Anke M. Klein

Biases in attention and interpretation in adolescents with varying levels of anxiety and depression

ABSTRACT This is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task (DPT), an Emotional Visual Search Task (EVST), and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying cognitive mechanisms.

Development and evaluation of a new paradigm for the assessment of anxiety-disorder-specific interpretation bias using picture stimuli

An important factor in cognitive theories of anxiety disorders is the way in which information is processed. Findings support the existence of a biased information-processing style in anxious children. So far, cognitive biases in children with anxiety disorders are typically assessed as a general phenomenon. Thus, there is a lack of studies in children focusing on anxiety-disorder-specific interpretation bias. A new forced choice paradigm using anxiety-disorder-specific material was developed. Pictures illustrating separation and social situations were carefully generated and evaluated in a pre-study. In a school sample of 265 children the paradigm was investigated. The pictures were able to trigger emotional response and the paradigm demonstrated good internal consistency, and construct validity. Results clearly indicate evidence for content-specificity of the materials. Furthermore, preliminary results suggest a disorder-specific interpretation bias.

Direct and indirect measures of spider fear predict unique variance in children's fear-related behaviour

This study investigated whether direct and indirect measures predict unique variance components of fearful behaviour in children. One hundred eighty-nine children aged between 9 and 12 performed a pictorial version of the emotional Stroop task (EST), filled out the Spider Anxiety and Disgust Screening for Children (SADS-C), the Spider Phobia Questionnaire for Children (SPQ-C), and took part in a Behavioural Assessment Test (BAT). The EST did not correlate with self-reports. Correlations of the self-reports and the BAT remained significant after partialling out EST performance. Likewise, the EST and the BAT still correlated significantly with each other when controlling for the self-reports. This indicates that both direct and indirect measures are useful for predicting unique variance components of fearful behaviour in children. Moreover, it may explain why some previous studies have not found a relationship between self-reported fear and EST performance.

Subjective fear, interference by threat, and fear associations independently predict fear-related behavior in children

BACKGROUND AND OBJECTIVES Several information-processing models highlight the independent roles of controlled and automatic processes in explaining fearful behavior. Therefore, we investigated whether direct measures of controlled processes and indirect measures of automatic processes predict unique variance components of childrens spider fear-related behavior. METHOD Seventy-seven children between 8 and 13 years performed an Affective Priming Task (APT) measuring associative bias, a pictorial version of the Emotional Stroop Task (EST) measuring attentional bias, filled out the Spider Anxiety and Disgust Screening for Children (SADS-C) in order to assess self-perceived fear, and took part in a Behavioral Assessment Test (BAT) to measure avoidance of spiders. RESULTS The SADS-C, EST, and APT did not correlate with each other. Spider fear-related behavior was best explained by SADS-C, APT, and EST together; they explained 51% of the variance in BAT behavior. LIMITATIONS No children with clinical levels of spider phobia were tested. The direct and the different indirect measures did no correlate with each other. CONCLUSIONS These results indicate that both direct and indirect measures are useful for predicting unique variance components of fear-related behavior in children. The lack of relations between direct and indirect measures may explain why some earlier studies did not find stronger color-naming interference or stronger fear associations in children with high levels of self-reported fear. It also suggests that children with high levels of spider-fearful behavior have different fear-related associations and display higher interference by spider stimuli than children with non-fearful behavior.

Biased interpretation and memory in children with varying levels of spider fear

This study investigated multiple cognitive biases in children simultaneously, to investigate whether spider-fearful children display an interpretation bias, a recall bias, and source monitoring errors, and whether these biases are specific for spider-related materials. Furthermore, the independent ability of these biases to predict spider fear was investigated. A total of 121 children filled out the Spider Anxiety and Disgust Screening for Children (SADS-C), and they performed an interpretation task, a memory task, and a Behavioural Assessment Test (BAT). As expected, a specific interpretation bias was found: Spider-fearful children showed more negative interpretations of ambiguous spider-related scenarios, but not of other scenarios. We also found specific source monitoring errors: Spider-fearful children made more fear-related source monitoring errors for the spider-related scenarios, but not for the other scenarios. Only limited support was found for a recall bias. Finally, interpretation bias, recall bias, and source monitoring errors predicted unique variance components of spider fear.

Interpretation modification training reduces social anxiety in clinically anxious children

The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli.

Biases in attention, interpretation, memory, and associations in children with varying levels of spider fear: Inter-relations and prediction of behavior.

BACKGROUND AND OBJECTIVES Cognitive theories suggest that cognitive biases may be related and together influence the anxiety response. However, little is known about the interrelations of cognitive bias tasks and whether they allow for an improved prediction of fear-related behavior in addition to self-reports. This study simultaneously addressed several types of cognitive biases in children, to investigate attention bias, interpretation bias, memory bias and fear-related associations, their interrelations and the prediction of behavior. METHODS Eighty-one children varying in their levels of spider fear completed the Spider Anxiety and Disgust Screening for Children and performed two Emotional Stroop tasks, a Free Recall task, an interpretation task including size and distance indication, an Affective Priming Task, and a Behavioral Assessment Test. RESULTS We found an attention bias, interpretation bias, and fear-related associations, but no evidence for a memory bias. The biases showed little overlap. Attention bias, interpretation bias, and fear-related associations predicted unique variance in avoidance of spiders. Interpretation bias and fear-related associations remained significant predictors, even when self-reported fear was included as a predictor. LIMITATIONS Children were not seeking help for their spider fear and were not tested on clinical levels of spider phobia. CONCLUSIONS This is the first study to find evidence that different cognitive biases each predict unique variance in avoidance behavior. Furthermore, it is also the first study in which we found evidence for a relation between fear of spiders and size and distance indication. We showed that this bias is distinct from other cognitive biases.

The relation between social anxiety and biased interpretations in adolescents with mild intellectual disabilities

BACKGROUND Cognitive theories of anxiety emphasize the importance of cognitive processes in the onset and maintenance of anxiety disorders. However, little is known about these processes in children and adolescents with Mild Intellectual Disabilities (MID). AIMS The aim of this study was to investigate interpretation bias and its content-specificity in adolescents with MID who varied in their levels of social anxiety. METHOD AND PROCEDURES In total, 631 adolescents from seven special secondary schools for MID filled in questionnaires to measure their levels of social anxiety. They also completed the Interpretation Recognition Task to measure how they interpret ambiguous situations. OUTCOMES AND RESULTS Adolescents with higher self-reported levels of social anxiety interpreted ambiguous scenarios as more negative than adolescents with lower self-reported social anxiety. Furthermore, this negative interpretation was specific for social situations; social anxiety was only associated with ambiguous social anxiety-related scenarios, but not with other anxiety-related scenarios. CONCLUSIONS AND IMPLICATIONS These findings support the hypothesis that socially anxious adolescents with MID display an interpretation bias that is specific for stimuli that are relevant for their own anxiety. This insight is useful for improving treatments for anxious adolescents with MID by targeting content-specific interpretation biases.

Differences between self- and peer-rated likability in relation to social anxiety and depression in adolescents with mild intellectual disabilities

BACKGROUND Social anxiety and depressive symptoms are relatively common in adolescents with Mild to Borderline Intellectual Disabilities (MBID). Unfortunately, there are only a few studies that focus on examining processes underlying social anxiety and depression in these adolescents. AIMS The aim was to examine the differences between self- and peer-rated likability in relation to social anxiety and depression in the classroom environment. METHODS AND PROCEDURES 631 normative non-clinical adolescents with MBID completed questionnaires to measure social anxiety, depression, and the estimation of their own likability by peers. Peer-reported likability was derived from peer-rating scales on likability. OUTCOMES AND RESULTS Adolescents with higher levels of social anxiety significantly rated their own likability as lower than their non-anxious peers. However, socially adolescents were equally liked by their peers. Adolescents with higher levels of depression were significantly less liked by their peers, but still underestimated their own likability than adolescents with lower levels of depression. CONCLUSIONS AND IMPLICATIONS Social anxiety and depression are linked to a biased interpretation of likability, but only depression is linked to actually being less liked by peers. Social anxiety and depression are partly based on similar underlying cognitive biases.

Biases in interpretation as a vulnerability factor for children of parents with an anxiety disorder

OBJECTIVE Children of parents with an anxiety disorder have a higher risk of developing an anxiety disorder than children of parents without an anxiety disorder. Parental anxiety is not regarded as a causal risk factor itself, but is likely to be mediated via other mechanisms, for example via cognitive factors. We investigated whether children of parents with an anxiety disorder would show an interpretation bias corresponding to the diagnosis of their parent. We also explored whether childrens interpretation biases were explained by parental anxiety and/or childrens levels of anxiety. METHOD In total, 44 children of parents with a panic disorder (PD), 27 children of parents with a social anxiety disorder (SAD), 7 children of parents with SAD/PD, and 84 children of parents without an anxiety disorder (controls) participated in this study. Parents and children filled out the Screen for Child Anxiety Related Disorders (SCARED) questionnaire, and children performed two ambiguous scenario tasks: one with and one without video priming. RESULTS Children of parents with PD displayed significantly more negative interpretations of panic scenarios and social scenarios than controls. Negative interpretations of panic scenarios were explained by parental PD diagnosis and childrens anxiety levels. These effects were not found for children of parents with SAD. Priming did not affect interpretation. CONCLUSION Our results showed that children of parents with PD have a higher chance of interpreting ambiguous situations more negatively than children of parents without anxiety disorders. More research is needed to study whether this negative bias predicts later development of anxiety disorders in children.