Systematic Review and Meta-Analysis: Eye-Tracking of Attention to Threat in Child and Adolescent Anxiety

Abstract Objective Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain on the direction and time-course of anxiety-linked biased attention patterns in youth. A meta-analysis of eye-tracking studies of biased attention for threat was used to compare the presence of an initial vigilance towards threat and a subsequent avoidance in anxious and non-anxious youth. Method PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were: studies including participants ≤18 years; reported anxiety using standardised measures; measured attention bias using eye-tracking with a free-viewing task; comparison of attention towards threatening and neutral stimuli; and available data to allow effect size computation for at least one relevant measure. A random effects model estimated between- and within-group effects of first fixations toward threat and overall dwell time on threat. Results Thirteen eligible studies involving 798 participants showed that neither youth with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youth showed significantly less overall dwell time on threat versus neutral stimuli than non-anxious controls (g=-0.26). Conclusion Contrasting with adult eye-tracking data and child and adolescent data from reaction time indices of attention biases to threat, there was no vigilance bias towards threat in anxious youth. Instead anxious youth were more avoidant of threat across the time-course of stimulus viewing. Developmental differences in brain circuits contributing to attention deployment to emotional stimuli and their relationship with anxiety are discussed.