent females and males and all adult females with intellectual disabilities had high test anxiety scores. However, the majority of adult males with intellectual disabilities obtained moderate test anxiety scores. In the worry and emotionality subscales, it was also found that the majority of adolescents and adults with intellectual disabilities were found to score high. The high test anxiety scores have been justified by the interview responses obtained from the three groups of respondents. A number of factors have been identified to be the major predictors of test anxiety in students with intellectual disabilities.

Memory dysfunction in panic disorder: an investigation of the role of chronic benzodiazepine use

BACKGROUND

Studies of the neurocognitive effects of long-term benzodiazepine use have been confounded by the presence of neurocognitive deficits characterizing the clinical conditions for which these medications are taken. Similarly, studies of the neurocognitive effects of anxiety disorders have been confounded by the inclusion of chronically benzodiazepine-medicated patients. This study was designed to tease apart the potentially confounding effects of long-term benzodiazepine use and panic disorder (PD) on memory and visuoconstructive abilities.

METHODS

Twenty chronically benzodiazepine-medicated and 20 benzodiazepine-free patients with PD with agoraphobia were compared with a group of 20 normal control participants, group-matched for age, education, and gender on a battery of neuropsychological tests assessing short-term, episodic long-term, and semantic memory, as well as visuoconstructive abilities.

RESULTS

Results indicated that benzodiazepine-free panic patients were relatively impaired in nonverbal short-term and nonverbal episodic long-term memory and visuoconstructive abilities, whereas verbal short-term and verbal episodic memory and semantic memory were preserved. Only limited evidence was found for more pronounced impairments in chronically benzodiazepine-medicated PD patients.

CONCLUSIONS

This study provides evidence that patients with PD are characterized by relative impairments in nonverbal memory and visuoconstructive abilities, independent of benzodiazepine use. Nonetheless, we found evidence that chronic treatment with benzodiazepines is associated with intensification of select relative impairments in this realm. Documentation of these deficits raises questions about the broader etiology of neurocognitive impairment in PD as well as its impact on daily functioning.

Effects of anxiety on memory storage and updating in young children

The relationship between trait anxiety and memory functioning in young children was investigated. Two studies were conducted, using tasks tapping verbal and visual-spatial short-term memory (Study 1) and working memory (Study 2) in preschoolers. On the verbal storage tasks, there was a detrimental effect of anxiety on processing efficiency (duration of preparatory intervals) on Word Span. Performance effectiveness (memory span) did not differ between high-anxious and low-anxious children. In the second study, evaluating memory updating in a dual-task context, high-anxious children performed worse than low-anxious children on two verbal working memory tasks. Therefore, when simple verbal storage is required, high-anxious children show only efficiency deficits; when executive demands are higher (i.e., verbal updating) both accuracy and efficiency are impaired. However, on the visual-spatial storage and updating measures, performance did not differ between the two anxiety groups. The results are discussed in the context of the attentional control theory (Eysenck, Derakshan, Santos, & Calvo, 2007).

Executive functioning in offspring at risk for depression and anxiety

BACKGROUND

Executive functioning deficits (EFDs) have been found in adults with major depression and some anxiety disorders, yet it is unknown whether these deficits predate onset of disorder, or whether they reflect acute symptoms. Studies of at-risk offspring can shed light on this question by examining whether EFDs characterize children at high risk for depression and anxiety who are not yet symptomatic.

METHODS

This study examined neuropsychological functioning in a sample of 147 children, ages 6-17 years (M age=9.16, SD=1.82), of parents with major depression (MDD) and/or panic disorder (PD) and of controls with neither disorder. Children were assessed via structured diagnostic interviews and neuropsychological measures.

RESULTS

Although parental MDD and PD were not associated with neuropsychological impairments, presence of current offspring MDD was associated with poorer performance on several executive functioning and processing speed measures. Children with current generalized anxiety showed poorer verbal memory, whereas children with social phobia had more omissions on a continuous performance task.

CONCLUSIONS

Findings suggest that EFDs do not serve as trait markers for developing anxiety or depression but appear to be symptomatic of current disorder.

Impaired spatial navigation in pediatric anxiety

BACKGROUND

Previous theories implicate hippocampal dysfunction in anxiety disorders. Most of the data supporting these theories stem from animal research, particularly lesion studies. The generalization of findings from rodent models to human function is hampered by fundamental inter-species differences. The present work uses a task of spatial orientation, which is known to rely on hippocampal function. Deficits in spatial navigation in anxious children suggest that the hippocampal network involved in spatial orientation is also implicated in anxiety disorders.

METHODS

Thirty-four treatment-naive children with an anxiety disorder (mean 11.00 years +/- 2.54) are compared to 35 healthy age- and IQ-matched healthy children (mean 11.95 years +/- 2.36) on a virtual, computer-based equivalent of the Morris Water Maze task.

RESULTS

Results indicate that children with anxiety disorder exhibit overall impaired performance relative to the comparison group. Anxious children made more heading direction errors and had worse accuracy in completing trials relative to controls.

CONCLUSIONS

The results present novel evidence that spatial orientation deficits occur in pediatric anxiety.

The importance of cognitive phenotypes in experimental modeling of animal anxiety and depression

Cognitive dysfunctions are commonly seen in many stress-related disorders, including anxiety and depression—the world's most common neuropsychiatric illnesses. Various genetic, pharmacological, and behavioral animal models have long been used to establish animal anxiety-like and depression-like phenotypes, as well as to assess their memory, learning, and other cognitive functions. Mounting clinical and animal evidences strongly supports the notion that disturbed cognitions represent an important pathogenetic factor in anxiety and depression, and may also play a role in integrating the two disorders within a common stress-precipitated developmental pathway. This paper evaluates why and how the assessment of cognitive and emotional domains may improve our understanding of animal behaviors via different high-throughput tests and enable a better translation of animal phenotypes into human brain disorders.

Threat interpretation bias as a vulnerability factor in childhood anxiety disorders

The present study examined threat interpretation biases in children 7-12 years of age with separation, social and generalised anxiety disorders (N=15), non-anxious offspring at risk due to parental anxiety (N=16) and non-anxious controls of non-anxious parents (N=14). Children provided interpretations of ambiguous situations to assess cognitive, emotional and behavioural responses. In comparison with non-anxious control children and at-risk children who did not differ from each other, anxious children reported stronger negative emotion and less ability to influence ambiguous situations. These results suggest that threat interpretation bias may be a cognitive factor associated with ongoing childhood anxiety but not a vulnerability factor associated with parental anxiety.

Research review: a neuroscience framework for pediatric anxiety disorders

Across a range of mammalian species, early developmental variations in fear-related behaviors constrain patterns of anxious behavior throughout life. Individual differences in anxiety among rodents and non-human primates have been shown to reflect early-life influences of genes and the environment on brain circuitry. However, in humans, the manner in which genes and the environment developmentally shape individual differences in anxiety and associated brain circuitry remains poorly specified. The current review presents a conceptual framework that facilitates clinical research examining developmental influences on brain circuitry and anxiety. Research using threat-exposure paradigms might most directly integrate basic and clinical perspectives on pediatric anxiety.