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.
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.
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