Waters, Allison M., Kokkoris, Liza L., Mogg, Karin, Bradley, Brendan P. and Pine, Daniel S. (2009) The time course of attentional bias for emotional faces in anxious children. Cognition and Emotion, 12, (6), 737-753. DOI: 10.1080/02699930903274355 This is an electronic version of an article published in Cognition and Emotion which is available online at: http://www.informaworld.com/smpp/content~db=all~content=a916209399. The time course of attentional bias for emotional faces in anxious children Allison M. Waters1, Liza L. Kokkoris1, Karin Mogg2, Brendan P. Bradley2, & Daniel S. Pine3 1 Griffith University, Australia University of Southampton, UK 3 National Institute of Mental Health, USA 2 Abstract The present study investigated the time course of attentional bias for angry and happy faces in 50 primary school-children (9 to 12 years). That is, the study examined the degree to which an anxiety-related attentional bias was moderated by the duration of threat exposure. Using a visual-probe task, children were shown angry and happy faces paired with neutral ones over two exposure durations: 500 and 1250 ms. Results revealed that higher levels of anxiety were associated with an attentional bias towards angry faces across the 500 ms and 1250 ms exposure durations. There were no effects of children’s anxiety or stimulus exposure duration on attentional bias for happy faces. Results are discussed in relation to threat-monitoring versus vigilance-avoidance patterns of attentional bias, and developmental considerations, including comparison with findings from studies of anxiety-related attentional biases in adults. Keywords: Attentional bias, emotional faces, anxiety, children Anxiety disorders represent one of the most common forms of childhood psychopathology (Michael, Zetsche & Margraf, 2007) and pose significant risk for concurrent and future impairment (Bittner et al., 2007). This suggests the need to understand mechanisms that contribute to the development and/or maintenance of childhood anxiety disorders. Cognitive models (e.g., Mogg & Bradley, 1998; Williams, Watts, MacLeod, & Mathews, 1997) emphasize the role of attentional bias in anxiety. Despite differences among the models, in general, they suggest that (a) anxious individuals disproportionately direct cognitive resources to threat-related stimuli, (b) such biases typically occur at early attentional stages of stimulus processing, and (c) initial orienting of attention to threat may be accompanied by subsequent attentional avoidance of threat in order to regulate anxious mood state. Researchers have commonly used the visualprobe task with emotional words or pictures to examine attentional biases for threat. In this task, paired stimuli (e.g., threat-neutral word pair; angry-neutral face pair) are presented simultaneously on a computer screen. The stimuli then disappear and are followed by a visualprobe presented in the spatial location of one of the stimuli to which participants respond. Faster responsetimes (RTs) to probes replacing threat compared with neutral stimuli reflect an attentional bias toward threat. Consistent with central tenets of cognitive theories of anxiety, numerous studies show that, compared with low anxious adults, anxious adults are 1 faster to respond to probes replacing threatening compared with neutral words or faces presented for short exposure durations (e.g., 500 ms), suggestive of an attentional bias towards threat (Bar-Haim, Lamy, Pergamin, BakermansKranenburg, & van IJzendoorn, 2007). However, evidence regarding the time-course of the bias is mixed (Bar-Haim et al., 2007; Frewen, Dozois, Joanisse & Neufeld, 2008). This has been examined in studies employing exposure durations varying between 100 and 1500 ms. For example, in adults with high trait anxiety and generalized anxiety disorder, the attentional bias towards threat words and faces did not significantly vary across these exposure durations (e.g., 100-1500 ms for threat words; 500-1250 ms for angry faces), with no evidence of avoidance of threat at longer durations (e.g., Bradley, Mogg, Falla, & Hamilton, 1998; Bradley, Mogg, White, Groom, & de Bono, 1999; Mogg, Bradley, de Bono, & Painter, 1997). In contrast, in adults with social phobia, the attentional bias for angry faces dissipated over time: i.e., they showed initial bias towards angry faces at 500 ms, but did not differ from non-anxious individuals at 1250 ms (Mogg, Philippot & Bradley, 2004). Studies employing other aversive pictures (e.g., attack, injury) found initial bias towards threat at short durations (500 ms), followed by subsequent avoidance at longer durations (1250-1500 ms) in adults with high trait anxiety (Koster, Verschuere, Crombez, & Van Damme, 2005) and blood-injury fear (Mogg, Bradley, Miles, & Dixon , 2004). One recent meta-analysis, albeit based only on adult studies, suggested that anxiety is characterized by an initial threat attentional bias (≤ 500 ms) which dissipates over time (≥ 1000 ms), such that high and low anxious adults do not consistently differ in attentional bias at longer exposures (Frewen et al., 2008). A growing literature has emerged on attentional bias for threat in childhood anxiety (see Muris & Field, 2008), although results have been inconsistent. For example, of six published studies examining attentional biases for angry faces at 500 ms, four reported a bias towards threat in childhood anxiety (e.g., Roy et al., 2008; Telzer et al., 2008; Waters, Mogg, Bradley, & Pine, 2008; Watts & Weems, 2006), whereas two unexpectedly revealed attentional avoidance of threat (e.g., Pine et al., 2005; Monk et al., 2006). However, these discrepant findings may be due to specific sample and experimental characteristics of those studies: maltreated children with post-traumatic stress disorder (PTSD) may engage in attentional avoidance of angry faces to avoid soliciting further harm (Pine et al., 2005); and the clinically anxious adolescents in Monk et al.’s (2006) study may have avoided threat due to the stressful nature of being assessed in an fMRI scanner. Furthermore, because of children’s relatively slow processing capabilities, other studies have utilized longer exposure durations than typically employed in studies of adults (e.g. 1000-1500 ms). Even with such relatively long presentations, several of these studies have found attentional vigilance for threat words in clinically anxious children (e.g., Dalgleish et al., 2003; Hunt, Keogh, & French, 2007; Taghavi, Neshat-Doost, Moradi, Yule, & Dalgleish, 1999; Vasey, Daleiden, Williams, & Brown, 1995) and test-anxious schoolchildren (Vasey, El-Hag, & Daleiden, 1996). However, studies using pictorial stimuli at longer exposures show mixed results e.g., in one study, clinically anxious children showed greater attentional bias for assorted threat scenes (at 1250 ms) than non-anxious children (Waters, Wharton, Zimmer-Gembeck, & Craske, 2008), whereas both anxious and non-anxious groups showed a threat bias in another study (Waters, Lipp, & Spence, 2004). Regarding non-clinical anxiety in schoolchildren, one study found that higher social anxiety was associated with greater attentional avoidance of negative faces (at 1000 ms) relative to neutral faces (Stirling, Eley, & Clark, 2006), whereas another found that higher trait anxiety was associated with greater bias towards negative faces (schematic faces at 1000 ms; HeimDreger, Kohlmann, Eschenbeck & Burkhardt, 2006). Thus, findings from studies with longer exposure durations have similarly been inconsistent and this may also be related to sample and experimental differences across studies. It is therefore difficult to draw firm conclusions about the time course of attentional bias in anxious children when there has been wide variation not only in the exposure durations utilized but also in the nature of the samples studied (e.g. clinical status, type of anxiety, age), the stimuli employed, and the experimental context. A study is needed that directly investigates the time course of the anxiety-related attentional bias using both short and long exposure durations within the same 2 sample of children assessed in the same testing environment, using the same stimuli. In the present study, we assessed attentional biases for angry and happy faces at both 500 and 1250 ms in children. The 500 ms exposure duration has been used widely in adult work (Bar-Haim et al., 2007) and, to a lesser extent, in child studies that have found both attention biases towards (Roy et al., 2008; Telzer et al., 2008; Waters, Mogg et al., 2008; Watts & Weems, 2006) and away (Monk et al., 2006; Pine et al., 2005) from angry faces. We also assessed attentional biases later in the time course with a 1250 ms exposure duration, because it allows direct comparison with both adult research (e.g., 1250 ms: Bradley et al., 1998; Koster et al., 2005; Mogg, Philippot et al., 2004) and child studies using similar durations (e.g.,1250 ms: Vasey et al., 1995, 1996; Waters et al., 2004; Waters, Wharton et al., 2008; 1000 ms: Heim-Dreger et al., 2006; Stirling et al., 2006; 1500 ms: Dalgleish et al., 2003).We sought to clarify whether nonclinical anxiety in children is associated with maintained attention to threat faces (Heim-Dreger et al., 2006) or subsequent attentional avoidance (Stirling et al., 2006). It was not feasible to assess more than two stimulus durations, because this would have made the task unacceptably long for young children. Based on previous theoretical and empirical work (e.g., Bar-Haim et al., 2007; Frewen et al., 2008), our primary hypothesis was that, in a normal sample of school-children, higher levels of anxiety would be associated with a greater attentional bias towards angry faces relative to neutral faces. Furthermore, if the bias is similar to that found in adults, children with high-normal levels of anxiety should show an attentional bias towards angry, relative to neutral, faces; whereas those with low-normal levels of anxiety should show no attentional bias (cf., Bradley et al., 1998; Bar-Haim et al., 2007). Regarding the time course of the bias, several different outcomes are possible. According to a recent meta-analysis and connectionist model (Frewen et al., 2008), the anxiety-related attentional bias should dissipate across the two exposure conditions: 500-1250 ms. However, according to another meta-analysis (Bar-Haim et al., 2007) and subsequent research in children (Heim-Dreger et al., 2006), the attentional bias should not vary across these exposure conditions in anxious individuals. Another possibility is that the anxietyrelated bias may switch from an initial bias towards angry faces at 500 ms (Telzer et al., 2008) to attentional avoidance at the longer exposure duration (Stirling et al., 2006). Predictions about the time course are made with caution, given limited and mixed evidence [e.g., there were no child studies in Frewen et al.’s (2008) meta-analysis, and only two child studies used pictorial stimuli in Bar-Haim et al.’s (2007, p. 15) meta-analysis]. A secondary aim was to assess the time course of attentional bias for happy faces. Previous research suggests that low anxious individuals have a greater attentional bias for positive stimuli than high anxious individuals (Frewen et al., 2008). These authors suggest that this positive bias may be acquired as a result of low anxious individuals having greater exposure to positive stimuli during early development. However, there is inconsistent evidence of attentional biases for positive stimuli in low and high anxious children (e.g., Roy et al., 2008; Waters, Mogg et al., 2008; Waters et al., 2004) and the time course of the bias for happy faces has never been assessed in prior studies. Based on Frewen et al. (2008), we predicted a greater attentional bias for happy faces in low than high anxious children and did not expect this bias to vary across the two exposure durations. Method Participants Participants were 50 children recruited from a local primary school (22 males; 28 females), aged 9.0 to 12.1 years (M = 10.8, SD = 1.1). None had participated in prior research. Ninety-six percent were born in Australia, 2% in the UK and 2% in Chile. For 76% of children, marital status of parents was reported as married, 6% divorced, 6% separated, 8% de facto and 4% single-never married. Eighty-two percent of participants lived with both parents while the remaining 18% lived with their mother only. Parents’ occupational status was assessed using the Daniel Prestige Scale (Daniel, 1983), a measure of Australian occupational prestige (0 = high to 7 = low), which indicated that children came from average-income Australian families (i.e., M = 4.12 (SD = 1.08) and M = 4.03 (SD = 1.11) for mothers’ and fathers’ occupations respectively). Ethical approval for this study was obtained from Griffith University’s Human Research Ethics Committee, the Education Department’s research review committee, and 3 the Principal of the participating school. Participants did not receive compensation for participating. Materials and apparatus Anxiety. The parent- and child-report formats of the Spence Children’s Anxiety Scale (SCAS-P, SCAS-C) (Spence, 1998) were utilised to assess anxiety severity. The SCAS-P, a 39 item parent report measure, and the SCAS-C, a 45item child self-report measure, yield total and subscale scores in accordance with the DSM-IV anxiety diagnoses and possess sound psychometric properties (Nauta et al., 2004; Spence, 1998). The State Scale of the State-Trait Anxiety Inventory for Children (STAIC; Spielberger, 1973) was completed by children to measure state anxiety at the time of testing. The State Scale consists of 20 self-report items to yield a total score and is psychometrically sound (Muris, Merckelbach, Ollendick, King, & Bogie, 2002; Spielberger, 1973). Depression. The Children’s Depression Inventory (CDI; Kovacs, 1992) was used to assess children’s self-reported depressive symptoms. This measure contains 27-items that yield a total score. Acceptable psychometric properties have been reported (Kovacs, 1992). Attentional bias. The visual-probe task and stimuli were similar to those used in prior studies of children using a 500 ms exposure duration (e.g., Monk et al., 2006; Pine et al., 2005; Roy et al., 2008; Telzer et al., 2008; Waters, Mogg et al., 2008;), and adults using both 500 and 1250 ms durations (e.g. Bradley et al., 1998, 1999; Mogg, Philippot et al., 2004). The task was programmed using E-prime 1.1 (Psychology Software Tools, Inc) and presented on a Dell Optiplex computer with a 17-inch, 75Hz CRT colour monitor. Stimuli were photographs of 64 adult actors (half male, half female) of Caucasian appearance, each presenting a neutral and either an angry, or happy expression resulting in 32 angry-neutral and 32 happy-neutral face pairs (see Bradley et al., 1998, for details). There were also 16 neutral-neutral face pairs which were used as filler trials. Each face pair was presented twice (once at each duration: 500 and 1250 ms) and the distance between the inner edges of the pictures was 9 cm when presented. Procedure After all required approvals for the study were obtained, children in grades 5-7 (i.e., aged 8 to 12 years) at the local primary school were visited and the study was explained to them. The information sheet, consent form, family demographic form, and SCAS-P were sent home with each child. A box was placed in each classroom so that children could return completed forms in envelopes provided. Only children with written parental consent participated. The age range of these children was 9 to 12 years. Testing took place during school time in a quiet room on school grounds. Participating children were collected and returned to their classrooms by the research assistant and were supervised at all times. Children first completed the visual-probe task followed by the questionnaires to avoid sensitisation. All items were read aloud by the research assistant to avoid variation in children’s reading ability affecting results. The sessions lasted approximately 45 minutes. For the visual-probe task, children sat approximately 60 cm in front of the computer and first completed 10 practice trials followed by 160 trials presented in random order. Each trial began with a fixation cross for 500 ms followed by two faces, one on the left and one on the right side of the screen, for either 500 or 1250 ms. One face was replaced by an asterisk probe for 1100 ms, balanced across trials and conditions. Participants identified the probe location (left or right) by pressing one of two keyboard keys. Critical trials presented an emotional expression (angry or happy) paired with a neutral expression from the same person. The asterisk probe replaced the emotional face on half the trials and the neutral face on other trials. Statistical analysis Attentional bias scores were derived from the RT data and used as the dependent variable in analyses. RTs from error trials (< 5% of trials) and outliers (< 200 ms, or > 3 SDs above each participant’s mean; < 1% trials) were removed from analyses. Overall mean RT was 562 ms. Attentional bias scores were calculated for each emotional face by computing the difference between mean RTs for incongruent trials (i.e., emotional face and probe appear at opposite locations) and congruent trials (i.e., emotional face and probe appear at the same location). Positive values indicate a bias towards, and negative values indicate a bias away, from the emotional face. 4 To test our main hypotheses for angry and happy faces, separate linear mixed models with Satterthwaite’s Approximation for degrees of freedom were computed with Exposure Duration (500 ms; 1250 ms) as the fixed effect and SCAS-P total scores treated as a continuous variable. The SCAS-P was used in the analyses to be consistent with our prior work (i.e., Waters, Mogg et al., 2008). Results Group Characteristics Means and SDs for questionnaire measures are given in Table 1. Total scores on the SCAS-P ranged from 4 to 51 and from 6 to 80 on the SCAS-C, reflecting wide variation in children’s anxiety levels. Scores also ranged from 20 to 49 on the STAIC-State Scale and from 35 to 67 on the CDI. Also, SCAS-P total scores correlated significantly with SCAS-C total scores (r = .40, p = .004) and STAIC scores (r = .32, p = .02) but not CDI t-scores (r = .17, p = .22). Attentional bias Angry faces. Table 1 shows the mean attentional bias scores for angry faces for the whole sample and those scoring above and below the median on the SCAS-P. Higher levels of anxiety were associated with larger attentional bias towards angry faces; i.e. significant main effect of Anxiety, F(1,48) = 8.26, p = .006, β = .81, p<.01, which supports our primary hypothesis. The main effect of Exposure Duration and the interaction between Anxiety x Exposure Duration were not significant, F < 1; i.e., the anxiety-related attentional bias for threat did not significantly vary across the two exposure conditions. Threat attentional bias scores for the whole sample (averaged across durations) were positively correlated with SCAS-P total scores (r = .30, p = .03), but not significantly with children’s age, CDI, SCAS-C or STAIC scores (r’s = -.16 to .1). To allow direct comparison with studies of adults with non-clinical anxiety (e.g. Bradley et al., 1998) and to facilitate meta-analyses (e.g. calculation of effect sizes in each condition), Table 1 includes means and SDs for attentional bias scores for children with above- and belowmedian SCAS-P scores. In support of our prediction, children with high-normal levels of anxiety showed a significant attentional bias for angry, relative to neutral, faces (one sample t-test of overall threat bias score vs. zero: t(24) = 3.43, p = 002), whereas children with low-normal levels of anxiety showed no bias (one sample t(24) = .99, p = .33). Happy faces. The analyses of attentional bias scores for happy faces, as a function of exposure duration and SCAS-P total scores, revealed no significant effects; all F’s < 1.16. Discussion The present study showed that higher levels of childhood anxiety were associated with an attentional bias towards angry faces. Moreover, the anxiety-related attentional bias towards angry faces did not significantly vary across the 500 and 1250 ms exposure durations. There were no effects of anxiety or exposure duration on attentional bias for happy faces. The finding that greater levels of anxiety were associated with an attentional bias towards angry faces is consistent with cognitive models (e.g., Mogg & Bradley, 1998; Muris & Field, 2008; Williams et al., 1997) and several child and adult studies (e.g., Bradley et al., 1998; 1999; Roy et al., 2008; Telzer et al., 2008; Waters, Mogg et al., 2008). The finding that an attentional bias towards angry faces was maintained across both stimulus durations (500 and 1250 ms) in children with higher levels of anxiety is very similar to the pattern of bias found in adults with non-clinical anxiety (Bradley et al., 1998): i.e., significant bias for angry faces in individuals with high-normal levels of anxiety, and no bias in those with low-normal anxiety. The present results contrast with three previous findings of attentional avoidance of angry faces in anxious children (Monk et al., 2006; Pine et al., 2005; Stirling et al., 2006). This is consistent with the contention that avoidance of threat at short exposure durations in clinical anxiety (i.e., Monk et al., 2006; Pine et al., 2005) may reflect specific diagnostic and experimental characteristics of those studies (Roy et al., 2008). The present findings also contrast with one prior non-clinical study that found avoidance of negative faces at a longer duration (Stirling et al., 2006). One explanation for the latter finding is that avoidance of angry faces in non-clinical children is characteristic of specific fear states, such as social fear (e.g., Stirling et al., 2006), rather than trait/general anxiety as assessed in the present study. Thus, prolonged threat-monitoring may be more characteristic of high trait or generalized childhood anxiety, (e.g. the present study; Dalgleish et al., 2003; Taghavi et al., 1999). 5 These findings raise the question of what underlying mechanism/s might explain prolonged attention to threat in some anxious children. Consistent with cognitive theories (e.g., Mogg & Bradley, 1998), one possibility is that anxious children appraise angry faces as more threatening compared to controls, and this appraisal difference promotes greater attention to threat. Future studies should assess children’s subjective appraisals of facial stimuli to address this issue. Another possibility is that ongoing monitoring of threats reflects a “better safe than sorry” approach for regulating elevated anxious arousal. Notably, children’s state anxiety scores correlated significantly with SCAS-P scores, meaning that children identified by parents as being anxious were themselves the most anxious at the time of testing. Another mechanism that may influence attentional bias is attention control. Recent studies indicate that a threat attentional bias is more evident in anxious children (Lonigan & Vasey, 2009) and adults (Derryberry & Reed, 2002) who have poor cognitive control, as they may be less able to shift attention away from threat once drawn to its spatial location. It is possible therefore that the more anxious children in the present sample also had lower levels of cognitive control. It will be important in future work to include measures of attentional/effortful control. Although the present study cannot elucidate the precise underlying mechanisms, prolonged attention to threat in anxious children may have important clinical implications for maintaining and possibly enhancing anxiety over time. For example, treatments for childhood anxiety may need to incorporate attention regulation training (Bögels & Mansell, 2004). This was recently highlighted by Waters, Wharton et al. (2008) who showed that after cognitive behavioural therapy that included psychoeducation, somatic management, cognitive restructuring and exposure therapy, anxious children continued to show a threat attentional bias compared to non-anxious control children. There were limitations to the present study. Children were drawn from the normal population and future studies should examine whether the results generalize to clinically anxious children. Another consideration is the choice of stimulus durations. This and previous investigations with children have typically applied exposure durations up to 1500 ms, so there is a need to explore attentional biases at longer durations (e.g., to further investigate avoidance). Also, the visual-probe task relies on manual RT to index attention and only provides snap-shot measures of attentional bias at a limited number of exposure durations. Eye tracking would help address whether anxious children remain fixed on threat stimuli, shift attention back and forth from threat in an unstable manner (e.g., Garner, Mogg, & Bradley, 2006), or even show anxiety-related attentional avoidance with much longer exposure durations (Frewen et al., 2008). Finally, the format of the visual-probe task used a probe-position (‘where is the probe?’) rather than probe-classification (‘what is the probe?’) or probe-detection response (‘is there a probe?’). Each version has advantages and disadvantages (see Mogg & Bradley, 1999); e.g. the probe-position task is simple and commonly used with children; the probe-classification task may encourage more even monitoring of both sides of the display, but produces more errors and RT variance. Comparison of data from these tasks showed similar patterns of bias in monitoring strategy and similar sensitivity to attentional bias (Mogg & Bradley, 1999). Thus, we used the probeposition task here because the participants were young children. Future research should consider the relative merits of each task, depending on specific study requirements. In summary, the present study indicates an attentional bias towards angry faces in anxious schoolchildren, which did not vary significantly across the 500 and 1250 ms exposure durations, consistent with attention being held on threat under these conditions. Further research using longer stimulus durations with clinical and non-clinical samples is needed to further assess attentional bias in childhood anxiety, as research with adults suggests that attentional avoidance of threat may become apparent at longer stimulus durations (Frewen et al., 2008). Moreover, longitudinal research is required to examine the contributory role of attention processes to the onset of anxiety at different stages of development. Acknowledgements: This research was supported by a Griffith University New Researcher Grant awarded to Dr Allison Waters. Thanks are due to Harvey Iwamoto for assistance with programming the task. 6 References Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133, 1-24. Bittner, A., Egger, H. L., Erkanli, A., Costello, J., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48, 11741183. Bögels, S. M., & Mansell, W. (2004). Attention processes in the maintenance and treatment of social phobia: Hypervigilance, avoidance and self-focused attention. Clinicial Psychology Review, 24, 827-856. Bradley, B. P., Mogg, K., Falla, S. J., & Hamilton, L. R. (1998). Attentional bias for threatening facial expressions in anxiety: Manipulation of stimulus duration. Cognition and Emotion, 12(6), 737-753. Bradley, B. P., Mogg, K., White, J., Groom, C., & de Bono, J. (1999). Attentional bias for emotional faces in generalised anxiety disorder. British Journal for Clinical Psychology, 38, 267-278. Dalgliesh, T., Taghavi, R., Neshat-Doost, H. T., Moradi, A., Canterbury, R., & Yule, W. (2003). Patterns of processing bias for emotional information across clinical disorders: A comparison of attention, memory, and prospective cognition in children and adolescents with depression, generalized anxiety, and posttraumatic stress disorders. Journal of Clinical Child and Adolescent Psychology, 32, 10-21. Daniel, A. E. (1983). Power, Privilege, and Prestige. Melbourne: Longman Cheshire. Derryberry, D., & Reed, M. A. (2002). Anxietyrelated attention biases and their regulation by attention control. Journal of Abnormal Psychology, 111(2), 225-236. Frewen, P. A., Dozois, D. J. A., Joanisse, M. F., & Neufeld, R.W. J. (2008). Selective attention to threat versus reward: Meta-analysis and neural-network modeling of the dot-probe task. Clinical Psychology Review. 28(2), 307-337. Garner, M., Mogg, K., & Bradley, B. P. (2006). Orienting and maintenance of gaze to facial expressions in social anxiety. Journal of Abnormal Psychology, 115(4), 760-770. Heim-Dreger, U., Kohlmann, C-W., Eschenbeck, H., & Burkhardt, U. (2006). Attentional biases for threatening faces in children: Vigilant and avoidant processes. Emotion, 6(2), 320-325. Hunt, C., Keogh, E., & French, C. C. (2007). Anxiety sensitivity, conscious awareness and selective attention biases in children. Behaviour Research and Therapy, 45(3), 497-509. Koster, E. H. W., Verschuere, B., Crombez, G., Van Damme, S. (2005). Time course of attention for threatening pictures in high and low trait anxiety. Behaviour Research and Therapy, 43, 1087-1093. Kovacs, M. (1992). Children's depression inventory. New York: Multi-Health Systems. Lonigan, C. J., & Vasey, M. W. (2009). Negative affectivity, effortful control, and attention to threatrelevant stimuli. Journal of Abnormal Child Psychology, 37, 387-399. Michael, T., Zetsche, U. & Margraf, J. (2007). Epidemiology of anxiety disorders. Psychiatry, 6(4), 136-142. Mogg, K., & Bradley, B. P. (1998). A cognitivemotivational analysis of anxiety. Behaviour Research and Therapy, 36, 809-848. Mogg, K., & Bradley, B. P. (1999). Some methodological issues in assessing attentional biases for threatening faces in anxiety: A replication study using a modified version of the probe detection task. Behaviour Research and Therapy, 37, 595-604. Mogg, K., Bradley, B. P., De Bono, J., Painter, M. (1997). Time course of attentional bias for threat information in non-clinical anxiety. Behaviour Research and Therapy, 35(4), 297-303. Mogg, K., Bradley, B. P., Miles, F., & Dixon, R. (2004). Time course of attentional bias for threat scenes: Testing the vigilance-avoidance hypothesis. Cognition and Emotion, 18(5), 689-700. Mogg, K., Philippot, P., Bradley, B. P. (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology, 113(1), 160-165. Monk, C. S., Nelson, E. E., McClure, E. B., Mogg, K., Bradley, B. P., Leibenluft, E., et al. (2006). Ventrolateral prefrontal cortex activation and attention bias in response to angry faces in adolescents with generalized anxiety disorder. The American Journal of Psychiatry, 163(6), 1091-1097. 7 Muris, P., & Field, A. P. (2008). Distorted cognition and pathological anxiety in children and adolescents. Cognition and Emotion, 22(3), 395-421. Muris, P., Merckelbach, H., Ollendick, T., King, N., & Bogie, N. (2002). Three traditional and three new childhood anxiety questionnaires: their reliability and validity in a normal adolescent sample. Behaviour Research and Therapy, 40(7), 753-772. Nauta, M. H., Scholing, A., Rapee, R., Abbott, M., Spence, S. H., & Waters, A. M. (2004). A parent-report measure of children's anxiety: Psychometric properties and comparison with child-report in a clinical and normal sample. Behaviour Research and Therapy, 42, 413-439. Pine, D. S., Mogg, K., Bradley, B. P., Montgomery, L., Monk, C. S., McClure, E., et al. (2005). Attention bias to threat in maltreated children: Implications for vulnerability to stress-related psychopathology. American Journal of Psychiatry, 162, 291-296. Roy, A. D., Vasa, R. A., Bruck, M., Mogg, D., Bradley, B. P., Sweeney, M., Bergman, L., McClure-Tone, E. B., Pine, D. S., M. D., & The Cams Team (2008). Attention bias toward threat in pediatric anxiety disorders. Child Adolescent Psychiatry, 47(10), 1-8. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545-566. Spielberger, C. D. (1973). State-trait anxiety inventory for children. Redwood City, CA: Mind Garden. Stirling, L. J., Eley, T. C., & Clark, D. M. (2006). Preliminary evidence for an association between social anxiety symptoms and avoidance of negative faces in school-age children. Journal of Clinical Child and Adolescent Psychology, 35(3), 440-445. Taghavi, M. R., Neshat Doost, H. T., Moradi, A., Yule, W., & Dalgliesh, T. (1999). Biases in visual attention in children and adolescents with clinical anxiety and mixed anxiety-depression. Journal of Abnormal Child Psychology, 27, 215-223. Telzer, E. H., Mogg, K., Bradley, B. P., Mai, X., Ernst, M., Pine, D. S. & Monk, C. S. (2008). Relationship between trait anxiety, prefrontal cortex, and attention bias to angry faces in children and adolescents. Biological Psychology, 79(2), 216-222. Vasey, M. W., Daleiden, E. L., Williams, L. L., & Brown, L. M. (1995). Biased attention in childhood anxiety disorders: A preliminary study. Journal of Abnormal Child Psychology, 23(2), 267-279. Vasey, M. W., El-Hag, N., & Daleiden, E. L. (1996). Anxiety and the processing of emotionally threatening stimuli: Distinctive patterns of selective attention among high- and low-test-anxious children. Child Development, 67, 1173-1185. Waters, A. M., Lipp, O. V., & Spence, S. H. (2004). Attentional bias toward fear-related stimuli: An investigation with nonselected children and adults and children. Journal of Experimental Child Psychology, 89, 320-337. Waters, A. M., Mogg, K., Bradley, P. B., & Pine, D. S. (2008). Attentional bias for emotional faces in children with generalized anxiety disorders. Journal of American Academy of Child and Adolescent Psychiatry, 47(4), 435-441. Waters, A. M., Wharton, T. A., Zimmer-Gembeck, M. J., & Craske, M. G. (2008). Threat-based cognitive biases in anxious children: Comparison with nonanxious children before and after cognitive behaviour treatment. Behaviour Research and Therapy, 46(3), 358-406. Watts, S. E., & Weems, C. F. (2006). Associations among selective attention, memory bias, cognitive errors, and symptoms of anxiety in youth. Journal of Abnormal Child Psychology, 34, 841-852. Williams, J. M. G., Watts, F. N., MacLeod, C., & Mathews, A. (1997). Cognitive psychology and emotional disorders (2nd ed.). Chichester: Wiley. 8 Table 1: Descriptive statistics for questionnaires and attentional bias scores ______________________________________________________________________________ Measure Overall (N=50) Above-median anxiety Below-median anxiety (N=25) (N=25) M SD M SD M SD ______________________________________________________________________________ SCAS-P 24.0 13.5 35.6 8.3 12.3 4.2 SCAS-C 32.3 15.5 37.2 17.6 27.4 11.3 STAI-S 34.7 7.3 37.2 6.7 32.3 7.2 CDI 46.0 7.4 46.8 8.5 45.2 6.2 500 ms 12.9 39.9 20.1 46.4 5.7 31.5 1250 ms 10.7 30.8 18.4 27.9 2.9 32.2 Overall 11.7 35.4 19.2 28.0 4.3 21.7 500 ms -5.7 40.6 -11.9 39.8 0.5 41.2 1250 ms 2.0 41.0 4.2 36.3 -0.1 45.8 Overall -1.8 40.8 -3.9 28.1 0.2 26.7 Angry bias: Happy bias: _______________________________________________________________________________ 2