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Attentional Bias in Children with Social Anxiety Disorder

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Abstract

Previous research stated a robust attentional bias to threat in adult anxiety. However, the number of studies analyzing attentional biases in clinically anxious children is limited and results are inconsistent. The present study aims to assess attentional biases in children with social anxiety disorder (n = 37) and healthy control children (n = 42) using a free-viewing eye-tracking paradigm. Children viewed different picture pairs consisting of social and non-social stimuli under two conditions (with/without a stressor to activate social threat perception). We found the direction of gaze regarding threatening stimuli to be context-dependent. Both groups showed a hypervigilance-avoidance pattern to angry faces when they were paired with houses. In face–face trials, angry faces were less often initially fixated than neutral or happy faces in both groups. However, schema activation differentially affected initial fixations in angry-neutral face pairs across groups. Children with social anxiety disorder more often initially directed their gaze to angry faces than did healthy control children, indicating a lack of inhibiting threat representations rather than a hypervigilance to threat.

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Notes

  1. Apart from the eye-tracking task and the anxiety questionnaires described below, further tasks and questionnaire measures were performed and administered to reach goals of other project parts (Asbrand et al. 2016): Trier Social Stress Test for Children (TSST-C; Buske-Kirschbaum et al. 1997); Five Minute Speech Sample (FMSS; Magaña et al. 1986); Culture Fair Intelligence Test (CFT 20-R; Weiß 2006); Fear of Negative Child Evaluation (FNCE; Schreier and Heinrichs 2010); Child Behavior Checklist (CBCL; Achenbach 2000); Depression Inventory for Children (DIKJ; Stiensmeier-Pelster 2000); Mini Social Phobia Inventory (Mini-SPIN; Connor et al. 2001); Symptom Checklist K-9 (SCL-K-9, a short form of the SCL-90-R; Derogatis and Unger 2010). Within the frame of a randomized controlled treatment trial, a subset of those questionnaires was administered up to five times (pre, post, follow-ups). The diagnostic procedure and each of the experimental tasks were performed on separate days, with the eye-tracking experiment conducted prior to the intervention program.

  2. Exclusion of invalid data in eye-tracking experiments is rarely reported in clinical studies. The investigation of attentional biases is often based on area of interest (AOI) analysis. According to Holmqvist et al. (2011, pp. 224–225), data offsets are major concerns for AOI analyses. The application of the algorithm described in our paper (level 3 in particular) refers to the suggestions made by Holmqvist et al., concerning how to deal with inaccurate data. As can be seen in Fig. 1, there were three levels of data exclusion. (1) We checked if data were recorded for the full 60 trials. (2) We checked the tracking ratio in the collected gaze data. Participants with a tracking ratio < 80% were excluded. (3) Scan path visualization of four stimulus pairs (balanced regarding position of stimuli, age and gender) was checked for data offset. Participants were excluded if two or more of these four stimulus pairs were rated as invalid (e.g. due to a miscalibration in one corner, drift in the eye-tracker). In this case, AOIs were not hit, although children might have looked at the stimulus.

  3. Following a request from an anonymous reviewer to include reliability of eye movement data in the discussion, reliability estimates for bias scores to threat were calculated post-hoc and added to the manuscript.

  4. The association between the self-reported anxiety level and the attentional bias scores and dwell time was analyzed following another request from an anonymous reviewer post-hoc.

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Funding

This research was supported by a grant from the German Research Foundation (DFG) to Nina Heinrichs (HE 3342/4-2) and Brunna Tuschen-Caffier (TU 78/5-2).

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Authors and Affiliations

  1. Department of Psychology, University of Braunschweig, Brunswick, Germany

    Steffen Schmidtendorf, Susanne Wiedau & Nina Heinrichs

  2. Institute of Psychology, Albert-Ludwigs University of Freiburg, Freiburg, Germany

    Julia Asbrand & Brunna Tuschen-Caffier

  3. Institut für Psychologie, Technische Universität Braunschweig, Humboldtstr. 33, 38106, Brunswick, Germany

    Steffen Schmidtendorf

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  1. Steffen Schmidtendorf
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Correspondence to Steffen Schmidtendorf.

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This work should be part of the cumulative dissertation of Steffen Schmidtendorf, which is supervised by Nina Heinrichs.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schmidtendorf, S., Wiedau, S., Asbrand, J. et al. Attentional Bias in Children with Social Anxiety Disorder. Cogn Ther Res 42, 273–288 (2018). https://doi.org/10.1007/s10608-017-9880-7

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