Early childhood temperament, particularly behavioral inhibition (BI), is seen as an expression of a child's biologically based reaction tendencies to novelty and threat. Behaviorally inhibited children have difficulty with peer interactions and exhibit withdrawal in novel social situations. In addition, BI children are at increased risk for anxiety in adolescence and into young adulthood. While research has helped identify the most at-risk children, due to extreme temperament, environmental risk factors, or biological vulnerabilities, we do not have strong interventions that may help ameliorate risk. Indeed, front-line or gold-standard interventions such as cognitive-behavioral therapy (CBT) have remittance rates of only 50%. The adult literature suggests that targeting attention biases to threat may help lessen anxious behaviors in at-risk children. This work builds on cognitive theories of anxiety that focus on information processing biases as well as empirical research suggesting that attention biases to threat may play a causal role in the emergence of anxiety. Indeed, recent work has found that attention bias modification (ABM) protocols that train attention away from threat decrease anxious symptoms and improve an individual's response to a laboratory stressor. Previous work has shown numerous biobehavioral parallels between BI and anxiety, and new studies emerging in the last two years also find that BI children show attention biases to threat. The current study will for the first time examine the efficacy of a multi-week ABM protocol with children at temperamental risk for anxiety. To examine the breath of the potential ABM effect the study will assess biobehavioral correlates of BI and anxiety at baseline and after intervention (outcome). These markers include event-related potential (ERP) response to attention bias, the neural correlates (via fMRI) of attention bias, right frontal encephalogram (EEG) asymmetry at rest, social behavior in an encounter with an unfamiliar same-age, same-sex peer, and finally, parental- and self-report of anxious symptomotology. Three groups of 9 to 12-year-old children will participate: BI children who will undergo an active ABM protocol (BI-ABM), BI children undergoing an attention placebo (BI-Placebo) and non- inhibited children who will also experience a placebo (non-BI-Placebo). It is our expectation that both BI groups will display a biobehavioral pattern of risk at baseline. However, post-ABM we predict that the BI-ABM group will show less risk than their BI-Placebo counterparts and may even be comparable to the non-BI- Placebo group. If successful, this proof of concept study will provide evidence for a novel intervention that is portable, efficient, easily-implemented and can be used with very young children. This would broaden our ability to ameliorate suffering and broaden access to treatment across geographic location, socioeconomic status, and age.

Public Health Relevance

Anxiety greatly limits a child's social functioning and can produce a two to three-fold increase in risk for anxiety or depression in adulthood. As such, we need effective treatments that are easily implemented, are appropriate for use with children, and can be applied in an efficient and broad-based manner. The current study will examine the impact of a computer-based intervention targeting attention biases to threat in children at risk for anxiety due to extreme temperament.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1-ERB-L (04))
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Wagner, Ann
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Pennsylvania State University
Schools of Arts and Sciences
University Park
United States
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Abend, Rany; de Voogd, Leone; Salemink, Elske et al. (2018) Association between attention bias to threat and anxiety symptoms in children and adolescents. Depress Anxiety 35:229-238
Morales, Santiago; Taber-Thomas, Bradley C; Pérez-Edgar, Koraly E (2017) Patterns of attention to threat across tasks in behaviorally inhibited children at risk for anxiety. Dev Sci 20:
Fu, Xiaoxue; Taber-Thomas, Bradley C; Pérez-Edgar, Koraly (2017) Frontolimbic functioning during threat-related attention: Relations to early behavioral inhibition and anxiety in children. Biol Psychol 122:98-109
Taber-Thomas, Bradley C; Morales, Santiago; Hillary, Frank G et al. (2016) ALTERED TOPOGRAPHY OF INTRINSIC FUNCTIONAL CONNECTIVITY IN CHILDHOOD RISK FOR SOCIAL ANXIETY. Depress Anxiety 33:995-1004
Morales, Santiago; Pérez-Edgar, Koraly; Buss, Kristin (2016) Longitudinal relations among exuberance, externalizing behaviors, and attentional bias to reward: the mediating role of effortful control. Dev Sci 19:853-62
Morales, Santiago; Fu, Xiaoxue; Pérez-Edgar, Koraly E (2016) A developmental neuroscience perspective on affect-biased attention. Dev Cogn Neurosci 21:26-41
Cole, Claire E; Zapp, Daniel J; Fettig, Nicole B et al. (2016) Impact of attention biases to threat and effortful control on individual variations in negative affect and social withdrawal in very young children. J Exp Child Psychol 141:210-21
Thai, Nhi; Taber-Thomas, Bradley C; Pérez-Edgar, Koraly E (2016) Neural correlates of attention biases, behavioral inhibition, and social anxiety in children: An ERP study. Dev Cogn Neurosci 19:200-10
Guyer, Amanda E; Jarcho, Johanna M; Pérez-Edgar, Koraly et al. (2015) Temperament and Parenting Styles in Early Childhood Differentially Influence Neural Response to Peer Evaluation in Adolescence. J Abnorm Child Psychol 43:863-74
Reeb-Sutherland, Bethany C; Rankin Williams, Lela; Degnan, Kathryn A et al. (2015) Identification of emotional facial expressions among behaviorally inhibited adolescents with lifetime anxiety disorders. Cogn Emot 29:372-82

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