Ellen M. Kessel

Neural reactivity to monetary rewards and losses differentiates social from generalized anxiety in children

BACKGROUND The relationship between reward sensitivity and pediatric anxiety is poorly understood. Evidence suggests that alterations in reward processing are more characteristic of depressive than anxiety disorders. However, some studies have reported that anxiety disorders are also associated with perturbations in reward processing. Heterogeneity in the forms of anxiety studied may account for the differences between studies. We used the feedback-negativity, an event-related potential sensitive to monetary gains versus losses (ΔFN), to examine whether different forms of youth anxiety symptoms were uniquely associated with reward sensitivity as indexed by neural reactivity to the receipt of positive and negative monetary outcomes. METHOD Participants were 390, eight- to ten-year-old children (175 females) from a large community sample. The ΔFN was measured during a monetary reward task. Self-reports of child anxiety and depression symptoms and temperamental positive emotionality (PE) were obtained. RESULTS Multiple regression analysis revealed that social anxiety and generalized anxiety symptoms were unique predictors of reward sensitivity after accounting for concurrent depressive symptoms and PE. While social anxiety was associated with a greater ΔFN, generalized anxiety was associated with a reduced ΔFN. CONCLUSIONS Different symptom dimensions of child anxiety are differentially related to alterations in reward sensitivity. This may, in part, explain inconsistent findings in the literature regarding reward processing in anxiety.

Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine

BACKGROUND Little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of preschool chronic irritability with psychiatric disorders, functional impairment, and service use at age nine in a large community sample. METHODS Four hundred and forty-six children were assessed at age three and again at age nine. Child psychopathology and functional impairment were assessed at age three with the Preschool Age Psychiatric Assessment (PAPA) with parents and at age nine with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. Items from the PAPA were used to create a dimensional measure of chronic irritability at age three. At age nine, mothers, fathers, and youth completed the Child Depression Inventory (CDI) and the Screen for Anxiety Related Disorders (SCARED). RESULTS Chronic irritability at age three predicted any current and lifetime anxiety disorders at age nine, current and lifetime generalized anxiety disorder, and current separation anxiety, after controlling for baseline anxiety disorders. In addition, preschool irritability predicted increases in anxiety and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive and anxiety symptoms on the CDI and SCARED. Lastly, preschool irritability predicted greater functional impairment and outpatient treatment use, even after controlling for all psychiatric disorders at baseline. CONCLUSIONS Findings underscore the central role of irritability in developmental psychopathology and support the importance of early detection and interventions targeting preschool irritability.

The impact of an unpredictable context and intolerance of uncertainty on the electrocortical response to monetary gains and losses

There is growing evidence that unpredictability and uncertainty can alter reward system functioning. The present study examined the impact of (1) a task-irrelevant unpredictable relative to predictable context and (2) individual differences in intolerance of uncertainty (IU) on the reward-related positivity (RewP), an event-related potential (ERP) response to monetary gains relative to losses. Specifically, 64 participants listened to predictable and unpredictable tone sequences while electroencephalography was recorded during a monetary gambling task. Participants also completed the Intolerance of Uncertainty Scale, which measures both cognitive distress (prospective IU) and behavioral inhibition (inhibitory IU) elicited by uncertainty, in addition to the Depression Anxiety Stress Scale-21 and Penn State Worry Questionnaire. Results indicated that the RewP was reduced during the unpredictable relative to the predictable context. Greater self-reported anxiety elicited by the unpredictable context was associated with a decreased RewP, and a decreased RewP was associated with poorer lose-shift behavioral adjustment. Furthermore, the RewP mediated the relationship between self-reported anxiety elicited by the unpredictable context and lose-shift behavioral adjustment. The IU subscales demonstrated the opposite relationship with the RewP across both contexts—inhibitory IU was associated with an attenuated RewP and prospective IU was associated with an enhanced RewP. In contrast, anxiety, depression, stress, and worry symptomatology were not associated with the RewP. This is the first study to demonstrate that an unpredictable context and individual differences in the degree to which people cannot tolerate uncertainty impact an ERP measure of reward system functioning.

Neural reactivity to monetary rewards and losses in childhood: longitudinal and concurrent associations with observed and self-reported positive emotionality.

Reward reactivity and positive emotion are key components of a theoretical, early-emerging approach motivational system, yet few studies have examined associations between positive emotion and neural reactivity to reward across development. In this multi-method prospective study, we examined the association of laboratory observations of positive emotionality (PE) at age 3 and self-reported positive affect (PA) at age 9 with an event-related potential component sensitive to the relative response to winning vs. losing money, the feedback negativity (ΔFN), at age 9 (N=381). Males had a larger ΔFN than females, and both greater observed PE at age 3 and self-reported PA at age 9 significantly, but modestly, predicted an enhanced ΔFN at age 9. Negative emotionality and behavioral inhibition did not predict ΔFN. Results contribute to understanding the neural correlates of PE and suggest that the FN and PE may be related to the same biobehavioral approach system.

Longitudinal Associations Between Preschool Disruptive Mood Dysregulation Disorder Symptoms and Neural Reactivity to Monetary Reward During Preadolescence

OBJECTIVE Reward-processing abnormalities are thought to be a key feature of various psychiatric disorders and may also play a role in disruptive mood dysregulation disorder (DMDD), a new diagnosis in DSM-5. In the current study, we used event-related potentials (ERP) sensitive to monetary gains (i.e., the reward positivity [RewP]) and losses (i.e., the N200) to examine associations between symptoms of DMDD during early childhood and later reward processing during preadolescence. METHODS To assess early emerging DMDD symptoms in a large longitudinal community sample (n=373) of 3-year old children, we administered a diagnostic interview, Preschool Age Psychiatric Assessment (PAPA) with parents. At a later assessment, ∼6 years later, children completed a monetary reward task while an electroencephalogram (EEG) was recorded. Childrens lifetime history of psychopathology was also assessed at that time using Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with the child and parent. RESULTS Multiple regression analyses revealed that age 3 DMDD symptoms predicted an enhanced RewP to monetary rewards in preadolescence. This association is independent of demographics and lifetime history of symptoms of depression, any anxiety disorder, attention-deficit disorder, oppositional defiant disorder, or conduct disorder Conclusions: Early manifestations of DMDD in children as young as 3 years old predicted enhanced reward processing later in development. These findings add to the growing corpus of literature on the pathophysiology of DMDD, and underscore the predictive validity of preschool DMDD on a neural level.

Disruptive mood dysregulation disorder at the age of 6 years and clinical and functional outcomes 3 years later.

BACKGROUND Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. METHOD A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. RESULTS DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. CONCLUSIONS Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.

Neural responses to social and monetary reward in early adolescence and emerging adulthood

Reward processing is often considered to be a monolithic construct, with different incentive types eliciting equivalent neural and behavioral responses. The majority of the literature on reward processing has used monetary incentives to elicit reward-related activity, yet social incentives may be particularly important due to their powerful ability to shape behavior. Findings from studies comparing social and monetary rewards have identified both overlapping and distinct responses. In order to explore whether reward processing is domain general or category specific (i.e., the same or different across reward types), the present study recorded ERPs from early adolescents (ages 12-13) and emerging adults (ages 18-25) while they completed social and monetary reward tasks. Temporospatial principal components analysis revealed morphologically similar reward positivities (RewPs) in the social and monetary reward tasks in each age group. In early adolescents, no significant difference was found between the magnitude of the RewP to social and monetary rewards. In emerging adults, however, the RewP to monetary rewards was significantly larger than the RewP to social rewards. Additionally, responses to feedback between the two tasks were not significantly correlated in either age group. These results suggest that both domain-general and category-specific processes underlie neural responses to rewards and that the relative incentive value of different types of rewards may change across development. Findings from this study have important implications for understanding the role that neural response to rewards plays in the development of psychopathology during adolescence.

Transdiagnostic factors and pathways to multifinality: The error-related negativity predicts whether preschool irritability is associated with internalizing versus externalizing symptoms at age 9.

There is increasing interest among developmental psychopathologists in broad transdiagnostic factors that give rise to a wide array of clinical presentations (multifinality), but little is known about how these processes lead to particular psychopathological manifestations over the course of development. We examined whether individual differences in the error-related negativity (ΔERN), a neural indicator of error monitoring, predicts whether early persistent irritability, a prototypical transdiagnostic construct, is associated with later internalizing versus externalizing outcomes. When children were 3 years old, mothers were interviewed about childrens persistent irritability and completed questionnaires about their childrens psychopathology. Three years later, EEG was recorded while children performed a go/no-go task to measure the ΔERN. When children were approximately 9 years old, mothers again completed questionnaires about their childrens psychopathology. The results indicated that among children who were persistently irritable at age 3, an enhanced or more negative ΔERN at age 6 predicted the development of internalizing symptoms at age 9, whereas a blunted or smaller ΔERN at age 6 predicted the development of externalizing symptoms. Our results suggest that variation in error monitoring predicts, and may even shape, the expression of persistent irritability and differentiates developmental trajectories from preschool persistent irritability to internalizing versus externalizing outcomes in middle to late childhood.

Depression symptom dimensions and asymmetrical frontal cortical activity while anticipating reward

Unipolar depression has been characterized as involving diminished approach motivation and reward sensitivity. A psychophysiological indicator of approach motivation involves an asymmetry in frontal EEG activity, such that greater left relative to right frontal cortical activity indicates increased approach motivation. Consistent with the perspective of reduced approach motivation tendencies, depression has been associated with decreased relative left frontal cortical activity. To date, supporting research has primarily relied on categorical diagnoses or composite symptom counts. However, given the heterogeneity in depression, it is unclear what specific symptom dimensions relate to decreased relative left frontal cortical activity. The present study examined the association between multiple depression symptom dimensions and asymmetrical frontal cortical activity while anticipating reward in separate undergraduate (n = 75) and clinical samples (current major depressive disorder [n = 68] and never depressed controls [n = 67]). All participants completed the Inventory of Depression and Anxiety Symptoms, a self-report measure of factor-analytically derived symptom dimensions. Frontal cortical activity was assessed during a computerized slot machine task while participants anticipated potential monetary reward or no incentive. In undergraduates with low depression symptoms and never depressed controls, reward trials relative to no-incentive trials elicited greater relative left frontal cortical activity. Furthermore, in both samples across all participants, increased dysphoria and lassitude symptoms were associated with decreased relative left frontal cortical activity while anticipating reward. The present study suggests that depression symptoms consistent with motivational disengagement are associated with decreased relative left frontal cortical activity.

Neurophysiological processing of emotion and parenting interact to predict inhibited behavior: an affective-motivational framework

Although inhibited behavior problems are prevalent in childhood, relatively little is known about the intrinsic and extrinsic factors that predict a childs ability to regulate inhibited behavior during fear- and anxiety-provoking tasks. Inhibited behavior may be linked to both disruptions in avoidance-related processing of aversive stimuli and in approach-related processing of appetitive stimuli, but previous findings are contradictory and rarely integrate consideration of the socialization context. The current exploratory study used a novel combination of neurophysiological and observation-based methods to examine whether a neurophysiological measure sensitive to approach- and avoidance-oriented emotional processing, the late positive potential (LPP), interacted with observed approach- (promotion) and avoidance- (prevention) oriented parenting practices to predict childrens observed inhibited behavior. Participants were 5- to 7-year-old (N = 32) typically-developing children (M = 75.72 months, SD = 6.01). Electroencephalography was continuously recorded while children viewed aversive, appetitive, or neutral images, and the LPP was generated to each picture type separately. Promotion and prevention parenting were observed during an emotional challenge with the child. Child inhibited behavior was observed during a fear and a social evaluation task. As predicted, larger LPPs to aversive images predicted more inhibited behavior during both tasks, but only when parents demonstrated low promotion. In contrast, larger LPPs to appetitive images predicted less inhibited behavior during the social evaluative task, but only when parents demonstrated high promotion; children of high promotion parents showing smaller LPPs to appetitive images showed the greatest inhibition. Parent-child goodness-of-fit and the LPP as a neural biomarker for emotional processes related to inhibited behavior are discussed.