Paying Attention to Pediatric Anxiety

June 21st, 2017

Many children have fears and worries, but some have a diagnosable anxiety disorder that can impair their social and academic functioning and even physical health. Anxiety is a painful experience; although it is often treatable, most young people and their parents would prefer to prevent it. Bethany Reeb-Sutherland, an assistant professor at Florida International University, is identifying some promising avenues for doing just that. Through her work with both animals and humans, Reeb-Sutherland has helped to identify pre-cursors of childhood anxiety and test preventive interventions. Her studies offer hope for a path to preventing and treating anxiety without the cost and side effects of medication.

Reeb-Sutherland is interested in identifying children who are likely to develop anxiety, and that has led her to study children with extreme shyness, or what psychologists call behavioral inhibition (BI). About ten percent of children are thought to exhibit BI, a type of temperament that involves excessive fear of new situations and people and is associated with a high risk of later anxiety. As a graduate student, Reeb-Sutherland ran across research showing that young children with BI who spent time in care outside the home (such as at daycare or a grandparent’s house) were less likely to remain inhibited than those who didn’t. The finding stuck out to her, because it was consistent with some research she had done on rats. She and her colleagues exposed half of a litter of young rats to a new environment for a few minutes a day for the first few weeks of life while the other half remained in their home cages at all times. “We found that those with a little bit of novelty exposure were less fearful and more sociable later on,” she explains. Perhaps, she thought, there was a link between the two findings – and a possible way to reduce the chances of anxiety in shy kids.

To explore that possibility, Reeb-Sutherland looks at what’s going on in the brains and behaviors of children with BI who do and do not go on to develop anxiety. She has found that those who have a stronger response to new stimuli tend to become more anxious. In one study of adolescents, the anxious participants showed about twice as much electrical activity in the brain when they heard an unexpected sound.

Another study of children and teens found that the anxious ones were more likely to startle when they feared an unpleasant blast of air, even when given a “safe” cue they had been told meant there would be no blast. Translating those findings to the real world, Reeb-Sutherland and her colleagues have looked at how mothers’ behavior can affect BI, and have found that children with BI who have overprotective moms tend to have more anxiety later on. “It’s understandable,” she points out. “Moms are trying to protect their kids because they know their kids are fearful.” But, she adds, her research suggests that “If you notice your child is inhibited, don’t necessarily avoid new situations; encourage your child to participate in them. You don’t want to completely immerse them in it, but don’t automatically assume it’s going to be harmful to them. In the long run, there is a payoff.”

Reeb-Sutherland is also testing a treatment for young people with anxiety called Attention Bias Modification Training (ABMT). Studies suggest that young people with anxiety appear to pay more attention to potentially threatening cues in their environment than their peers. For example, when shown angry and neutral faces during an experiment, their attention is drawn more quickly to the angry face, even if they have been told to look for a dot that suddenly appears behind the neutral face. Researchers call this phenomenon attention bias to threat, and it is often visible in children well before they develop anxiety symptoms. That opens up an avenue for prevention and treatment, instead of or in addition to psychotherapy or medication.

There has been some research showing that if you train people to pay more attention to the neutral face and less attention to the angry one (for example, by always putting the dot they are searching for behind the neutral face), “you see decreases in their self-reported anxiety outside the lab and some decreases in their attention bias” as measured by brain activity, Reeb-Sutherland says. The research is not yet conclusive, she adds, but her own studies are showing neurological changes such that there is less activity in brain regions associated with fear and emotional reactions. “On an almost subliminal level, the training teaches them that these faces aren’t threatening,” she explains.

Reeb-Sutherland is cautious about drawing treatment recommendations from her research, but she is hopeful about it opening a new path for young people who are anxious or at high risk of developing anxiety. Some researchers are even beginning to use smartphone apps for real-world ABMT. She points out that her own and others’ studies have been conducted under very controlled lab conditions, but she acknowledges, “it’s a good start.”

Bethany Reeb-Sutherland is a recipient of the Federation of Associations in Behavioral & Brain Sciences (FABBS) Early Career Impact Award, which will be presented during the 2017 annual meeting of the International Society for Developmental Psychobiology in Washington, D.C.

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