Anxiety disorders are commonly acquired during childhood, and early onset is associated with increased severity and risk for long-term mental health problems.. A number of theorists suggest that anxiety disorders are acquired and maintained due to the interaction of individual differences and environmental factors. The literature has identified significant variation among information processing styles between anxious and non-anxious children, with anxious children demonstrating a range of interpretation, memory and attention biases that influence their response to fear related stimuli and associated threat and safety cues. Whilst individual variation may make some children more susceptible to the acquisition of anxiety, this risk is amplified when occurring in concert with certain environmental variables, such as parental style.  Parental factors known to influence the acquisition of anxiety include overcontrolling and critical parenting, however, the implications of these factors as they relate to treatment, particularly parenting, is less clear and findings are often disparate.  This symposium addresses cognitive and parental factors that influence anxiety disorders in children and adolescents, and their impact on treatment outcome. The symposium brings together an international group of researchers from Macquarie University, Australia, Reading University, and Oxford University, UK.  Four studies will be presented examining: discriminatory indirect fear learning in anxious and non-anxious children; the influence of cognitive biases on worry in anxious adolescents; anxiety related attention biases towards emotional faces ; the influence of family interactions (domains) on treatment outcomes. The studies provide novel insights into the development of anxiety and have implications for future research and interventions.

Presenters: Jodie Anagnos, Suzannah Stuijfzand, Jonathan Hill, and Annabel Songco, Discussant:  Helen Dodd

Oxford University, UK; Macquarie University, Australia; Reading University, UK

The impact of maternal behaviours on fear reduction during an indirect fear learning task with anxious and non-anxious children

 Authors: Jodie Anagnos, Carol Newall, and Jennie Hudson, Centre for Emotional Health, Macquarie University, Australia

Previous research has indicated that mothers of anxiety disordered (AD) children display anxiogenic behaviours towards their offspring during anxiety provoking tasks, and often promote avoidant solutions to problems. Other findings suggest that AD children demonstrate impaired fear learning and display difficulty inhibiting a fear response in the presence of safety cues. Theoretical models of fear learning suggest that intra-individual differences, such as impaired response to safety cues may interact with environmental factors (e.g., maternal behaviour) to influence the course of anxiety. The interaction between maternal behaviour and impaired reduction of fear in AD and nonAD children is examined in the present study. Mothers were tasked with reducing fear in their children and facilitating behavioural approach, following the child’s acquisition of fear to a novel animal stimulus using an indirect fear learning paradigm. Findings indicated that mothers of AD children compared to mothers of nonAD children exhibited heightened rates of reassurance statements and reduced frequency of encouragement to approach. AD children maintained increased levels of fear compared to nonAD children on cognitive and behavioural measures of fear following interaction with their mothers. Implications for treatment are considered.

Cognitive Biases and Adolescent Worry 

Authors: Ms. Annabel Songco and Professor Elaine Fox, Department of Experimental Psychology, University of Oxford

Key words: Worry, Adolescents, Cognitive biases, Information-processing

Worry is a common phenomenon in adolescents, yet some young people experience excessive worries that cause significant distress and interference in their daily lives. This pathological worry is a risk factor for a range of negative developmental outcomes and is a defining feature of generalized anxiety disorder (GAD). Whilst the literature on worry and GAD in adults is well established, there is a relatively small body of research examining the mechanisms underlying the development and maintenance of adolescent worry. The present study investigated how cognitive biases such as attention, interpretation and memory bias are associated with worry in adolescents. Participants were 504 adolescents aged 11 to 14 (mean age= 12.9) who completed cognitive processing tasks and self-report measures. This study is part of a three-wave longitudinal study (CogBIAS-L-S) and data presented are from time-point one. The results showed that interpretation bias and memory bias were important information processing biases associated with adolescent worry. Negative interpretations of ambiguous social scenarios (beta = 0.12, p <.05) and non-social scenarios (beta = 0.10, p <.05) were related to high worry, whilst positive interpretations of ambiguous social scenarios were related to low worry (beta = -0.14, p <.05). In addition, negative memory bias was significantly associated with high worry (beta = 0.18, p <.05). A better understanding of how these cognitive biases operate during adolescence has important implications for identifying the mechanisms to target during treatments and early interventions in adolescent populations.  

This work was supported by the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007–2013)/ERC grant agreement no: [324176].

Anxiety Differences in Visual Attention to Emotional Faces in Four to Eight-year-olds 

Authors: Suzannah Stuijfzand, Bobby G. Stuijfzand, Shirley Reynolds, and Helen F. Dodd

There is robust evidence of an attention bias-anxiety relationship in children. However, there is a paucity of studies with children below 8-years-old due to a lack appropriate measures of attention bias. This study uses a new child friendly eye-tracking task to investigate whether anxiety related attention biases exist in children aged 4 to 8 years. A community sample of 104 children split into high and low anxious groups completed the task. Children viewed happy-neutral and angry-neutral face pairs. Initial analyses found vigilance to emotional faces in all children and young children looked less at angry faces. Growth curve analyses revealed a moderation by age where younger and older children show differences in the nature of anxiety related biases. Effortful control influenced withdrawal from faces. Results highlight the importance of considering developmental factors in the anxiety-attention bias relationship and have implications for the age appropriateness of anxiety treatments targeting attention bias. 

Parent-adolescent interactional predictors of poor outcome for on-line CBT for anxiety disorders

Authors: Jonathan Hill, Polly Waite, Cathy Creswell, University of Reading, UK

Background

We suggest there are four kinds of parent-child interactions (domains) focused on safety, attachment, discipline and exploration, and that problem solving is reduced where the identity of domains is unclear (Hill et al 2003). We predicted that low domain clarity would be associated with poorer treatment outcome for adolescent anxiety disorders.

Method

33 adolescents aged 13 – 16 with DSM-IV anxiety disorder were randomized to immediate or delayed on-line CBT and followed at 6 months (N = 31). Parent-adolescent interactions were assessed at baseline using three mildly anxiety provoking tasks (Waite & Creswell 2015). Intrusiveness, warmth and total domain unclear sequences were rated by psychology graduates (all ICCs >= .78). Measures included CGAS, and parent and child reported SCAS and CAIS.

Results

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Discussion

The findings provide initial evidence that domain unclear parent-child interactions are associated with poorer outcomes for on-line CBT for adolescent anxiety disorders.

Conclusions

Larger controlled studies are required to determine whether domain clarity moderates treatment effects for adolescent anxiety disorders and if so whether a domains based intervention improves outcomes.