Attentional bias and physiological stress sensitivity in children and adolescents with an anxiety disorder

Although periods of heightened anxiety are part of normal psychological development (Gullone et al., 2 001; Stevenson-Hinde, & Shouldice, 1995; Westenberg et al., 2 004), a significant proportion of all children and adolescents report anxiety levels above developmentally appropriate levels and in some of these children and adolescents the anxiety levels may be so severe that they can be diagnosed as an anxiety disorder (Verhulst et al., 1997). In childhood and adolescence, anxiety disorders are among the most frequently assigned psychiatric diagnoses (Bernstein & Borchardt, 1991). Based on self reports (Diagnostic Interview Schedule for Children: DISC; Shaffer et al., 1993) the prevalence of anxiety disorders in Dutch adolescents (aged 13-18 years) is approximately 10.5 percent (Verhulst et al., 1997). These disorders may be chronic and substantially disrupt the quality of life and development of the children and adolescents involved (Bastiaansen et al., 2 006; Keller et al., 1992; Ollendick and King, 1994). The most frequently diagnosed anxiety disorders during childhood and adolescence are: Separation Anxiety Disorder, Generalized Anxiety Disorder, and Social Phobia. There may be a developmental trajectory underlying the origin of these anxiety disorders, as the average age of being diagnosed with a Separation Anxiety Disorder seems to be significantly lower than, for instance, Generalized Anxiety Disorder, a disorder becoming more prominent during adolescence (Westenberg et al., 1999, 2 001)

Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

Abstract OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD: Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). RESULTS: Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. CONCLUSIONS: Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial