Search

Background: Youth with anxiety disorders struggle with managing emotions relative to peers, but the neural basis of this difference has not been examined. Methods: Youth (Mage=13.6; range=8-17) with (n=37) and without (n=24) anxiety disorders completed a cognitive reappraisal task while undergoing fMRI. Emotional reactivity and regulation, functional activation, and beta-series connectivity were compared across groups. Results: Groups did not differ on emotional reactivity or regulation. However, affect ratings and fronto-limbic activation after viewing aversive imagery (with and without regulation) were higher for anxious youth. Anxious youth did not demonstrate age-dependent changes in regulation, whereas regulation in control youth increased linearly. Stronger amygdala-vmPFC connectivity related to greater anxiety in control youth, but less anxiety in anxious youth. Stronger amygdala-frontal pole connectivity related to worse emotion regulation in control youth, but better emotion regulation in anxious youth. Conclusions: Anxious youth regulate when instructed, but this does not relate to age. Viewing aversive imagery related to heightened negative affect even after reappraisal, accompanied by higher fronto-limbic activation. Emotion dysregulation in youth anxiety disorders may stem from heightened emotionality and potent bottom-up neurobiological responses to aversive stimuli. Findings suggest the importance of treatments focused on both reducing initial emotional reactivity and bolstering regulatory capacity.

Background Youth anxiety interventions have potential to reduce risk for depression and suicidality. Methods This naturalistic follow-up of the multi-site, comparative treatment trial, inking and behavior, and depressive symptoms 3-11 years (mean 6.25 years) following 12-week evidence-based youth anxiety treatment. Participants (N = 319; 10-26 years, mean 17 years) completed semiannual questionnaires and annual diagnostic interviews for 4 years. Results One-fifth (20.4%) of the sample met DSM-IV criteria for a mood disorder, 32.1% endorsed suicidal ideation, and 8.2% reported suicidal behavior. Latent class growth analysis yielded two linear trajectories of depressive symptoms, and 85% of the sample demonstrated a persistent low-symptom course over seven assessments. Child/Adolescent Anxiety Multimodal Study (CAMS) 12-week treatment outcome (positive response, remission) and treatment condition (cognitive behavior therapy [CBT], medication, CBT + medication, pill placebo) were not associated with subsequent mood disorder or suicidal thinking. CAMS remission predicted absence of suicidal behavior, and treatment response and remission predicted low depressive symptom trajectory. Greater baseline self-reported depressive symptoms predicted all long-term mood outcomes, and more negative life events predicted subsequent mood disorder, depressive symptom trajectory, and suicidal ideation. Conclusions Effective early treatment of youth anxiety, including CBT, medication, or CBT + medication, reduces risk for subsequent chronic depressive symptoms and suicidal behavior. Attention to (sub)clinical depressive symptoms and management of negative life events may reduce odds of developing a mood disorder, chronic depressive symptoms, and suicidality. Findings contribute to evidence that early intervention for a primary disorder can serve as secondary prevention.

BACKGROUND: Pediatric anxiety disorders are chronic and impairing conditions that are characterized by risk aversion and avoidance; however, the neural correlates of decision making under risk in anxious youth remain poorly understood. METHODS: Youth with a primary diagnosis of separation anxiety, social phobia, or generalized anxiety disorder (n = 16) and healthy controls (n = 15), performed a risky decision-making task under conditions of potential gain or loss while undergoing a functional magnetic resonance imaging (fMRI) scan. RESULTS: Analyses were conducted to examine neural response to risky versus nonrisky choices in each condition. Anxious youth made fewer risky choices during potential loss compared to controls. Both groups elicited strong frontostriatal activation during risky choice. During risky choice in the gain condition, controls exhibited greater activation in ventral putamen during risky choice than during nonrisky choice and than anxious youth. In the loss condition, controls exhibited greater activation in medial prefrontal cortex during risk-taking while anxious youth exhibited greater engagement of amygdala and insula. Neural activation during risky choice was associated with individual differences in anxiety symptom severity, such that as anxiety symptomatology increased, there was decreased recruitment of the ventral striatum in the gain condition and increasing recruitment of the amygdala in the loss condition. CONCLUSIONS: Youth with anxiety disorders differ from their nonanxious peers on both behavioral and neurobiological indices during risky decision making; these differences are exacerbated by symptom severity and they shed light on the pathophysiology of pediatric anxiety. Neural correlates of risky decision making in anxious youth and healthy controls. Language: en

Pediatric anxiety disorders are chronic and impairing conditions that are characterized by risk aversion and avoidance; however, the neural correlates of decision making under risk in anxious youth remain poorly understood.Youth with a primary diagnosis of separation anxiety, social phobia, or generalized anxiety disorder (n = 16) and healthy controls (n = 15), performed a risky decision-making task under conditions of potential gain or loss while undergoing a functional magnetic resonance imaging (fMRI) scan.Analyses were conducted to examine neural response to risky versus nonrisky choices in each condition. Anxious youth made fewer risky choices during potential loss compared to controls. Both groups elicited strong frontostriatal activation during risky choice. During risky choice in the gain condition, controls exhibited greater activation in ventral putamen during risky choice than during nonrisky choice and than anxious youth. In the loss condition, controls exhibited greater activation in medial prefrontal cortex during risk-taking while anxious youth exhibited greater engagement of amygdala and insula. Neural activation during risky choice was associated with individual differences in anxiety symptom severity, such that as anxiety symptomatology increased, there was decreased recruitment of the ventral striatum in the gain condition and increasing recruitment of the amygdala in the loss condition.Youth with anxiety disorders differ from their nonanxious peers on both behavioral and neurobiological indices during risky decision making; these differences are exacerbated by symptom severity and they shed light on the pathophysiology of pediatric anxiety. Neural correlates of risky decision making in anxious youth and healthy controls.