Abnormal Attention Modulation of Fear Circuit Function in Pediatric Generalized Anxiety Disorder

1. Context. Considerable work implicates abnormal neural activation and disrupted attention to facial-threat cues in adult anxiety disorders. However, in pediatric anxiety, no research has examined attention modulation of neural response to threat cues. 2. Objective. To determine whether attention modulates amygdala and cortical responses to facial threat cues differentially in adolescents with generalized anxiety disorder (GAD) and healthy adolescents. 3. Design. Case-control study. 4. Setting. Government clinical research institute. 5. Participants. Adolescent volunteers, 15 with GAD and 20 diagnosis-free. 6. Main Outcome Measure(s). Blood oxygenation level-dependent (BOLD) signal, as measured via functional magnetic resonance imaging (fMRI). During fMRI scans, participants completed a face-emotion rating task that systematically manipulated attention. 7. Results. While attending to their own subjective fear, patients, but not controls, showed greater activation to fearful than to happy faces (small volume corrected p’s \u3c .05) in a distributed network including the amygdala, ventral PFC (vPFC), and anterior cingulate cortex (ACC). Right amygdala findings appeared particularly strong. Functional connectivity analyses demonstrated positive correlations among the amygdala, vPFC, and cingulate. 8. Conclusions. Findings provide the first evidence in juveniles that GAD-associated patterns of pathological fear-circuit activation are particularly evident during certain attention states. Specifically, fear-circuit hyperactivation occurred in an attention state involving focus on subjectively-experienced fear. These findings underscore the importance of attention and its interaction with emotion in shaping function of the adolescent human fear circuit