Cognitive processes and the development of psychopathology in children at risk for anxiety disorders.

This study addresses Children of Parents with an Anxiety Disorder (CPAD). They
are at increased risk to develop an anxiety disorder somewhere in life. Little
is known of the risk-factors that contribute to the vulnerability for anxiety
disorders in these children.
Distortions in information processing seem to play a major role in the
maintenance of anxiety disorders, but studies on causality are almost entirely
lacking. By studying non anxious high risk children with a longitudinal design
we can relate cognitive biases to later level of anxiety, adding evidence on
the hypothesized causal role of cognitive biases. This knowledge is of greatest
importance scientifically as well as for possible prevention. The proposed
study investigates associations between threat-related stimuli and biases in
the perception of threat and selective attention to threat-stimuli in CPAD*s. A
follow-up of 2 years enables us to prospectively relate the cognitive bias to
later level of anxiety.
This study will add to knowledge on risk factors for anxiety disorders, so that
children at risk may be more precisely targeted and appropriate (preventive)
interventions may be developed.

Goal of the study is to establish evidence on cognitive biases in a high risk
population and on the longitudinal impact of such biases. We hypothesize that
CPAD*s show biases in their information processing when compared to control
children. We expect that priming of fear relevant schema*s lead to increased
threat perception in children who do not have an anxiety disorder yet. We
furthermore expect that especially the CPAD*s who do show biases in their
information processing are at higher risk to develop an anxiety disorder or
symptoms of anxiety in the course of follow-up as compared to children without
such a bias.

Longitudinal observational study with matched controls to test for differences
in performance on a number of computer tasks (indirect measures) that measure
distortions in information processing (Ambiguous Story Task, Emotional Stroop
Task, Auditory Interpretation Task, Affective Priming Task). Follow-up will be
two years, with 1 assessment per year (the first year via questionnaires, the
second again with the indirect measures), to investigate the relationship
between cognitive distortions in information processing and future level of
anxiety.

One of the computertasks, the Ambiguous Story Task, presents short stories that
do not have an ending and include ambiguous information. Children are asked to
finish the stories. During this task, a prime is added to activate a potential
cognitive fear network in the children, through which their perceptions of the
stories may be altered. The prime consists of three video fragments of a panic
disordered, social phobic and a spider phobic woman. They describe their
feelings, actions and thougths when confronted with a fear provoking event. We
expect that exposure to the prime in vulnerable children may activate their
latent information processing biases, whereas we do not expect a priming effect
(or a smaller priming effect) in the control children. The prime is considered
to be an intervention because it may affect the children's behaviour, resulting
in more negative interpretations of the stories in the Ambiguous Story Task.
The effect of the prime is neutralized by showing video fragments of a
therapist that describes the treatment for social phobia, panic disorder and
spider phobia.

We consider the risk of serious adverse events due to our materials or design
to be minimal, and we will register and report on any incidents that occur.
Particularities of this study that may give rise to some concern about their
impact are outlined in the following:
The first assessment consists of a diagnostic interview, questionnaires, and
the computer tasks. This assessment will be spread over 2 appointments of 90
minutes to avoid weariness. The appointments will take place at the outpatient
anxiety or can take place at their homes to minimize the travelling time for
participants.
For a number of children, the diagnostic interview will result in a diagnosis
of a psychiatric disorder. A psychologist will inform those children and their
parents on the nature of the disorder and will advise them on the possibilities
for treatment (in accordance with the multidisciplinary guidelines for
treatment of anxiety disorders). The treatment advice will depend on the
perceived burden of the disorder by the child and his parents.
During the Ambiguous Story Task, children will be exposed to three two-minute
videos of three different women who describe their fear for spiders, fear for
social situations or panic attacks. This priming is necessary to activate a
potential latent fear network in children without symptoms of anxiety. After
the children have completed the computer task, the priming will be neutralized
by showing a video of a therapist describing the treatment of the disorders.
Priming paradigms are often used in studies with adults, showing no harmful
effects. In children, we know of only one study that used a prime (similar to
the prime in the proposed study), no adverse effects were reported (Schneider
et al., 2002).
The Emotional Stroop Task and the Affective Priming Task both measure reaction
times on fearful versus non fearful stimuli, the use of these tests with
normal, as well as clinically anxious children is common in experimental
psychopathology research and no adverse effects are known. Usually, children
tend to enjoy the computer tasks.
The proposed study is group related, as we can only investigate the structure
of the information processing and its abnormalities in children at risk for
anxiety disorder by examining this specific group.