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

doi:10.1016/j.jaac.2019.06.006

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 59, Issue 1, January 2020, Pages 88-99.e1

https://doi.org/10.1016/j.jaac.2019.06.006 Get rights and content

Objective

Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain regarding 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 toward threat and a subsequent avoidance in anxious and nonanxious youths.

Method

PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were as follows: studies including participants ≤18 years of age; reported anxiety using standardized measures; measured attention bias using eye tracking with a free-viewing task; comparison of attention toward 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 youths with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youths showed significantly less overall dwell time on threat versus neutral stimuli than nonanxious 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 toward threat in anxious youths. Instead, anxious youths 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.

Section snippets

Eligibility Criteria

We included studies that met the following criteria: (1) Because of practical considerations relating to translation, and because the majority of biomedical literature is published in English-language journals,²⁵ with no clear systematic bias of such language restriction in trials reported in conventional medicine,²⁶ the study had to be available in English. (2) The study must be an original investigation. (3) The study must investigate human participants ≤18 years of age. (4) The study must

Search Results

Figure 1 illustrates the literature search and study selection process. Initial searches identified 3,871 studies. After removing duplicates, this was reduced to 1,818 studies. After excluding by abstract, this number was reduced to 29 studies. Full-text screening resulted in exclusion of 16 more studies, resulting in 13 eligible studies.

Study Characteristics

Study characteristics are displayed in Table 1.36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 The entire data set was scanned for outliers; these were

Discussion

This first meta-analysis of eye-tracking measures of attention bias in child and adolescent anxiety included data from 798 participants aged 3 to 18 years across 13 studies. A significantly greater tendency to direct first fixations on threatening over neutral stimuli did not characterize or differentiate anxious and nonanxious children or adolescents. Instead, anxious youths showed a greater tendency to avoid maintaining their gaze on threat compared to nonanxious youths, a difference that

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Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.
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: Mr. Lisk is supported by a UK Medical Research Council studentship (MR/K50130X/1) and the European Commission FP7 Braintrain grant (602186). Dr. Lau has received funding from the UK Medical Research Council (MR/N006194/1).

: This article is part of a special series devoted to the subject of anxiety and OCD. The series covers current topics in anxiety and OCD, including epidemiology, translational neuroscience, and clinical care. The series was edited by Guest Editor Daniel A. Geller, MBBS, FRACP.

: Disclosure: Dr. Bar-Haim has active competitive grants from the U.S. Department of Defense, the US-Israel Binational Science Foundation, the Israel Science Foundation, and JOY Ventures. Dr. Lau has active competitive grants from the British Academy and Mental Health Research UK. Mr. Lisk, Ms. Vaswani, and Ms. Linetzky have reported no biomedical financial interests or potential conflicts of interest.

View full text

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

Objective

Method

Results

Conclusion

Section snippets

Eligibility Criteria

Search Results

Study Characteristics

Discussion

Behav Res Ther

Clin Psychol Rev

Clin Psychol Rev

Behav Res Ther

Clin Psychol Rev

Brain Cogn

J Behav Ther Exp Psychiatry

Eur J Vasc Endovasc Surg

Dev Cogn Neurosci

J Behav Ther Exp Psychiatry

Biol Psychol

J Affect Disord

Psychol Bull

J Anxiety Disord

Psychiatry Res

J Affect Disord

J Behav Ther Exp Psychiatry

Clin Psychol Rev

Trends Cogn Sci

Psychiatr Clin North Am

Clin Psychol Rev

Biol Psychol

J Anxiety Disord

J Behav Ther Exp Psychiatry

Behav Res Ther

Depression and Other Common Mental Disorders: Global Health Estimates

Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

Arch Gen Psychiatry

Attentional bias in emotional disorders

J Abnorm Psychol

Annual research review: An expanded account of information-processing mechanisms in risk for child and adolescent anxiety and depression

J Child Psychol Psychiatry

Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study

Psychol Bull

Anxiety and cognitive performance: attentional control theory

Emotion

Brief report time course of attentional bias for threat scenes: testing the vigilance-avoidance hypothesis

Cogn Emot

Do threatening stimuli draw or hold visual attention in subclinical anxiety?

J Exp Psychol Gen

Attentional bias for threat: evidence for delayed disengagement from emotional faces

Cogn Emot

Cognitive Psychology and Emotional Disorders

Orienting and maintenance of gaze to facial expressions in social anxiety

J Abnorm Psychol

Eye tracking methodology: theory and practice

Identifying fixations and saccades in eye-tracking protocols. Proceedings of the 2000 Symposium on Eye Tracking Research & Applications

ACM

Attention trajectories, mechanisms and outcomes: at the interface between developing cognition and environment

Dev Sci

Age-related changes in attentional control across adolescence: how does this impact emotion regulation capacities?

Front Psychol

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