Attention Alterations in Pediatric Anxiety: Evidence from Behavior and Neuroimaging

Abstract Background Pediatric anxiety disorders involve greater capture of attention by threatening stimuli. However, it is not known if disturbances extend to non-threatening stimuli, as part of a pervasive disturbance in attention-related brain systems. We hypothesized that pediatric anxiety involves greater capture of attention by salient, non-emotional stimuli, coupled with greater activity in the portion of the inferior frontal gyrus (IFG) specific to the ventral attention network (VAN). Methods A sample of children (n=129, 75 females, MAge=10.6), approximately half of whom met criteria for a current anxiety disorder, completed a task measuring involuntary capture of attention by non-emotional (square boxes) and emotional (angry and neutral faces) stimuli. A subset (n=61) completed a task variant during fMRI. A priori analyses examined activity in functional brain areas within the right IFG, supplemented by a whole-brain, exploratory analysis. Results Higher clinician-rated anxiety was associated with greater capture of attention by non-emotional, salient stimuli (F(1,125)=4.94, p=.028) and greater activity in the portion of the IFG specific to the VAN (F( 1 , 57 )=10.311, p=.002). Whole-brain analyses confirmed that the effect of anxiety during capture of attention was most pronounced in the VAN portion of the IFG, along with additional areas of the VAN and the default mode network. Conclusions The pathophysiology of pediatric anxiety appears to involve greater capture of attention to salient stimuli, as well as greater activity in attention-related brain networks. These results provide novel behavioral and brain-based targets for treatment of pediatric anxiety disorders.