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Executive functioning in high-trait anxious children: A cognitive vulnerability factor?

Authors:
Executive functioning in high-trait anxious children
Executive functioning in high-trait anxious children:
A cognitive vulnerability factor?
Authors: Laura Visu-Petra*, Lavinia Cheie, Oana Mocan
Developmental Psychology Lab, Babeș-Bolyai University, Cluj-Napoca, Romania
Manuscript published in Moore, K., Kaniasty, K., Buchwald, P., & Sesé, A. (2013). Stress and Anxiety:
Applications to Health and Well-Being, Work Stressors, and Assessment. Berlin: Logos Verlag.
Reference: Visu-Petra, L., Cheie, L., & Mocan, O. (2013). Executive functioning in high-trait
anxious children: A cognitive vulnerability factor? In Moore, K., Kaniasty, K., Buchwald, P., &
Sesé, A. (Eds.) Stress and Anxiety: Applications to Health and Well-Being, Work Stressors, and
Assessment (pp. 153 160). Berlin: Logos Verlag.
Executive functioning in high-trait anxious children
1
Introduction
The development of cognitive control mechanisms, also known as executive functions,
has been closely related to cognitive and emotional growth throughout the lifespan. In adults, a
substantial body of research points to the important role played by cognitive control in
determining and modulating the typical or dysfunctional relationship between cognitive and
emotional processes (Pessoa, 2008). For example, in emotional disorders such as anxiety, a clear
link has been established between altered emotional processes and executive (dys)functions. A
unifying theory has been developed, The Attentional Control Theory (ACT; Eysenck,
Derakshan, Santos, & Calvo, 2007; Derakshan & Eysenck, 2009), which accounts for the effects
of anxiety on executive functioning. In the case of high-anxious individuals, anxiety-related
worrisome thoughts create cognitive interference and require the activation of auxiliary
processes and strategies. This depletion of resources impairs attentional control, which leads to
performance decrements in executive functions such as inhibition, updating and shifting (the
model proposed by Miyake and collaborators, 2000). Despite a growing body of evidence
supporting the ACT’s predictions in adults (see Eysenck & Derakshan, 2011, for a recent
review), the relationship between anxiety and executive functioning in children has been
generally overlooked. More recently, however, several researchers turned their attention towards
this domain (see Visu-Petra, Cheie, & Miu, 2012, for a recent review). Their increasing interest
could be accounted by several crucial needs: (1) to reveal early vulnerability markers that would
aid revealing the underpinning mechanisms of anxiety disorders development (see Hadwin &
Field, 2010); (2) to investigate the early precursors of the documented executive functioning
deficits in adults (e.g. Berggren & Derakshan, 2012); and (3) to unravel the cognitive
Executive functioning in high-trait anxious children
2
mechanisms underpinning high-anxious children’s academic underachievement (e.g. Owens,
Stevenson, Hadwin, & Norgate, 2012a). This chapter aims to review the preliminary evidence
relating individual differences in executive functioning to symptoms of anxiety from early
childhood to adolescence, and the potential impact of this relationship for academic performance
during these sensitive developmental periods.
Updating/Working memory
This section reviews the current evidence regarding children’s performance deficits on
working memory (WM) tasks with emotionally-neutral stimuli, as well as on tasks involving
emotionally-relevant information.
WM for emotionally-neutral information
The relationship between nonclinical anxiety and updating was mainly investigated in
school-aged children, by directly addressing ACT’s (Eysenck et al., 2007) predictions suggesting
a detrimental effect of anxiety on performance efficiency and accuracy. Hadwin, Brogan, and
Stevenson (2005) investigated the detrimental effects of state anxiety upon WM performance, in
a sample of 9- to 10-year-olds, using verbal and spatial WM tests. Findings revealed that
anxiety’s impact was mostly reflected in terms of efficiency, as high-anxious children took longer
to complete the backward digit span task, and put more effort in order to complete the forward
digit span task, compared to their low-anxious counterparts. Consistent with these results, in a
study using a mental arithmetic task varying in WM demands (Ng & Lee, 2010), 10-year-olds
with high trait test anxiety achieved comparable scores in terms of WM performance accuracy,
Executive functioning in high-trait anxious children
3
but took longer times to complete the verbal task. Again, performance efficiency was found to be
detrimentally affected by anxiety.
Moreover, high levels of trait-anxiety were negatively related to WM performance
accuracy. Such results were found by Owens, Stevenson, Norgate, & Hadwin (2008), who
investigated the relationship between trait anxiety, WM, and academic performance in a sample
of 11- to 12-year-olds. As predicted by the ACT, trait anxiety’s negative influence was evident in
the verbal WM task, and less evident in visuo-spatial WM. Consistent with these results, in a
study investigating the relationship between negative affect (trait anxiety and depression), worry,
working memory, and academic performance (Owens, Stevenson, Hadwin, & Norgate, 2012b) in
12- to 13-years-olds, higher levels of anxiety were found to decrease WM performance in tasks
with high executive load.
Although the number of studies is limited, the abovementioned findings depict a consistent
pattern of results, generally confirming ACT's predictions in school-aged children. However,
given that both WM and anxiety develop relatively early, prospective studies beginning in early
childhood are required. In this respect, the trait anxiety WM relationship was already
evidenced in preschoolers. Visu-Petra, Miclea, Cheie, and Benga (2009) first investigated the
effects of trait anxiety on simple span accuracy and response timing in 3- to 6-year-olds. In line
with the ACT predictions and findings in school-aged children, results showed that trait anxiety
was a longitudinal negative predictor of both span accuracy and efficiency. The microanalysis of
response timing indicated that high-anxious preschoolers displayed longer times to prepare their
answers, as well as longer pauses in-between words. Consequently, Visu-Petra, Cheie, Benga &
Alloway (2011) investigated both short-term memory and WM performance in relation to trait
Executive functioning in high-trait anxious children
4
anxiety, in high- and low-anxious 3- to 7-year-olds. Findings revealed that while performance in
the visuo-spatial tasks did not differ between the two anxiety groups, high anxious children
displayed poorer performance on the verbal measures. When simple verbal storage was required,
high-anxious preschoolers displayed efficiency impairments only, while both efficiency and
accuracy of response were impaired when sustained verbal updating was required.
To conclude, although the literature is rather scarce, there is consistent evidence
confirming the detrimental effects of trait anxiety in both school-age and preschool children.
Taken together, findings suggest that: (1) compared to verbal WM, visuo-spatial updating is
impaired to a lesser degree (see Hadwin et al., 2005; Owens et al., 2008; Visu-Petra et al., 2011);
(2) higher levels of anxiety mainly disrupt children's updating efficiency (see Hadwin et al.,
2005; Owens et al., 2008; Ng & Lee, 2010; Visu-Petra et al., 2011); (3) high-anxious children's
performance effectiveness (accuracy) can also be disrupted, when the WM task requires higher
levels of executive control (see Owens et al., 2012b; Visu-Petra et al., 2011).
WM for emotionally-relevant information
Very few studies have investigated WM for emotional information in nonclinical
developmental samples, and the existent results are rather inconsistent (see Visu-Petra et al.,
2012 for a review). In the verbal WM domain, the first data were derived from studies conducted
with schoolchildren. Daleiden (1998) investigated the effects of trait anxiety on a conceptual and
perceptual verbal memory task in 11- to 13-year-olds. Findings revealed that memory for
negative words (as compared to positive and neutral) was superior in the high-anxious group,
when recall related to conceptual memory. Cognitive biases in 8- to 14-year-olds were also
Executive functioning in high-trait anxious children
5
investigated by Reid, Salmon, and Lovibond (2006). The authors assessed anxiety, depression,
and aggression symptoms, and used a verbal memory task involving positive and negative self-
descriptors in order to assess potential memory biases. Contrasting Daleiden’s (1998) previous
findings, no memory bias towards negative information was found as specific to anxiety
symptoms. More recently, WM for emotional information was investigated in younger children
with low and high trait anxiety. Using a modified list learning task containing negative, positive,
and neutral words, Cheie and Visu-Petra (2012) explored potential emotional biases in verbal
short-term memory, in a sample of 3- to 7-year-olds. Findings revealed an immediate memory
avoidance of negative information in high-anxious preschoolers, although this tendency was not
maintained in the delayed memory task.
In sum, developmental research has focused on tasks involving lists of emotional words
that participants were required to recall, and the results did not converge into a consistent pattern.
The inconsistency could be accounted for by methodological diversity: (1) tasks involving only
recall of distinct emotional stimuli might only elicit subtle effects that could be evident in
clinical samples and less in children with trait anxiety (see Bishop, Dalgleish, & Yule, 2004, for
a similar proposal in developmental nonclinical depression); (2) the task material could be not
engaging enough / too abstract for young children.
The relationship between trait anxiety and emotional biases was also explored in tasks
tapping visual updating. Using a memory updating task in a sample of 5- to 7-year-olds, Visu-
Petra, Ţincaş, Cheie, and Benga (2010) revealed that high-anxious children’s WM performances
were impaired, as they displayed both less efficient and less accurate responses in updating
happy faces, but were more accurate in updating angry faces. The results suggest that anxiety-
Executive functioning in high-trait anxious children
6
related neurobehavioral interactions could occur during early development, while processing
anxiety-relevant emotional visual information, supporting the possibility of a continuum of
anxiety symptoms - anxiety disorders documented by previous research (Schniering, Hudson, &
Rapee, 2000).
Inhibition
The relationship between individual differences in inhibition and anxiety symptoms has
received very little support in nonclinical samples. In the case of pediatric anxiety, several
studies using emotional stimuli indicated that inhibitory control is affected by stimulus valence
and by the use of incentives. For example, in an antisaccade task, Hardin et al. (2009) showed
that biased processing of task-irrelevant threat in anxious adolescents negatively impacts
inhibitory control, perhaps by raising arousal prior to behavioral performance. Also, anxious
adolescents displayed no performance improvement following exposure to task-irrelevant
positive emotional cues, compared to healthy adolescents, who presented such a pattern of
improvement. Recent research from the same group (Mueller et al., 2012) using an emotion-
modified antisaccade task showed that threat-related information improved antisaccade accuracy
in healthy but not anxious youth. In a study using a different inhibitory task the GoNoGo
paradigm, Waters and Valvoi (2009) found a selective interference by angry faces in anxious
girls, but not in boys. A similar task had been used in a pediatric anxiety sample by Ladouceur et
al. (2006), who showed that children with anxiety had significantly slower reaction times to
neutral face Go trials embedded in angry face NoGo trials. In one of the few investigations with
nonclinical samples, Richards, French, Nash, Hadwin, and Donnely (2007) used an emotional
Executive functioning in high-trait anxious children
7
Stroop task and found that high-anxious 11-year-old children showed greater threat-related
interference than the low-anxious children on anxiety-related words. To conclude, there is some
evidence that processing threatening information influences the performance on inhibition tasks
in children and adolescents diagnosed with an anxiety disorder. However, there is very limited
evidence indicating that children with higher levels of anxiety who do not fulfill the criteria for a
clinical diagnosis are also impaired on inhibition tasks using neutral or threat-relevant
information.
Set-shifting
One of the main predictions of the ACT is that anxiety will impair processing efficiency
and often performance effectiveness on tasks that involve the shifting function. In adults, there
are studies that confirm this prediction (e.g. Ansari, Derakshan & Richards, 2008; Derakshan,
Smyth & Eysenck, 2009) and also studies that found inconsistent results (e.g. Kofman, Meiran,
Greenberg, Bales, & Cohen, 2006).
The ability to flexibly switch between tasks has been studied using the task switching
paradigm, in which participants rapidly alternate between making decisions about one of two
dimensions of the same stimulus, such as its color or shape, on a trial-by-trial basis. The stimulus
remains the same across tasks; however, the participants are required to switch their attention
between these dimensions depending on the task being performed (Cragg & Nation, 2009).
There are only a few studies that investigated early anxiety-related impairments in
children while performing a set-shifting task. On one hand, there are studies which found anxiety
related switching deficits in a prospective memory task administered to preschoolers (Cheie,
Executive functioning in high-trait anxious children
8
Miclea, & Visu-Petra, submitted). Some anxiety-related deficits were also found in school age-
children in an emotional task-switching paradigm (Mocan, Stanciu, & Visu-Petra, submitted).
On the other hand, some studies fail to document the presence of anxiety-related impairments in
attentional set-shifting in preschoolers (Țincaș, Dragoș, Ionescu, & Benga, 2007).
Putting the pieces together: Executive functioning, high-trait anxiety
and academic achievement
In general, executive functions have been shown to play a central role in sustaining and
calibrating the development of academic skills. Also, it has been well documented that a higher
level of anxiety is related to poorer academic achievement (e.g. Crozier & Hostettler, 2003;
Woodward & Fergusson, 2001). However, although there is reason to believe that the anxiety-
related inhibitory/set-shifting/updating deficits described before might be related to academic
failure in high anxious children, there has been no empirical investigation to test this hypothesis.
Within the ACT framework (Eysenck et al., 2007), the interaction between anxiety and WM
constitutes a potential mechanism that may account for anxiety's detrimental effect on academic
performance. However, there are few studies specifically focusing on the association between
anxiety, WM, and academic performance.
Making first steps in this direction, Owens et al. (2008) found verbal WM to partially
mediate the relationship between trait anxiety and academic performance, accounting for 51% of
the association. More recently, Owens et al. (2012b) also showed that the link between negative
affect (trait anxiety and depression) and academic performance in schoolchildren is partly driven
by the strong association between updating and academic achievement. Moving one step further,
Executive functioning in high-trait anxious children
9
Owens et al. (2012a) explored the role of WM capacity in the high anxiety low performance
relationship. Findings revealed that WM capacity had a moderating effect in 12- to 14-year-olds:
for those with low WM capacity, increases in trait anxiety were related to decreases in cognitive
test performance; while for those with high WM capacity, the situation was reversed. The results
are in line with similar findings in undergraduates (Johnson & Gronlund, 2009), showing that
individuals lower in WM capacity were most vulnerable to trait anxiety's disruptive effect on
performance.
Taken together, these studies provide strong evidence suggesting that WM is an important
neurocognitive mechanism underlying anxiety's detrimental effect on academic performance.
Moreover, findings suggest that anxiety has a differential association with performance,
depending on general WM capacity (Johnson & Gronlund, 2009; Owens et al., 2012b) and on
whether verbal or visual-spatial WM resources are involved (Owens et al., 2008). Further
research is required to investigate the differential contribution of executive processes (shifting,
inhibition, updating) in explaining the anxiety-academic achievement interplay across
development.
Acknowledgements
This work was supported by a grant from the Romanian National Authority for Scientific
Research, CNCS UEFISCDI, project number PNII-ID-PCCE-2011-2-0045.
Executive functioning in high-trait anxious children
10
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... To summarize, our current understanding of the relative contributions of trait and state anxiety on cognitive performance is limited. Furthermore, studies involving school-aged children are relatively scarce (Visu-Petra, Cheie, & Mocan, 2013). A notable exception is Ursache and Raver's (2014) study on 9-to 12- ...
... The interplay between anxiety and WM has been observed in a large number of studies (e.g., Eysenck & Derakshan, 2011;Visu-Petra et al., 2013). Based on these findings and the ACT framework, the effects of anxiety on WM constitute a plausible mechanism for the well-documented link between anxiety and performance. ...
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This study investigated the effect of individual differences in state anxiety on tasks tapping the central executive, phonological, and visuo‐spatial components of working memory (WM). It was designed to test Eysenck and Calvo’s processing efficiency theory (PET) which suggests that the phonological and executive components of WM may be important in understanding learning outcomes in anxiety. Typically‐developing children aged 9–10 years were split into high and low state anxiety groups. They performed three WM tasks – forward and backward digit span (assumed to measure phonological and central executive components of WM respectively) and a spatial working memory task (measuring the visuo‐spatial component of WM). Measurements of task accuracy were taken as an indicator of performance outcome or effectiveness. Time taken to complete tasks and a subjective rating of mental effort were taken as measurements of performance efficiency. No differences were found between high and low state anxiety groups in task accuracy for any measure. Children in the high state anxiety group, however, took longer to complete the backward digit span task and reported increased mental effort in the forward digit span task, indicating some effect of anxiety on measures of performance efficiency.
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Stressful life situations can impair or facilitate various cognitive functions. In the present study, the effect of examination stress on students was examined using two executive function tasks, task-switching and the Stroop task, in a between-subject crossover design. Students showed increased anxiety in the 2 week period prior to exams compared to the beginning of the semester, manifested as higher scores on the Spielberger State-Trait Anxiety Scale and a shift to more sympathetic activation when heart rate variability was assessed. During the stressful period, the switching cost was reduced on a spatial task-switching paradigm and reaction times in the Stroop task were faster. This is the first study to show stress-induced facilitation of performance on these executive function tasks.
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There have been many attempts to account theoretically for the effects of anxiety on cognitive performance. This article focuses on two theories based on insights from cognitive psychology. The more recent is the attentional control theory (Eysenck, Derakshan, Santos, & Calvo, 2007), which developed from the earlier processing efficiency theory (Eysenck & Calvo, 1992). Both theories assume there is a fundamental distinction between performance effectiveness (quality of performance) and processing efficiency (the relationship between performance effectiveness and use of processing resources), and that anxiety impairs processing efficiency more than performance effectiveness. Both theories also assume that anxiety impairs the efficiency of the central executive component of the working memory system. In addition, attentional control theory assumes that anxiety impairs the efficiency of two types of attentional control: (1) negative attentional control (involved in inhibiting attention to task-irrelevant stimuli); and (2) positive attentional control (involved in flexibly switching attention between and within tasks to maximize performance). Recent (including unpublished) research relevant to theoretical predictions from attentional control theory is discussed. In addition, future directions for theory and research in the area of anxiety and performance are presented.
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Why is the Study of Information Processing Biases in Child Anxiety Important?Information Processing Biases in Childhood Anxiety: Theoretical and Research IssuesThe Origin and Treatment of Information Processing Biases in Childhood AnxietySummaryAcknowledgementsReferences