Bumping heart and sweaty palms: physiological hyperarousal as a risk factor for child social anxiety

How and Why to Add Autonomic Phenotyping and Autonomic Balancing Interventions Into Eating Disorder Treatment

Autonomic assessment has traditionally been used for cardiovascular evaluation, but its applications extend into the field of eating disorders and psychiatry at large. By measuring heart rate, heart rate variability, and electrodermal activity with wearable sensor technology, one can observe state and trait adaptive responses of the parasympathetic and sympathetic nervous systems. Individuals on the anorexia and atypical anorexia nervosa spectrum often present with high heart rate variability, conventionally considered cardioprotective, yet likely maladaptive in these disorders. With this phenotype, it may be advantageous to employ a unique, yet logical therapeutic strategy of enhancing sympathetic response while reducing parasympathetic response. With the integration of autonomic phenotyping (i.e., aggregating psychophysiological indices), data-driven idiographic treatment approaches have the potential to go beyond choosing the most effective psychotherapy for an individual. Determining individual autonomic phenotypes, regardless of eating disorder diagnosis, can augment other idiographic outcomes to inform treatment options and monitor progression of the disorder.

A proof of concept study on digital interventions for reducing socio-evaluative stress and anxiety in youth

Youth often struggle with heightened sensitivity to social judgement, increasing their vulnerability to fear in social situations. This study investigates brief digital interventions aimed at regulating cognitive and affective disturbances related to social anxiety, specifically focusing on fear responses in a social-evaluative threat context. One-hundred-twenty healthy youth were randomly assigned to one of four conditions: attention training, detached mindfulness, slow breathing, or an active control condition. To induce social-evaluative threat, participants delivered a public speech after a 12-min video intervention. We assessed subjective anxiety levels, metacognition, heart rate variability (HRV), and subjective and objective performance ratings throughout the experiment. Results indicated that the slow breathing intervention significantly increased HRV immediately after the intervention, during the public speaking task, and during the recovery and reduced state anxiety immediately after the intervention. In contrast, attention training and detached mindfulness did not yield significant effects, although detached mindfulness did increase HRV immediately post-intervention. These preliminary findings suggest that brief digital interventions, especially slow breathing, may effectively alleviate fear responses in youth during social-evaluative contexts, highlighting their potential as accessible support tools.

The Relations Between Sensory Modulation, Hyper Arousability and Psychopathology in Adolescents with Anxiety Disorders

BACKGROUND

Sensory modulation may play a significant role in psychiatric conditions, including anxiety, and explain arousability levels, behavioral disorders, and functional deficits. Yet, studies about sensory modulation in adolescents with anxiety disorders are scarce.

PURPOSE

To profile the prevalence of sensory modulation difficulties (SMDs) in adolescents with anxiety and examine their relations to arousability and psychopathology. The study compared adolescents with anxiety disorders to healthy controls using physiological measures and self-reports that reflect daily life scenarios. Then, the study examined the relationship between SMDs, arousability, and psychopathological severity in the study group.

METHOD

Participants were 106 adolescents, aged 10.5-18 years and their parents. The study group included 44 participants diagnosed with anxiety disorder by psychiatrists. The control group included 62 healthy participants matched by age and gender to the study group. Parents completed the demographic questionnaire and the Child Behavior Checklist (CBCL). The adolescents completed The Revised Children's Manifest Anxiety Scale (RCMAS) and the Adolescent/Adult Sensory Profile (AASP) and underwent the electrodermal activity (EDA) and pulse rate tests while listening to extreme sensory stimuli of auditory startles.

RESULTS

Based on AASP, the study group had a higher prevalence of SMDs expressed in lower sensory seeking, difficulties in registering sensory stimuli, and higher sensory sensitivity and avoidance. The study group presented higher arousability while listening to the startles as manifested in higher heart rate and EDA responses. The physiological results correlated with SMD levels measured by the AASP self-reports. SMDs correlated with psychopathological severity.

CONCLUSIONS

SMDs may characterize adolescents with anxiety disorders and impact their arousability, symptoms severity, and daily functioning. Therefore, sensory modulation should be evaluated using both self-reports (to reflect implications in real life from patients' own voices) along with objective measures to explain daily behaviors by underlying physiological mechanisms. This may focus intervention towards better health, function, and development.

Physiological correlates of anxiety in childhood and adolescence: A systematic review and meta-analysis

Anxiety is one of the most prevalent problems that affects children and adolescents. The vast majority of diagnostic tools for anxiety depend on written or verbal reports from children and adolescents or their significant others. The validity and reliability of such reports can be compromised by their subjective nature. Thus, there is growing interest in whether anxiety can be indexed with objective physiological measures. The key aim of this systematic review and meta-analysis was to determine which physiological measures are most reliably associated with elevated levels of anxiety amongst children and adolescents. Online databases (e.g., PsycINFO, Embase, Medline) were searched for relevant studies according to pre-determined criteria. Twenty-five studies comprising 2502 participants (N = 1160 with high anxiety) met inclusion, identifying 11 groups of physiological measures. Our meta-analysis revealed that skin conductance level is the most sensitive measure of anxiety (d = 0.83), followed by electromyography (EMG) measures (d = 0.71) and skin conductance response (d = 0.58). However, the included studies varied in terms of subjective measures, study designs, experimental task measures, and physiological measures. Consideration of these differences in methodology offer potential directions for future research.

Genetic and polygenic investigation of heart rate variability to identify biomarkers associated with Anxiety disorders

Given that anxiety disorders (AD) are associated with reduced vagally-mediated heart rate variability (HRV), genetic variants related to HRV may provide insight into anxiety etiology. This study used polygenic risk scores (PRS) to explore the genetic overlap between AD and HRV, and investigated whether HRV-related polymorphisms influence anxiety risk. Resting vagally-mediated HRV was measured using a wearable device in 188 European individuals (AD=101, healthy controls=87). AD PRS was tested for association with resting HRV, and HRV PRS for association with AD. We also investigated 15 significant hits from an HRV genome-wide association study (GWAS) for association with resting HRV and AD and if this association is mediated through resting HRV. The AD PRS and HRV PRS showed nominally significant associations with resting HRV and anxiety disorders, respectively. HRV GWAS variants associated with resting HRV were rs12980262 (NDUFA11), rs2680344 (HCN4), rs4262 and rs180238 (GNG11), and rs10842383 (LINC00477). Mediation analyses revealed that NDUFA11 rs12980262 A-carriers and GNG11 rs180238 and rs4262 C-carriers had higher anxiety risk through lower HRV. This study supports an anxiety-HRV genetic relationship, with HRV-related genetic variants translating to AD. This study encourages exploration of HRV genetics to understand mechanisms and identify novel treatment targets for anxiety.

Heart rate variability: Evaluating a potential biomarker of anxiety disorders

Establishing quantifiable biological markers associated with anxiety will increase the objectivity of phenotyping and enhance genetic research of anxiety disorders. Heart rate variability (HRV) is a physiological measure reflecting the dynamic relationship between the sympathetic and parasympathetic nervous systems, and is a promising target for further investigation. This review summarizes evidence evaluating HRV as a potential physiological biomarker of anxiety disorders by highlighting literature related to anxiety and HRV combined with investigations of endophenotypes, neuroimaging, treatment response, and genetics. Deficient HRV shows promise as an endophenotype of pathological anxiety and may serve as a noninvasive index of prefrontal cortical control over the amygdala, and potentially aid with treatment outcome prediction. We propose that the genetics of HRV can be used to enhance the understanding of the genetics of pathological anxiety for etiological investigations and treatment prediction. Given the anxiety-HRV link, strategies are offered to advance genetic analytical approaches, including the use of polygenic methods, wearable devices, and pharmacogenetic study designs. Overall, HRV shows promising support as a physiological biomarker of pathological anxiety, potentially in a transdiagnostic manner, with the heart-brain entwinement providing a novel approach to advance anxiety treatment development.

Emotional and socio-cognitive processing in young children with symptoms of anxiety

Many children with anxiety disorders exhibit significant and persistent impairments in their social and interpersonal functioning. Two components essential for successful social interaction are empathy and theory of mind (ToM). Both constructs develop rapidly in childhood, but no study has simultaneously examined these skills in young children with emerging mental health problems, including those with symptoms of anxiety. This study investigated empathy and ToM in children with anxiety symptomatology and examined their relationship with anxiety severity. A cross-sectional study was carried out with 174 children aged 4-8 years with emerging mental health difficulties who were referred by school teachers for an assessment because of emotional, cognitive, or behavioural problems at school. Participants completed empathy and ToM tasks. Parents were interviewed and rated children's emotional and behavioural problems. Correlational analyses indicated that elevated anxiety was associated with better cognitive ToM and worse affective empathy; there were no associations between anxiety and either cognitive empathy or affective ToM. Subsequent regression analyses demonstrated that whilst enhanced cognitive ToM was explained by age and verbal IQ, anxiety symptoms uniquely predicted impaired affective empathy. These results indicate that children with symptoms of anxiety have difficulty in sharing in other people's emotions. As a result, they may find it difficult to behave in socially adequate ways in interactions with others that involve affective sharing. These findings encourage the use of early and targeted interventions that improve affective empathy development in children with anxiety symptoms.

Social Anxiety in Neurodevelopmental Disorders: The Case of Fragile X Syndrome

Despite significant advances in understanding and treating social anxiety in the general population, progress in this area lags behind for individuals with intellectual disability. Fragile X syndrome is the most common cause of inherited intellectual disability and is associated with an elevated prevalence rate of social anxiety. The phenotype of fragile X syndrome encompasses multiple clinically significant characteristics that are posed as risk markers for social anxiety in other populations. Here, evidence is reviewed that points to physiological hyperarousal, sensory sensitivity, emotion dysregulation, cognitive inflexibility, and intolerance of uncertainty as primary candidates for underlying mechanisms of heightened social anxiety in fragile X syndrome. A multilevel model is presented that provides a framework for future research to test associations.

Virtual reality for biochemistry education: the cellular factory

Virtual Reality (VR) involves the coupling of visual communication hardware and software. The technology is capable of offering transformative educational practice and is increasingly being adopted within the biochemistry domain to better understand complex biochemical processes. This article documents a pilot study for the efficacy of VR in biochemistry education at undergraduate university level, focusing on the citric acid cycle: a central process for extracting energy in most cellular life forms. 10 participants were equipped with a VR headset and electrodermal activity (EDA) sensors, then immersed within a digital environment where they were able to learn the 8 main steps of the citric acid cycle within a virtual lab by completing 8 levels of activity. Post and pre surveys were taken, along with EDA readings throughout the students' interaction with VR. Research findings support the hypothesis that VR increase students' understanding, particularly if students feel engaged, stimulated and intend to use the technology. Moreover, EDA analysis indicated that the majority of participants demonstrate enhanced engagement in the education-based VR-experience as measured by elevated levels of skin conductance, a marker for autonomic arousal and a measure of engagement in an activity.

Anxiety Sensitivity Social Concerns Predicts Electrodermal Activity during the Niacin Biological Challenge Paradigm

Anxiety sensitivity social concerns (ASSC), or the fear of observable anxiety symptoms, is a risk factor for social anxiety. ASSC predicts anxiety following the niacin biological challenge, a paradigm in which niacin is used to manipulate facial flushing during a speech task. However, it remains unclear if ASSC predicts physiological arousal during this task. The current study was designed to examine the effects of ASSC on self-reported distress and electrodermal activity (EDA) during the niacin biological challenge in a sample of undergraduates (N = 36; M age = 18.9, SD = 0.84; 69.4% female). Participants were randomly assigned to one of four conditions in a 2 (100 mg niacin vs. 100 mg sugar) × 2 (instructional set) design. Participants completed a speech task in a virtual reality environment. Participants rated their distress halfway through the speech and EDA was averaged over four intervals. There was a main effect for ASSC on subjective distress. There was a significant ASSC by condition interaction predicting EDA, in that ASSC was related to EDA only in the niacin condition. ASSC also was more strongly related to EDA anticipating the speech. These findings highlight the role of ASSC in predicting anxiety and physiological arousal.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample

Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.

Vocalization and physiological hyperarousal in infant-caregiver dyads where the caregiver has elevated anxiety

Co-regulation of physiological arousal within the caregiver-child dyad precedes later self-regulation within the individual. Despite the importance of unimpaired self-regulatory development for later adjustment outcomes, little is understood about how early co-regulatory processes can become dysregulated during early life. Aspects of caregiver behavior, such as patterns of anxious speech, may be one factor influencing infant arousal dysregulation. To address this, we made day-long, naturalistic biobehavioral recordings in home settings in caregiver-infant dyads using wearable autonomic devices and miniature microphones. We examined the association between arousal, vocalization intensity, and caregiver anxiety. We found that moments of high physiological arousal in infants were more likely to be accompanied by high caregiver arousal when caregivers had high self-reported trait anxiety. Anxious caregivers were also more likely to vocalize intensely at states of high arousal and produce intense vocalizations that occurred in clusters. High-intensity vocalizations were associated with more sustained increases in autonomic arousal for both anxious caregivers and their infants. Findings indicate that caregiver vocal behavior differs in anxious parents, cooccurs with dyadic arousal dysregulation, and could contribute to physiological arousal transmission. Implications for caregiver vocalization as an intervention target are discussed.

Child-parent cardiac transference is decreased following disrupted/absent early care

Parental input shapes youth self-regulation development, and a lack of sensitive caregiving is a risk factor for youth mental health problems. Parents may shape youth regulation through their influence over biological (including neural) and behavioral development during childhood at both micro (moment-to-moment) and macro (global) levels. Prior studies have shown that micro-level parent-child interactions shape youth's biology contributing to youth mental health. However, it remains unclear whether prior disrupted/absent care affects those moment-to-moment parent-youth interactions in ways that increase risk for youth psychopathology. In the current study, we calculated transfer entropy on cardiac data from parent-youth dyads where the youth had either been exposed to disrupted care prior to adoption or not. Transfer Entropy (TE) tracks information flow between two signals, enhancing quantification of directional coupling, allowing for the examination of parent-child and child-parent influences. Using this novel approach, we identified lower cardiac information transfer from youth-to-parents in dyads where the youth had been exposed to disrupted/absent early care. Moreover we showed that the degree to which the parent's physiology changed in response to youth's physiology was negatively related to the youth's mental health, representing a potential pathway for elevated mental health risk in populations exposed to disrupted/absent early care.

Emotional Reactivity and Regulation in Preschool-Age Children Who Do and Do Not Stutter: Evidence From Autonomic Nervous System Measures

Purpose: This experimental cross-sectional research study examined the emotional reactivity and emotion regulation in preschool-age children who do (CWS) and do not stutter (CWNS) by assessing their psychophysiological response during rest and while viewing pictures from the International Affective Picture System (Lang et al., 2008). Method: Participants were 18 CWS (16 boys and two girls; mean age 4 years, 5 months) and 18 age- and gender-matched CWNS. Participants' psychophysiological responses were measured during two baselines and two picture viewing conditions. Skin conductance level (SCL) and heart rate were measured to assess emotional reactivity. Respiratory sinus arrhythmia (RSA) was measured to assess emotional regulation. Participants' shyness and executive function were assessed via parent report and considered for their effects on participants' psychophysiological responses. Results: First, CWNS and CWS did not differ in their initial baseline SCL, heart rate, or RSA, but all participants had higher SCL and lower RSA in the second baseline, subsequent to the first challenge condition, compared to the first baseline. Second, during the challenge conditions, CWS did not differ from CWNS in their SCL, but showed a significantly higher heart rate than CWNS. Third, CWS exhibited a significantly lower RSA during the challenge conditions compared to CWNS. Lastly, the temperamental quality of shyness was associated with preschool-age children's SCL, such that participants who were rated higher in shyness had a higher SCL during the challenge conditions. Participants' executive function had a marginally significant effect on the RSA, such that the participants who had higher executive function composite scores exhibited lower RSA during the challenge conditions. Conclusions: Our findings suggest that CWS and CWNS did not differ in their emotional reactivity and emotional regulation abilities at rest. During challenge conditions, however, CWS tended to be more emotionally reactive, as indicated by a higher heart rate, and also employed more emotional regulation, indexed by a greater decrease in RSA, compared to CWNS. Preschool-age children's behavior is largely dominated by reactivity, but there is the emergence of regulation, which can help children adjust to various contextual demands. For CWS who are more emotionally reactive, regulatory skills may be particularly critical to their prognosis and treatment.

Autonomic Nervous System Response to Speech Production in Stuttering and Normally Fluent Preschool-Age Children

Purpose We studied speech-related sympathetic nervous system arousal of preschool-age children who do (CWS) and do not stutter (CWNS) and its association with children's proclivity to experience negative emotions and children's self-reported attitudes toward speaking. Method Electrodermal activity measures were collected from 32 preschool-age children while they engaged in a picture description and a nonword repetition task. Children's proclivity to experience negative emotions was assessed with a parent report questionnaire. Children's communication attitude was assessed with a self-report questionnaire. Results CWS did not differ from CWNS in their sympathetic arousal during a picture description task. However, during a more challenging nonword repetition task, preschool-age CWS had a higher sympathetic arousal level than CWNS. Although CWS were rated by their caregivers as more fearful and prone to sadness, children's tendency to experience stronger and more frequent negative emotions was not associated with their sympathetic arousal during speaking. Lastly, although CWS had a more negative communication attitude than CWNS, it was not associated with their level of sympathetic arousal during speaking. Conclusions Our findings suggest that age-appropriate social communication tasks are not inherently more stressful for preschool-age CWS and are not associated with state-related stress or anxiety that is often reported for adults who stutter. However, speaking tasks that place a higher demand on children's cognitive-linguistic system may be more taxing and challenging to preschool CWS than CWNS, leading to a higher level of arousal.

Intergenerational transmission of attentional bias and anxiety

Earlier evidence has revealed a bi-directional causal relationship between anxiety and attention biases in adults and children. This study investigated the prospective and concurrent relations between anxiety and attentional bias in a sample of 89 families (mothers, fathers, and first-born children). Parents' and children's attentional bias was measured when children were 7.5 years old, using both a visual probe task and visual search task with angry versus happy facial expressions. Generalized and social anxiety symptoms in parents and children were measured when children were 4.5 and 7.5 years old. Anxiety in parents and children was prospectively (but not concurrently) related to their respective attentional biases to threat: All participants showed a larger attentional bias to threat in the visual search (but not in the visual probe) task if they were more anxious at the 4.5 (but not at the 7.5) year measurement. Moreover, parents' anxiety levels were prospectively predictive of the visual search attentional bias of their children after controlling for child anxiety. More anxiety in mothers at 4.5 years was related to a faster detection of angry among happy faces, while more anxiety in fathers predicted a faster detection of happy among angry faces in children at 7.5 years. We found no direct association between parental and child attentional biases. Our study contributes to the recently emerging literature on attentional biases as a potential mechanism in the intergenerational transmission of anxiety by showing that parents' anxiety rather than parents' attentional bias contributes to the intergenerational transmission of risk for child anxiety.

Stress reactivity in healthy child offspring of parents with anxiety disorders

Several studies suggest that anxiety disorders (AD) involve dysregulation of the autonomic nervous system (ANS) and hypothalamic-pituitary (HPA) axis. However, it is unknown if alterations in these biological systems are premorbid markers of AD risk or a state-dependent feature of anxiety. This study examined ANS and HPA-axis response to a laboratory stressor in healthy child offspring of parents with (n = 55) and without (n = 98) a history of AD. High frequency heart rate variability (HF-HRV) was assessed during sitting and standing baseline conditions and during a speech task where participants remained standing. Salivary cortisol was measured at baseline and at 15, 30, 45 and 60 min post-speech. Subjective anxiety was assessed with a visual analogue scale. Children of parents with AD displayed reduced HRV and a blunted cortisol response to the speech task compared to children of non-anxious parents. No risk group effect was found for anxiety ratings. These preliminary data suggest that healthy children of anxious parents exhibit altered stress reactivity to an acute laboratory stressor. Further research is needed to confirm findings and identify mechanisms that may account for altered self-regulation processes to a stressor in children at familial risk for AD.

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version

BACKGROUND

There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation.

METHODS

K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients.

RESULTS

A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders.

CONCLUSIONS

The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.