A comparison of selective attention and facial processing biases in typically developing children who are high and low in self-reported trait anxiety

Anxious youth and adults share threat-biased interpretations of linguistic and visual ambiguity: A proof of concept study

Interpretation bias, or the threatening appraisal of ambiguous information, has been linked to anxiety disorder. Interpretation bias has been demonstrated for linguistic (e.g., evaluation of ambiguous sentences) and visual judgments (e.g., categorizing emotionally ambiguous facial expressions). It is unclear how these separate components of bias might be associated. We examined linguistic and visual interpretation biases in youth and emerging adults with (n = 44) and without (n = 40) anxiety disorder, and in youth-parent dyads (n = 40). Linguistic and visual biases were correlated with each other, and with anxiety. Compared to non-anxious participants, those with anxiety demonstrated stronger biases, and linguistic bias was especially predictive of anxiety symptoms and diagnosis. Age did not moderate these relationships. Parent linguistic bias was correlated with youth anxiety but not linguistic bias; parent and youth visual biases were correlated. Linguistic and visual interpretation biases are linked in clinically-anxious youth and emerging adults.

Facial emotion recognition in adopted children

Children adopted from public care are more likely to experience emotional and behavioural problems. We investigated two aspects of emotion recognition that may be associated with these outcomes, including discrimination accuracy of emotions and response bias, in a mixed-method, multi-informant study of 4-to-8-year old children adopted from local authority care in the UK (N = 42). We compared adopted children's emotion recognition performance to that of a comparison group of children living with their birth families, who were matched by age, sex, and teacher-rated total difficulties on the Strengths and Difficulties Questionnaire (SDQ, N = 42). We also examined relationships between adopted children's emotion recognition skills and their pre-adoptive histories of early adversity (indexed by cumulative adverse childhood experiences), their parent- and teacher-rated emotional and behavioural problems, and their parents' coded warmth during a Five Minute Speech Sample. Adopted children showed significantly worse facial emotion discrimination accuracy of sad and angry faces than non-adopted children. Adopted children's discrimination accuracy of scared and neutral faces was negatively associated with parent-reported behavioural problems, and discrimination accuracy of angry and scared faces was associated with parent- and teacher-reported emotional problems. Contrary to expectations, children who experienced more recorded pre-adoptive early adversity were more accurate in identifying negative emotions. Warm adoptive parenting was associated with fewer behavioural problems, and a lower tendency for children to incorrectly identify faces as angry. Study limitations and implications for intervention strategies to support adopted children's emotion recognition and psychological adjustment are discussed.

Understanding de novo onset of anxiety during COVID-19: Pre-pandemic socio-emotional functioning in vulnerable children

Background

There is a need to understand and mitigate the psychological impacts of the COVID-19 pandemic for children known to be vulnerable. Data from prior to the pandemic are required to provide robust assessments of the socio-emotional impacts of COVID-19 and identify those who are more vulnerable.

Method

This study capitalises on an ongoing UK study of primary school children (4-8 years) identified prior to the pandemic as "at risk" for mental health problems by teachers. We collected mental health and social-emotional functioning data prior to the pandemic (Time 1) and re-assessed this cohort (N = 143) via researcher-led videocalls during lockdown (Time 2, summer 2020) and post-lockdown, 12 months later (Time 3; summer 2021).

Results

Mental health problems, particularly clinically significant anxiety, increased from 34% to 43% during lockdown and to 48% post-lockdown. Parental mental health difficulties (anxiety and depression) were prevalent during lockdown (40%) but had decreased 1 year later (20%). Children who developed clinically significant anxiety during the pandemic had impaired socio-emotional functioning at Time 1 (i.e., impaired emotion recognition, low self-esteem and social problems) and a high proportion (44%) had no contact with any peers during lockdown, which may have contributed to their anxiety, especially their school anxiety.

Conclusion

The pandemic appears to have exacerbated anxiety in already vulnerable children. A profile of socio-emotional problems identified a group of children who developed significant anxieties during the pandemic. These socio-emotional processes can be targeted for intervention to mitigate the negative mental health consequences of the pandemic and contribute to resilience in children.

The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis

Cognitive theories have postulated the relational nature of different cognitive biases in the development and maintenance of anxiety disorders. To test this combined cognitive bias hypothesis, this review addressed the following questions: (i) whether different cognitive biases are associated with each other and (ii) whether one bias influences another bias. We identified 36 articles that studied the relationship between cognitive biases (attention, interpretation and memory bias). Of these, 31 studies were entered into two meta-analyses. Sixteen studies were included in the first meta-analysis of the correlation between cognitive bias indices. A further 15 studies were included in another meta-analysis to examine the transfer effects of cognitive bias modification (CBM) to another bias. Both meta-analyses yielded small but significant overall pooled effect sizes after the removal of outliers (r = 0.11 and g = 0.19 respectively). Moderator analyses revealed that the relationship between interpretation and memory bias was significantly stronger than other types of cognitive bias correlations and CBM is more potent in modifying biases when it was delivered in the laboratory compared with online. Our review quantifies the strength of the relationships between biases and transfer effects following CBM, which serves as a basis to further understand the mechanisms underlying biased information processing.

Emotional face expressions recognition in childhood: developmental markers, age and sex effect

Recognizing emotional face expressions in others is a valuable non-verbal communication and particularly relevant throughout childhood given that children's language skills are not yet fully developed, but the first interactions with peers have just started. This study aims to investigate developmental markers of emotional facial expression in children and the effect of age and sex on it. A total of 90 children split into three age groups: 6-7 years old (n = 30); 8-9 years old (n = 30); 10-11 years old (n = 30) took part in the study. Participants were exposed to 38 photos in two exposure times (500 ms and 1000 ms) of children expressing happiness, sadness, anger, disgust, fear and surprise on three intensities, plus images of neutral faces. Happiness was the easiest expression to be recognized, followed by disgust and surprise. As expected, 10-11-year-old group showed the highest accuracy means, whereas 6-7-year-old group had the lowest means of accuracy. Data support the non-existence of female advantage.

Examining the Effects of Stuttering and Social Anxiety on Interpretations of Ambiguous Social Scenarios Among Adolescents

PURPOSE

The proclivity to construe ambiguous information in a negative way is known as interpretation bias, which has been implicated in the onset and/or maintenance of social anxiety. The purpose of this study was to examine group and individual differences in interpretation bias among young people who stutter and their typically fluent peers during the adolescent years when social fears and worries tend to escalate.

METHODS

A total of 99 adolescents (13 to 19 years old) participated, including 48 adolescents who stutter (67% male) and 51 typically fluent controls (68% male). They completed a computerized vignette-based interpretation bias task in which they first read 14 short ambiguous social scenarios (half including a verbal interaction, half including a non-verbal interaction). They were then presented with four possible interpretations of each scenario including two negative interpretations (one target, one foil) and two positive interpretations (one target, one foil). Participants used a 4-point Likert scale to rate how similar in meaning each interpretation was to the original scenario. Participants also completed self-report measures of social and general anxiety, and provided a speech sample for stuttering analysis.

RESULTS

There was no effect of stuttering on interpretations; the adolescents who stutter rated interpretations across both verbal and non-verbal scenarios comparably to the controls, and stuttering severity did not affect interpretation ratings. However, across groups, there was a significant effect of social anxiety such that higher social anxiety was associated with more negative interpretations, and lower social anxiety was associated with more positive interpretations.

DISCUSSION

This study provides preliminary evidence that social anxiety may affect how adolescents interpret ambiguous social cues in verbal and non-verbal scenarios more than stuttering, although more research into how people who stutter process social information is warranted.

Validity of the WISC-V in Youth with Autism Spectrum Disorder: Factor Structure and Measurement Invariance

Objective: Assessment of intellectual abilities in individuals with autism spectrum disorder (ASD) is a core component of a comprehensive diagnostic evaluation. However, relatively limited information is available regarding the validity of one of the most commonly-used measures of intelligence, the Wechsler Intelligence Scale for Children - 5th Edition (WISC-V) in ASD.Method: We investigated the factor structure and measurement invariance of the WISC-V in a sample of 349 children aged 6-16 diagnosed with ASD using single- and multi-group confirmatory factor analysis. The comparison group was the WISC-V standardization sample.Results: A four-index bifactor solution best fit the ASD group data. Measurement invariance analyses indicated support for configural and metric, but not scalar, invariance of the published 5-index structure, suggesting systematic differences in performance among some subscales in ASD. The 7-subtest FSIQ scale had partial scalar invariance after relaxing equality constraints on the Coding and Digit Span subtest intercepts, suggesting sources other than theorized IQ ability contribute to lower scores on these subtests within ASD. The Cognitive Proficiency Index (CPI) failed to demonstrate appropriate fit in baseline models. The General Ability Index (GAI) had full configural, metric, and scalar invariance.Conclusions: Statistical bias on the WISC-V within ASD in processing speed and working memory subtests creates significant limitations for the use of FSIQ and especially CPI index scores in ASD populations. The GAI showed strong measurement properties and should be considered as the preferred indicator of overall intellectual functioning when assessing children with ASD using the WISC-V.

What drives prioritized visual processing? A motivational relevance account

Emotion is fundamental to our being, and an essential aspect guiding behavior when rapid responding is required. This includes whether we approach or avoid a stimulus, and the accompanying physiological responses. A common tenet is that threat-related content drives stimulus processing and biases visual attention, so that rapid responding can be initiated. In this paper, it will be argued instead that prioritization of threatening stimuli should be encompassed within a motivational relevance framework. To more fully understand what is, or is not, prioritized for visual processing one must, however, additionally consider: (i) stimulus ambiguity and perceptual saliency; (ii) task demands, including both perceptual load and cognitive load; and (iii) endogenous/affective states of the individual. Combined with motivational relevance, this then leads to a multifactorial approach to understanding the drivers of prioritized visual processing. This accords with current recognition that the brain basis allowing for visual prioritization is also multifactorial, including transient, dynamic and overlapping networks. Taken together, the paper provides a reconceptualization of how "emotional" information prioritizes visual processing.

The relation between generalized anxiety disorder symptoms and content-specific interpretation biases for auditory stimuli in children

BACKGROUND AND OBJECTIVES

Cognitive theories of fear suggest that biases in interpretation are content-specific: Fearful children should only interpret materials negatively if they are specifically related to the content of their fear. So far, there are only a few studies available that report on this postulated content-specificity of interpretation processes in childhood fear. The goal of this study was to examine interpretation bias and its content-specificity in children with varying levels of Generalized Anxiety Disorder (GAD) symptoms.

METHODS

In an Auditory Interpretation Task (AIT), two words that differ by one phoneme are acoustically blended so that one can hear only one of the words. In the current AIT, we included GAD-related blends, negatively-valenced fear-related blends and positive blends. Multiple-choice (n = 371) or open-ended (n = 295) responses were collected from 666 nonclinical children between 7 and 13 years of age.

RESULTS

Children with higher levels of self-reported GAD showed significantly more negative interpretations of ambiguous GAD-related blends in the multiple-choice version than children with lower levels of GAD. There were no differences when interpreting the other ambiguous blends. This result was not found with the open-ended version.

LIMITATIONS

Effects were relatively small, some GAD-stimuli were sub-optimal, and the task was administered in a classroom setting. Even though we ensured that all children were able to hear all words clearly, this may have impacted the results.

CONCLUSIONS

The findings only partly support the idea that fearful children display cognitive biases specific for fear-relevant stimuli, and more research is needed to replicate the results and test the usability of the AIT.

An Investigation of Executive Functioning in Pediatric Anxiety

Although science's understanding (e.g., etiology, maintaining factors, etc.) of pediatric anxiety and related problems has grown substantially over recent years, several aspects to anxiety in youths remain elusive, particularly with relation to executive functioning. To this end, the current study sought to examine several facets to executive functioning (i.e., cognitive flexibility, inhibition, planning, working memory) within a transdiagnostic sample of youths exhibiting varying degrees of anxiety symptoms. One hundred six youths completed a comprehensive battery, including several self-report measures (e.g., Multidimensional Anxiety Scale for Children [MASC] or MASC-2) and an automated neurocognitive battery of several executive functioning tasks (Intradimensional/Extradimensional [IDED], Stop Signal [SST], Spatial Span [SSP], Stockings of Cambridge [SOC] tasks). Regression analyses indicated that youths exhibiting marked anxiety symptoms demonstrated increased planning time and probability of inhibition compared with youths with minimal or no anxiety symptoms. Youths with marked anxiety symptoms similarly demonstrated better cognitive flexibility (i.e., set shifting) compared with youths with minimal anxiety. In addition, analyses indicated a trend such that youths exhibiting marked anxiety symptoms demonstrated poorer working memory compared with youths with no anxiety symptoms. Group classification did not predict remaining outcomes. Limitations and future areas of research are discussed.

Biases in attention, interpretation, memory, and associations in children with varying levels of spider fear: Inter-relations and prediction of behavior

BACKGROUND AND OBJECTIVES

Cognitive theories suggest that cognitive biases may be related and together influence the anxiety response. However, little is known about the interrelations of cognitive bias tasks and whether they allow for an improved prediction of fear-related behavior in addition to self-reports. This study simultaneously addressed several types of cognitive biases in children, to investigate attention bias, interpretation bias, memory bias and fear-related associations, their interrelations and the prediction of behavior.

METHODS

Eighty-one children varying in their levels of spider fear completed the Spider Anxiety and Disgust Screening for Children and performed two Emotional Stroop tasks, a Free Recall task, an interpretation task including size and distance indication, an Affective Priming Task, and a Behavioral Assessment Test.

RESULTS

We found an attention bias, interpretation bias, and fear-related associations, but no evidence for a memory bias. The biases showed little overlap. Attention bias, interpretation bias, and fear-related associations predicted unique variance in avoidance of spiders. Interpretation bias and fear-related associations remained significant predictors, even when self-reported fear was included as a predictor.

LIMITATIONS

Children were not seeking help for their spider fear and were not tested on clinical levels of spider phobia.

CONCLUSIONS

This is the first study to find evidence that different cognitive biases each predict unique variance in avoidance behavior. Furthermore, it is also the first study in which we found evidence for a relation between fear of spiders and size and distance indication. We showed that this bias is distinct from other cognitive biases.

Impaired Facial Affect Perception in Unaffected Children at Familial Risk for Panic Disorder

Recent studies suggest that impaired processing of facial affect has a familial component and may reflect a marker of liability to psychopathology. This study investigated whether facial affect processing is impaired in offspring with parental panic disorder (PD). Psychiatrically healthy children with parental PD (n = 51) and age and sex matched control children with no parental psychopathology (n = 51) completed a standard facial recognition task. High-risk children made more errors recognizing fearful faces than controls and misattributed fear and angry facial affect as surprised. High-risk females also made more errors recognizing sad faces compared to low risk females and misattributed sadness as fear. No difference emerged for self-rated anxiety while viewing facial expressions. However, self-rated anxiety correlated moderately with misrecognition of fearful facial affect in high-risk children. Overall, our data suggest that the ability to correctly recognize negative facial emotions is impaired in children with parental PD. Further research is needed to confirm if these deficits represent a trait marker of liability for PD and elucidate the contribution of genetic and family environmental influences.

Psychometric properties of reaction time based experimental paradigms measuring anxiety-related information-processing biases in children

Theoretical frameworks highlight the importance of threat-related information-processing biases for understanding the emergence of anxiety in childhood. The psychometric properties of several tasks measuring these biases and their associations with anxiety were examined in an unselected sample of 9-year-old children (N=155). In each task, threat bias was assessed using bias scores reflecting task performance on threat versus non-threat conditions. Reliability was assessed using split-half and test-retest correlations of mean reaction times (RTs), accuracy and bias indices. Convergence between measures was also examined. Mean RTs showed substantial split-half and test-retest correlations. Bias score reliability coefficients were near zero and non-significant, suggesting poor reliability in children of this age. Additionally, associations between bias scores and anxiety were weak and inconsistent and performance between tasks showed little convergence. Bias scores from RT based paradigms in the current study lacked adequate psychometric properties for measuring individual differences in anxiety-related information-processing in children.

Emotion-recognition abilities and behavior problem dimensions in preschoolers: evidence for a specific role for childhood hyperactivity

Facial emotion-recognition difficulties have been reported in school-aged children with behavior problems; little is known, however, about either this association in preschool children or with regard to vocal emotion recognition. The current study explored the association between facial and vocal emotion recognition and behavior problems in a sample of 3 to 6-year-old children. A sample of 57 children enriched for risk of behavior problems (41 were recruited from the general population while 16 had been referred for behavior problems to local clinics) were each presented with a series of vocal and facial stimuli expressing different emotions (i.e., angry, happy, and sad) of low and high intensity. Parents rated children's externalizing and internalizing behavior problems. Vocal and facial emotion recognition accuracy was negatively correlated with externalizing but not internalizing behavior problems independent of emotion type. The effects with the externalizing domain were independently associated with hyperactivity rather than conduct problems. The results highlight the importance of using vocal as well as facial stimuli when studying the relationship between emotion-recognition and behavior problems. Future studies should test the hypothesis that difficulties in responding to adult instructions and commands seen in children with attention deficit/hyperactivity disorder (ADHD) may be due to deficits in the processing of vocal emotions.

Investigating the genetic and environmental bases of biases in threat recognition and avoidance in children with anxiety problems

Background

Adults with anxiety show biased categorization and avoidance of threats. Such biases may emerge through complex interplay between genetics and environments, occurring early in life. Research on threat biases in children has focuses on a restricted range of biases, with insufficient focus on genetic and environmental origins. Here, we explore differences between children with and without anxiety problems in under-studied areas of threat bias. We focused both on associations with anxious phenotype and the underlying gene-environmental correlates for two specific processes: the categorisation of threat faces and avoidance learning.

Method

Two-hundred and fifty 10-year old MZ and DZ twin pairs (500 individuals) completed tasks assessing accuracy in the labelling of threatening facial expressions and in the acquisition of avoidant responses to a card associated with a masked threatening face. To assess whether participants met criteria for an anxiety disorder, parents of twins completed a self-guided computerized version of the Development and Well-being Assessment (DAWBA). Comparison of MZ and DZ twin correlations using model-fitting were used to compute estimates of genetic, shared and non-shared environmental effects.

Results

Of the 500 twins assessed, 25 (5%) met diagnostic criteria for a current anxiety disorder. Children with anxiety disorders were more accurate in their ability to recognize disgust faces than those without anxiety disorders, but were commensurate on identifying other threatening face emotions (angry, fearful, sad). Children with anxiety disorders but also more strongly avoided selecting a conditioned stimulus than non-anxious children. While recognition of socially threatening faces was moderately heritable, avoidant responses were heavily influenced by the non-shared environment.

Conclusion

These data add to other findings on threat biases in anxious children. Specifically, we found biases in the labelling of some negative-valence faces and in the acquisition of avoidant responses. While non-shared environmental effects explained all of the variance on threat avoidance, some of this may be due to measurement error.

Relating Individual Differences in Trait-Anxiety to Memory Functioning in Young Children

There is extensive evidence indicating cognitive biases at several stages of information processing in high-anxious children. Little research, however, has investigated a potential memory bias toward negative information in high-anxious young children. We studied immediate and delayed verbal recall as well as delayed visual recognition in a sample of high-trait-anxious (HA) and low-trait-anxious (LA) preschoolers (N = 76, mean age = 65 months), using stimuli containing task-irrelevant emotional valence (positive, negative, neutral). The findings revealed that, compared to their LA counterparts, HA preschoolers displayed (1) a tendency to be less accurate in the immediate verbal recall task, (2) poorer recall of negative words in the immediate condition and poorer recall of neutral words in the delayed condition, (3) impaired delayed recognition of identities with happy facial expressions and a tendency to better recognize identities expressing anger. Results are discussed considering the dynamic interplay between personality, emotion and cognitive factors during early development.

Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate

Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P  =  .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

Emotion recognition in children with autism spectrum disorders: relations to eye gaze and autonomic state

Respiratory Sinus Arrhythmia (RSA), heart rate, and accuracy and latency of emotion recognition were evaluated in children with autism spectrum disorders (ASD) and typically developing children while viewing videos of faces slowly transitioning from a neutral expression to one of six basic emotions (e.g., anger, disgust, fear, happiness, sadness, and surprise). Children with ASD were slower in emotion recognition and selectively made more errors in detecting anger. ASD children had lower amplitude RSA and faster heart rate. Within the ASD group, children with higher amplitude RSA recognized emotions faster. Less severe ASD symptoms and increased gaze to the eye region in children with ASD were related to more accurate emotion recognition.

Role of attention in the regulation of fear and anxiety

Emotion regulation makes use of specific aspects of attention and executive functions that are critical for the development of adaptive social functioning, and perturbations in these processes can result in maladaptive behavior and psychopathology. Both involuntary and voluntary attention processes have been examined at both the behavioral and the neural levels and are implicated in the maintenance of fearful or anxious behaviors. However, relatively little is known about how these attention processes come to influence emotional behavior across development. The current review summarizes the extant literature on the links between voluntary and involuntary attention processes and the role that these attention processes have in the etiology, maintenance, and regulation of anxious behavior.