Visual scanpaths predict treatment response in children and adolescents with social anxiety disorder

Treatment response in pediatric social anxiety disorder (SAD) is highly variable, and symptoms may be maintained by maladaptive attention. A previous study found that youth with SAD scan a more restricted area of faces than healthy controls during emotion recognition, potentially limiting interpretation of social cues. The current study followed up on these results by examining whether restricted face scanning 1) predicts response to psychological treatment, and 2) changes with successful treatment. Youth with SAD (n = 59) were assessed prior to treatment with internet-delivered cognitive behavioral therapy (ICBT) or supportive therapy (ISUPPORT) and then again three months after treatment. Restricted scanning of faces predicted a smaller symptom reduction, independent of treatment arm. Scanpath distribution was moderately stable from T1 to T2 and did not change with treatment. Restricted scanning of faces may be a risk factor for sustained SAD symptoms after therapy. As the visual scanpath is a key aspect of human visual processing, inflexible scanning could potentially interfere with information processing. Implications for theories of attention in pediatric SAD are discussed.