Attentional bias towards threatening stimuli in children with anxiety: A meta-analysis

Although it is well known that anxious adults show selective attention to threatening stimuli, research investigating attentional bias in children with anxiety has produced mixed results. The purpose of this paper is to provide a comprehensive analysis of studies investigating attentional bias in children with anxiety. Using a systematic search for articles which included both children with anxiety and reported data suitable for a meta-analysis, 38 articles were identified involving 4221 subjects (anxiety n=2222). We used a random effects meta-analysis with standardized mean difference as our primary outcome to estimate between- and within-group effects of attentional bias towards threat-related information in children with anxiety. Overall, children with anxiety showed a significantly greater bias to threat-related stimuli, compared to controls (d=0.21). Children with anxiety also showed a significant bias to threat-related stimuli, over neutral stimuli (d=0.54), which was greater than the bias shown by control children (d=0.15). Specific variables in attentional bias were also explored, with varying results. The review concluded that anxious children do show a similar bias towards threatening stimuli as has been documented in adults, albeit to a lesser degree and this bias is moderated by age, such that the difference between anxious and control children increases with age. Given the small number of studies in some areas, future research is needed to understand the precise conditions under which anxious children exhibit selective attentional biases to threat-related stimuli.