Content uploaded by Santiago Morales
Author content
All content in this area was uploaded by Santiago Morales on Jan 27, 2019
Content may be subject to copyright.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
1
Attention bias to reward predicts behavioral problems and moderates early risk to externalizing
and attention problems
Development and Psychopathology
Santiago Morales1*, Natalie V. Miller1, Sonya V. Troller-Renfree1,
Lauren K. White2, Kathryn A. Degnan3, Heather A. Henderson4, & Nathan A. Fox1.
1Department of Human Development and Quantitative Methodology, The University of
Maryland, College Park, MD, USA
2Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
3Department of Psychology, Catholic University of America, Washington DC, USA
4Department of Psychology, University of Waterloo, Waterloo, Canada
*3304 Benjamin Building, Campus Dr., College Park MD 20742.
Email: moraless@umd.edu.
Acknowledgments: We thank the many research assistants involved in collecting and coding the
data presented in this manuscript. We also thank the participating families without whom the
study would not have been possible.
Funding: This research was supported by grants from the National Institute of Health MH093349
and HD017899 to NAF.
!
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
2
Abstract
The current study had three goals. First, we replicated recent evidence that suggests a
concurrent relation between attention bias to reward and externalizing and attention problems at
age 7. Second, we extended these findings by examining the relations between attention and
behavioral measures of early exuberance (3 years), early effortful control (4 years), and
concurrent effortful control (7 years), as well as later behavioral problems (9 years). Finally, we
evaluated the role of attention to reward in the longitudinal pathways between early exuberance
and early effortful control to predict externalizing and attention problems. Results revealed that
attention bias to reward was associated concurrently and longitudinally with behavioral
problems. Moreover, greater reward bias was concurrently associated with lower levels of
parent-reported effortful control. Finally, attention bias to reward moderated the longitudinal
relations between early risk factors for behavioral problems (gender, exuberance, and effortful
control) and later externalizing and attention problems – such that these early risk factors were
most predictive of behavioral problems for males with a large attention bias to reward. These
findings suggest that attention bias to reward may act as a moderator of early risk, aiding the
identification of children at the highest risk for later behavioral problems.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
3
A main goal of developmental psychopathology research is to identify early risk factors
for later behavioral problems. In the same vein, developmental psychopathology aims to
elucidate the mechanisms of equifinality and multifinality in order to identify individuals at
greatest risk for psychopathology and to aid early intervention and prevention. How children
attend to social information may be associated with behavioral problems and help explain
variations in the developmental pathways from early risk. The current study examines relations
between children’s propensity to attend towards positively-valenced stimuli (i.e., attention bias to
reward) and behavioral problems in the externalizing domain. Moreover, we examine the role of
attention bias to reward on the longitudinal relations between known early risk factors of
externalizing and attention problems.
Behavioral problems in the externalizing domain include aggressive, disruptive, or
conduct problems, as well as attention problems. Although they are often separated into specific
disorders (e.g., oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity
disorder; ADHD), they frequently co-occur and are believed to share similar developmental
antecedents, such as temperamental traits that indicate high approach tendencies and/or lack of
regulation (Faraone et al., 2018; Tackett, 2010). For instance, developmental research has
identified an early behavioral profile marked by positive affect, high activity levels, and high
approach towards novelty, called exuberance (Fox, Henderson, Rubin, Calkins, & Schmidt,
2001). Exuberance is thought to be driven by a motivational state of heightened sensitivity to
reward and reward expectancy, leading to bold approach to novelty and impulsivity (Degnan et
al., 2011; Polak-Toste & Gunnar, 2006). Exuberance is considered a risk factor for behavioral
problems as it often predicts later externalizing and attention problems (Morales, Beekman,
Blandon, Stifter, & Buss, 2015; Nigg, Goldsmith, & Sachek, 2004; Putnam & Stifter, 2005;
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
4
Tackett, 2010). For instance, Putnam and Stifter identified a group of exuberant children,
characterized by increased positive affect and behavioral approach in toddlerhood, and found
that exuberance was associated with higher levels of externalizing problems at age 2 (Putnam &
Stifter, 2005) and at age 4 (Stifter, Putnam, & Jahromi, 2008). Similarly, Morales et al. (2015)
found that exuberance in toddlerhood was predictive of a composite of externalizing and
attention problems during preschool.
Self-regulatory abilities, such as effortful control, are also known early risk factors for
externalizing and attention problems. Effortful control is commonly defined as the ability to
control behavior by inhibiting a prepotent response (inhibitory control) and/or to activate an
alternative, subdominant response (Kochanska & Knaack, 2003; Rothbart & Bates, 2006). In
other words, effortful control refers to the general ability to volitionally modulate, inhibit, or
activate behavior and attention. As such, effortful control allows individuals to meet societal
demands and early deficits in effortful control are a strong marker of maladaptive trajectories,
including later externalizing and attention problems (Eisenberg et al., 2009; Lemery, Essex, &
Smider, 2002; Moffitt et al., 2011; Morales, Pérez-Edgar, & Buss, 2016). For instance, Lemery
and colleagues (2002) found that poorer effortful control in early childhood (3.5-4.5 years)
predicted externalizing and attention problems one year later (5.5 years).
In sum, exuberance and effortful control are significant early risk factors for externalizing
and attention problems; however, they are far from perfect indicators of these later problems.
Indeed several studies fail to find significant direct associations between these early risk factors
and later behavioral problems (e.g., Degnan et al., 2011; Murray & Kochanska, 2002; Rhoades,
Greenberg, & Domitrovich, 2009). From a developmental psychopathology perspective, the term
multifinality describes different developmental pathways from a common early individual trait.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
5
Multifinality implies that there may be unexamined processes that account for variable
developmental trajectories from early risk. Social information processing is a more proximal risk
factor and potential moderator that could explain the heterogeneity of developmental pathways
from early exuberance and effortful control. Specifically, the way individuals attend to different
environmental cues shapes their interpretation of the situation, causing them to react or behave
accordingly (Crick & Dodge, 1994). Notably, the emotional salience of cues plays a crucial role
in social information processing (Lemerise & Arsenio, 2000) as documented by the large
literature on the impacts of affect-biased attention on psychopathology.
Affect-biased attention is the tendency to selectively attend to environmental cues that are
pertinent to the individual’s psychological state, shaping how individuals interpret and ultimately
respond to their environment (Derryberry & Reed, 1996, 2002; Todd, Cunningham, Anderson, &
Thompson, 2012). As such, cognitive models of psychopathology propose that affect-biased
attention impacts, potentially in a causal manner, individuals’ thought, emotion, and behavior
(e.g., Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007; Morales,
Fu, & Pérez-Edgar, 2016). Moreover, affect-biased attention may help identify and explain the
different developmental pathways stemming from a common early risk factor (i.e., exuberance or
effortful control). Although most of this evidence comes from the internalizing literature, in
which the link between attention bias towards negative or threatening stimuli and anxiety has
been extensively studied, it has recently been proposed that affect-biased attention acts as a
general mechanism that influences thoughts and behavior across several socioemotional domains
(Morales, Fu, et al., 2016).
As reviewed in Morales et al. (2016), an attention bias toward reward-related stimuli is
associated with approach-oriented emotions in several different domains of functioning (e.g.,
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
6
extraversion, drug addiction, obesity). Support for the role of attention biases in approach-
oriented emotions comes from studies examining biases towards positively-valenced stimuli (i.e.,
happy faces). Happy faces are considered to be social rewards as viewing happy facial
expressions typically activates reward-related areas (e.g., striatum and orbitofrontal cortex;
Cremers, Veer, Spinhoven, Rombouts, & Roelofs, 2015; Luking, Pagliaccio, Luby, & Barch,
2016; Monk et al., 2008; O’Doherty et al., 2003). As such, attention biases to these positive
stimuli are commonly conceptualized as attention bias toward reward (Frewen, Dozois, Joanisse,
& Neufeld, 2008; Morales, Pérez-Edgar, et al., 2016; Shechner et al., 2012). Studies in adults
find that attention bias to reward is positively related to positive affect (Tamir & Robinson,
2007) and extraversion (Derryberry & Reed, 1994), and negatively related to anxiety and
depression (Frewen et al., 2008; Shechner et al., 2012). In addition, training adults to attend
toward reward increases positive affect (Grafton, Ang, & MacLeod, 2012; Taylor, Bomyea, &
Amir, 2011) and reduces anxiety in children and adults (Britton et al., 2013; Heeren, Reese,
McNally, & Philippot, 2012; Waters, Pittaway, Mogg, Bradley, & Pine, 2013). Finally, attention
bias to reward moderates the relation between early temperamental risk and later anxiety, such
that early temperamental risk predicted later anxiety only for children who displayed a reduced
attention bias to reward (Shechner et al., 2012; White et al., 2017). In sum, attention bias to
reward is related to increased positive affect and may serve as a protective factor against the risk
of internalizing problems.
However, an attention bias to reward may not be adaptive in all contexts. Several studies
highlight the role of reward processing in the development and maintenance of externalizing
behavior problems. Specifically, children with externalizing and attention problems are more
sensitive to rewards as they persevere toward rewards even in the presence of adverse outcomes
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
7
and prefer immediate rewards over larger but delayed rewards, compared to children without
these problems (Frick et al., 2003; Gatzke-Kopp et al., 2009; Luman, Oosterlaan, & Sergeant,
2005; Luman, van Meel, Oosterlaan, & Geurts, 2012; O’Brien & Frick, 1996). As such, it is
possible that high levels of attention bias to reward, although protective in some contexts, may
be maladaptive in other contexts – particularly among children who are already at increased risk
for externalizing and attention problems (e.g., children high in temperamental exuberance or low
in effortful control).
Supporting this notion, prior work in community samples of children has found that
attention bias to reward was concurrently related to a composite measure of externalizing and
attention problems (He, Li, Wu, & Zhai, 2017; Morales, Pérez-Edgar, et al., 2016) and higher
ADHD symptoms (Cremone, Lugo-Candelas, Harvey, McDermott, & Spencer, 2018). Moreover,
Morales et al. (2016) found that attention bias to reward at age six was predicted by parent
reports of temperamental exuberance at age two. In addition, the longitudinal relation between
toddler exuberance and later attention bias toward reward was mediated by effortful control at
age four, suggesting that effortful control is one of the underlying processes accounting for the
relation between early exuberance and attention bias toward reward. A concurrent relation
between increased attention bias to reward and lower effortful control was recently reported in
another sample of six-year-old children (Cole, Zapp, Fettig, & Pérez-Edgar, 2016). Together,
these findings suggest that attention bias to reward may be a marker of high approach and,
coupled with low levels of effortful control, may predict behavioral problems marked by
impulsive behavior such as externalizing and attention problems.
The current study aims to support and extend this literature in multiple ways. In order to
assess the robustness and generalizability of the relations of attention bias to reward with
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
8
externalizing problems and effortful control, the current study attempts to replicate them. This is
especially important given the reproducibility crisis psychological science (Open Science
Collaboration, 2015) and the lack of replication studies in developmental science (Duncan,
Engel, Claessens, & Dowsett, 2014). To better understand attention bias to reward as a risk
factor, more work is needed exploring the relations between attention bias to reward, behavioral
problems, and known risk factors for externalizing and attention problems (e.g., low effortful
control and exuberance). For instance, to better understand the direction of effects, it is important
to evaluate whether attention bias to reward is associated with behavioral problems both
concurrently and longitudinally. Moreover, most of the studies to date have relied on parent
reports of exuberance and effortful control (for exception see He et al., 2017). Parental reports
are only one source of information on children’s temperament and utilizing other methods, such
as behavioral measures, provide unique and complementary evidence (Kagan & Fox, 2006). As
such, it is of interest to evaluate whether attention bias to reward is associated with behavioral
measures of early exuberance and effortful control.
Moreover, paralleling the findings from the internalizing literature (e.g., White et al.,
2017), in addition to examining direct associations, it is important to examine whether attention
bias to reward exacerbates early risk factors to predict later externalizing and attention problems.
Indeed, most studies examining the relation between attention bias and early temperament do not
find a direct relation, but rather find that attention bias moderates the relation between early
temperament and later behavioral problems (Cole et al., 2016; He et al., 2017; Morales, Pérez-
Edgar, & Buss, 2015; Pérez-Edgar et al., 2011; White et al., 2017). As such, it is possible that
attention bias to reward, beyond predicting behavioral problems, may also help to specify the
pathways from early risk to later behavioral problems.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
9
Finally, another important extension of the previous findings is to explore whether gender
impacts the effect of attention bias to reward on externalizing behavior problems. Gender
differences in externalizing and attention problems have been extensively documented, with
males being more likely to display externalizing and attention problems when compared to
females (e.g., Bongers, Koot, Van der Ende, & Verhulst, 2003; Offord et al., 1987). Males are
also more likely to display higher levels of exuberant behavior and lower levels of effortful
control compared to females (Else-Quest, Hyde, Goldsmith, & Van Hulle, 2006), suggesting that
they may be at greater early risk for externalizing and attention problems. Moreover, some
studies suggest different developmental pathways to externalizing problems for males and
females (Buss, Kiel, Morales, & Robinson, 2014; Hay et al., 2017; Miller, Degnan, Hane, Fox, &
Chronis-Tuscano, 2018; Morales, Beekman, et al., 2015; Rubin, Burgess, Dwyer, & Hastings,
2003; Vidal-Ribas, Pickles, Tibu, Sharp, & Hill, 2017). Specifically, these studies suggest that
risk factors such as exuberance and effortful control act in a gender specific manner (Buss et al.,
2014). For instance, Buss et al. (2014) found that boys with low levels of inhibitory control and
high levels of approach to novelty were at particularly high risk for externalizing and attention
problems, compared with boys high in effortful control and girls. As such, in order to identify for
which children attention bias to reward is most predictive of risk for behavior problems, it is of
interest to examine whether the role of attention bias to reward differs by gender.
Current study
In sum, the current study has three goals. First, it aims to replicate the concurrent
relations between attention bias to reward, externalizing problems and attention problems, and
parent-reported effortful control—all measured at age seven. We focus on externalizing and
attention problems during school age as behavioral problems often emerge during school years
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
10
and can be highly impairing to the individual (e.g., DuPaul, Morgan, Farkas, Hillemeier, &
Maczuga, 2016). Although many children display moderate to high levels of externalizing
behaviors during toddlerhood and preschool, there is a normative decrease in these behaviors
with age. However, children who maintain high levels of these behaviors upon school entry often
experience impairments across multiple domains (e.g., peer relationships, academic) and are at
increased risk for later maladjustment (Campbell, Spieker, Burchinal, Poe, & NICHD Early
Child Care Research Network, 2006). Based on previous studies, we hypothesized that attention
bias to reward would be positively related to externalizing and attention problems, and
negatively related to parent-reported effortful control.
Second, we extend these findings by examining the relations between attention bias to
reward (age seven) and behavioral measures of early exuberance (age three), early effortful
control (age four), and concurrent effortful control (age seven). Moreover, we examine the
longitudinal prediction of attention bias to reward (age seven) to externalizing and attention
problems two years later (age nine). Building on Morales et al. (2016), we hypothesized that
attention bias to reward would be predicted by early exuberance (age three) and effortful control
(age four). Moreover, we hypothesized that attention bias to reward would longitudinally predict
externalizing and attention problems.
Third, the present study examines the moderating role of attention to reward in the
longitudinal pathways between early exuberance and early effortful control to predict later
externalizing and attention problems at age 9. We expected that the effects of these known
predictors of externalizing and attention problems (exuberance, low effortful control) would be
stronger for children with a large attention bias to reward. In addition, given gender differences
in the incidence of behavioral problems and the developmental pathways from early predictors to
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
11
later externalizing and attention problems (Buss et al., 2014; Hay et al., 2017; Miller et al., 2018;
Morales, Beekman, et al., 2015; Rubin et al., 2003; Vidal-Ribas et al., 2017), we explore the role
of gender as a moderator of these relations. In sum, we expected that the effects of these known
predictors of externalizing and attention problems (namely, exuberance, low effortful control,
and being a male) would be stronger for children with an enhanced attention bias to reward.
Figure 1. Conceptual representation of the aims of the paper. Note: EC = effortful control. Aim 2
is tested as zero-order relations.
Methods
Participants
Participants were part of a larger longitudinal study on temperament and socioemotional
development conducted in a large metropolitan area the United States (for a detailed description
of the recruitment and screening procedures for the larger longitudinal study see Hane, Fox,
Henderson, & Marshall, 2008). Two hundred ninety one children (53.6% females) were selected
in infancy. Based on the initial sample demographics, mothers were 69.4% Caucasian, 16.5%
African American, 7.2% Hispanic, 3.1% Asian, 3.4% other, and 0.3% missing. Information on
family income was not collected for the sample; however, mothers in the sample reported on
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
12
their level of education: 35.7% were graduate school graduates, 41.9% were college graduates,
16.2% were high school graduates, 5.5% reported other forms of education, and 0.7% were
missing.
Of the original sample (N=291), 218 had data at the three-year visit, 205 had data on the
behavioral effortful control composite at the 4-year visit, 174 had attention bias data at the 7-year
visit, 169 had behavioral effortful control data at the 7-year visit, 190 had parent reports of
externalizing, attention problems, and effortful control at 7 years, and 184 had parent reports of
externalizing and attention problems at 9 years. Examining the patterns of missing data revealed
that mother’s ethnicity (non-Hispanic Caucasian vs. other minority groups) was associated with
missing data on exuberance (χ2(1) = 9.28, p = .002) and questionnaire measures at the 7-year
visit (χ2(1) = 8.99, p = .003) – such that children with data on these measures were more likely to
have non-Hispanic Caucasian mothers. Because of this, maternal ethnicity was included as a
covariate on the SEM analyses. Missing data on all other variables was not associated with
children’s gender, mother’s ethnicity, maternal education, or temperament during the screening
procedure (p’s > .10). In addition, participants were further removed from the analyses due to
poor performance in the behavioral tasks and after deleting outliers (see details below).
Measures
Age 3 exuberance. At 3 years of age, children were assessed for exuberant affect and
behavior during a behavioral inhibition paradigm (Fox et al., 2001), as well as a positive
affect/risk-taking paradigm (Pfeifer, Goldsmith, Davidson, & Rickman, 2002; Putnam & Stifter,
2005). The behavioral inhibition paradigm included the following tasks: free play, stranger
approach, robot, and tunnel. For more details on these tasks, see Fox et al. (2001). As described
in Degnan et al. (2011), the exuberance/risk-taking tasks included asking children to put on a
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
13
blood pressure cuff, jump on a trampoline, touch a gorilla mask, climb up steps toward the wall,
touch a realistic-looking snake, touch an unpredictable mechanical dragon toy, and sit close to
the experimenter to read a book. For each of these tasks, children were asked by the
experimenter to approach or perform each activity. If they did not approach, the experimenter
prompted them. Once they approached/performed the task, or it was clear that they were refusing
to participate, the experimenter moved on to the next set of stimuli. Throughout the risk-taking
episodes, the experimenter maintained a neutral tone, except while reading the book, when the
experimenter was permitted to try to engage participants as much as possible. Each task was
coded for latency to touch/approach the stimuli, latency to vocalize, proportion of time spent in
proximity to the mother, proportion of time spent in proximity to the experimenter, number of
experimenter prompts, activity level (range: 0–3), and degree of approach toward stimuli (range:
0–3). Inter-rater reliability (ICCs across 20% of the cases) for these continuous measures ranged
from .78 to .98 (M = .87). Each task was also coded in 30-s epochs for the presence of smiling,
positive vocalizations, talking to the experimenter, smiling at the experimenter, gesturing to the
experimenter, verbal initiations to the experimenter, and willingness to perform each task. Inter-
rater reliability (kappas) for these measures ranged from .60 to .82 (M = .70).
All scores were standardized and averaged across tasks. Average scores that were highly
skewed were dichotomized as 0 (not present) and 1 (present). Average codes were then
combined into three subscales: Positivity, Approach, and Sociability. The Positivity subscale
included smiling and positive vocalizations (α = .81). The Approach subscale included latencies
to touch/approach the stimuli (reverse-scored), proximity to the mother (reverse-scored), latency
to vocalize (reverse-scored), activity level, number of prompts (reverse-scored), degree of
approach, and willingness to perform each task (α = .83). The Sociability subscale included all of
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
14
the codes with reference to the experimenter: proximity, talking, smiling, gesturing, and verbal
initiations (α = 86). Finally, an Exuberance measure was computed by averaging the Positivity,
Approach, and Sociability subscales (M = 0.10, SD = 0.29, α = .71, intercorrelations: .24 to .57).
Exuberance scores were inspected for outliers (> 2.5 SD from the mean) and three scores were
removed.
Age 4 behavioral effortful control. At age 4, a behavioral composite of effortful control
was created from the mean of the standardized scores of the following tasks: Day-Night Stroop,
Grass-Snow Stroop, and a Go/Nogo task. All tasks were significantly correlated with each other
(r’s >.22, p’s < .005). Children with at least one score were included in the composite. A similar
composite has been previously used in this sample (White, McDermott, Degnan, Henderson, &
Fox, 2011).
The Day-Night Stroop requires children to actively inhibit a prepotent response and give
a subdominant response (Gerstadt, Hong, & Diamond, 1994). This task has been used in
previous studies to assess individual differences inhibitory control (Carlson & Moses, 2001). The
task requires children to say the word “Day” when presented with a picture of the moon and
“Night” when presented with a picture of the sun. After the initial training, there were several
practice trials (up to a maximum of 10). There was a total of sixteen test trials, with the sun and
moon pictures presented eight times each in a pseudorandom order. Children who did not get one
of each trial type correct during practice trials or who completed less than half of the test trials
were excluded from analyses (n=12). Moreover, data from four children were excluded due to
experimenter error and one outlier score was removed (> 2.5 SD from the mean). The outcome
of interest was children’s response accuracy, or percent correct, on the test trials, reflecting a
child’s ability to inhibit a prepotent response. Reliability was estimated as the Spearman-Brown-
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
15
corrected correlation between the percent accuracy scores of two random halves of the test trials
(r = .84).
The Grass-Snow Stroop, akin to the Day-Night Stroop, required children to inhibit a
dominant response and give an alternative, subordinate response (Carlson & Moses, 2001). The
Grass-Snow task has been used in previous studies to assess individual differences inhibitory
control (Carlson & Moses, 2001; White et al., 2011). The primary difference between the Day-
Night and Grass-Snow Stroop tasks is the reduction in verbal load on the Grass-Snow by asking
children to respond by pointing rather than speaking. A large board with a white card attached to
the upper-left corner, a green card attached to the upper–right corner, and two foam cut-outs
shaped like hands centered below the colored cards. The child was told to point to the white card
when the experimenter said “grass” and to point to the green card when the experimenter said
“snow.” After the initial training, children were given several practice trials (up to a maximum of
10). There was a total of sixteen test trials, with the white and green picture cards presented eight
times each in a pseudorandom order. Children who did not get one of each trial type correct
during practice trials or who completed less than half of the test trials were excluded from
analyses (n=6). Moreover, data from one child were excluded due to experimenter error and four
outlier scores were removed (> 2.5 SD from the mean). The outcome of interest was children’s
response accuracy on the test trials, or percent correct, reflecting a child’s ability to inhibit a
prepotent response. Reliability was estimated as the Spearman-Brown-corrected correlation
between response accuracy of two random halves of the test trials (r = .94).
The Zoo Game is a computer-based Go/No-go task based off Durston et al. (2002).
Children were told that animals from the zoo have escaped from their cages and that the
zookeeper needed help catching the animals. Children were further told to not catch the monkey
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
16
because it was the zookeeper’s assistant helping them catch the animals. Children were
instructed to press a button to catch all of the animals (go trials), and to not respond for the
monkey who helped the zookeeper catch the animals (no-go trials). On each trial, an animal
stimulus was presented on the screen for 700 ms, followed by a blank screen for 2300 ms or until
the child responded; the inter-trial interval was 500 ms. Children were given 12 practice trials
and a total of 120 test trials, presented in two blocks of 60 trials each. The task consisted of 75%
Go trials and 25% no-go trials. All Go and No-go data were cleaned to remove anticipatory
responses (RTs < 200 ms) prior to the computation of accuracy measures. Response accuracy
was calculated on both Go and No-go trials. Children who did not have correct scores on at least
60% of the task were excluded from the analysis (n=18). As in previous studies (He et al., 2010),
the percent correct on the No-go trials served as the index of inhibitory control, with greater
percentage correct indicative of greater inhibitory control. Scores were examined for outliers (>
2.5 SD from the mean) and no scores were removed. Reliability for the No-go accuracy scores
was calculated as the Spearman-Brown-corrected correlation between two random halves (r =
.94).
Age 7 attention bias. A variation of the dot-probe task (MacLeod, Mathews, & Tata,
1986) was used to assess attention bias to reward at age 7. The task consisted of a fixation cross
presented in the center of the screen (1000 ms) followed by a display of a pair of horizontally-
aligned facial expressions (500 ms). One of the faces was replaced by arrow, oriented either up
or down, that appeared for 300 ms. Children were asked to indicate the probe’ s orientation via
button press and had up to 1,700 ms to respond. For each face pair a neutral facial expression
was always matched with an angry, happy, or another neutral facial expression modeled by the
same actor. Facial images were taken from the NimStim face stimulus set (Tottenham et al.,
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
17
2009). There were 64 angry-neutral, 64 happy-neutral, and 32 neutral-neutral trials. A subset of
children (n = 38) completed a longer version of the task containing 240 trials. For these children,
the first 160 trials were selected to be comparable with other children. The current study
examined the happy-neutral trials, which were presented in two different conditions: congruent
trials, in which the happy-neutral face pair was followed by an arrow in the same position as the
happy face; or incongruent trials, in which the probe appeared on the opposite side of the happy
face.
As detailed in White et al., (2017), dot-probe reaction time (RT) and accuracy data were
processed using standard cleaning methods (Eldar, Ricon, & Bar-Haim, 2008). Incorrect trials,
trials with RTs < 200 ms, and trials with RTs +/- 2 SDs of each condition from the individual’s
mean were excluded from analyses. Children who had poor task performance (indexed by
accuracy rates < 65%: n= 63) were excluded from the current analyses. Similar accuracy cutoffs
have been used in previous dot-probe studies (Pérez-Edgar et al., 2010). Children excluded due
to poor accuracy were more likely to be males, χ2(1)=7.51, p=.006, and had lower behavioral
effortful control at age 4, t(162)=2.08, p=.04, and age 7, t(164)=3.31, p=.001. The cleaned RTs
were used to create attention bias to reward scores by subtracting the average RT from congruent
happy trials from the average RT from the incongruent happy trials. Positive scores indicate an
attention bias to reward; negative scores indicate an attention bias away from reward. Finally,
bias scores were examined for outliers (> 2.5 SD from the mean) and three scores were removed
from the data. Reliability for the attention bias to reward scores was estimated as the Spearman-
Brown-corrected correlation between two random halves (r = .50).
Age 7 behavioral effortful control. Children completed a similar version of a Go/Nogo
task (Zoo Game) described above. The differences between the tasks at the two ages were that
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
18
instead of one monkey, five different orangutans appeared in the no-go trials (one orangutan per
trial) and children completed more trials. Children completed four blocks of 70 trials (280 trials
total). Participants completed 12 practice trials. On each trial, an animal stimulus was presented
on the screen for 500 ms, followed by a blank screen for 900 ms or until the child responded; the
inter-trial interval was jittered between 200–300 ms. Stimuli were presented using E-Prime
Software (Schneider, Eschman, & Zuccolotto, 2002).
All Go and No-go data were cleaned to remove anticipatory responses (RTs < 200 ms)
prior to the computation of accuracy measures. Data were excluded from analysis if the
participant did not achieve at least 60% accuracy during the task (n = 0). Parallel to the four-year
measure, percent correct on the No-go trials served as the index of inhibitory control. Finally,
one score was removed due to outlier status (> 2.5 SD from the mean). Reliability for the No-go
accuracy scores was estimated as the Spearman-Brown-corrected correlation between two
random halves (r = .91).
Age 7 parent-reported effortful control. The Effortful Control factor from the Short
form of the Child Behavior Questionnaire (CBQ; Putnam & Rothbart, 2006) was used as a
measure of children’s effortful control. The Effortful Control factor includes the scales of
attention focusing, inhibitory control, low-intensity pleasure, and perceptual sensitivity. In the
CBQ, the primary caregiver responded to whether statements were true about their child on a
scale ranging from 1 (extremely untrue) to 7 (extremely true). The CBQ effortful control factor is
a valid and reliable measure of effortful control, with adequate reliability in our sample (α = .80).
Age 7 and Age 9 externalizing and attention problems. Children’s externalizing and
attention problems were assessed by parent-report on the Rule-Breaking Behavior, Aggressive
Behavior, and the Attention Problems scales of the Child Behavior Checklist (CBCL) at both age
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
19
seven and age nine assessment periods. The CBCL is a well-validated parent-report
questionnaire used to assess the socioemotional functioning of young children (Achenbach &
Rescorla, 2001). For each item in the checklist, the child’s primary caregiver rated from 0 to 2
how well each item describes their child (0 = not true to 2 = very/often true). Because we wanted
to examine relations with the externalizing spectrum, we took a transdiagnostic approach and
created a composite of externalizing and attention problems by summing the ratings from the
Rule-Breaking Behavior, Aggressive Behavior, and the Attention Problems scales. This is a
similar approach used in previous studies examining attention bias to reward and externalizing
using the Health Behavior Questionnaire (e.g., Morales, Pérez-Edgar, et al., 2016), which
combines externalizing and attention problems (Armstrong, Goldstein, & The MacArthur
Working Group on Outcome Assessment, 2003; Essex et al., 2002). The Rule-Breaking Behavior
scale is composed of 17 items describing transgressive and disobedient behaviors. The
Aggressive Behavior scale is composed of 18 items describing combative and oppositional
behaviors. The Attention Problems scale composed of 10 items describing impulsive and
inattentive behaviors. All scales were significantly correlated with each other (r’s >.45, p’s <
.001). Because the composite score was positively skewed at both ages (Skewage7=1.22,
Kurtosisage7=1.61; Skewage9=1.31, Kurtosisage9=1.73), scores were transformed by taking the
square root to improve normality (Skewage7=0.05, Kurtosisage7=-0.25; Skewage9=0.23,
Kurtosisage9=-0.51).
Analyses
The first two goals, examining direct relations with attention bias to reward, were
evaluated using zero-order correlations. The third goal—examining the moderating role of
attention bias to reward on the relations between early risk factors and later externalizing and
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
20
attention problems—was evaluated by performing a path model using full information maximum
likelihood estimation (FIML) to handle missing data to reduce potential bias in the parameter
estimates (Enders & Bandalos, 2001). This allowed the inclusion of all participants with data on
one or more variables (as opposed to list-wise deletion). Moreover, due to the missing data and
to correct for any departures from multivariate normality, the model was estimated using a robust
maximum likelihood estimator and a scaled test chi-squared statistic (Satorra & Bentler, 2001).
The model predicted externalizing and attention problems at age 9 using early exuberance, early
effortful control, and attention bias to reward. In addition, to examine if attention bias to reward
moderated the predictive effects of early exuberance and early effortful control, we examined the
two-way interactions between exuberance and attention bias as well as effortful control and
attention bias. Interactions were created by centering the predictors of interests and computing
their cross-product. Significant two-way interaction effects were probed using simple slope
analysis (Aiken, West, & Reno, 1991). Specifically, the effects of the predictor variable (i.e.,
exuberance or effortful control) on externalizing and attention problems were examined at
different levels of attention bias, representing attention bias away (-1 SD), no attention bias
(mean), and attention bias toward (+1 SD).
To examine if the main or interactive effects of the model differed by gender, separate
models were performed for males and females. We compared the chi-square value from a model
in which the regression coefficients were constrained to be equal across gender groups, to the
chi-square value from a model that allowed regression coefficients to vary across males and
females. A significant difference between the chi-square values demonstrates that the regression
coefficients significantly differ between males and females. Because children excluded from the
dot-probe task due to poor accuracy performance were more likely to be males and had lower
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
21
effortful control, the model controlled for performance accuracy during the dot-probe task as in
previous studies with this sample (Nozadi et al., 2017; White et al., 2017). Finally, preliminary
analyses suggested that maternal education, r = .17, p = .018, and maternal ethnicity, rpb =
.21, p = .003, were related to effortful control at age 4, such that children of mothers with higher
levels of education and children of non-Hispanic Caucasian mothers had higher levels of
effortful control. Given these relations, maternal education and maternal ethnicity were also
included as covariates in the analysis.
All analyses were performed in R (R Development Core Team, 2008) using the psych
(Revelle, 2017) and lavaan (Rosseel, 2012) packages. Figures were created using the ggplot2
package (Wickham, 2016).
Results
Aim 1: Replicating the concurrent relations between attention bias to reward, externalizing
problems and attention problems, and parent-reported effortful control at age 7
As predicted by our first set of hypotheses, directly replicating previous studies, attention
bias to reward at age 7 was concurrently related to higher externalizing and attention
problems, r(100) = .22, p = .03, and lower effortful control as reported by the parent, r(100) = -
.21, p = .03.
Aim 2: Examining relations between attention bias to reward (age 7) and behavioral
measures of early exuberance (age 3), early effortful control (age 4), effortful control (age
7), and externalizing and attention problems (age 9)
In line with our second set of hypotheses, attention bias to reward was longitudinally
associated with externalizing and attention problems two years later (9 years), r(88) = .35, p <
.001. However, contrary to our expectations, attention bias to reward was not related to age 3
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
22
exuberance, r(99) = -.07, p = .50, age 4 effortful control, r(96) = .07, p = .50, or behavioral
measures of concurrent effortful control, r(97) = -.11, p = .29. As shown in Table 1, we observed
several gender differences. As expected, females were lower in externalizing at age 7, rpb = -
.23, p = .001, and age 9, rpb = -.25, p < .001, and higher in parent-reported effortful control, rpb =
.28, p < .001, as well as behavioral effortful control at age 4, rpb = .25, p < .001, and age 7, rpb =
.25, p < .001, compared to males. However, there were no gender differences in attention bias to
reward, rpb = -.11, p = .27, or exuberance, rpb = -.040, p = .56.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
23
Table 1. Means, standard deviations, and correlations with confidence intervals
Variable
N
M
SD
1
2
3
4
5
6
7
1. Gender
291
***
***
2. Exuberance (3)
215
0.10
0.28
-.04
[-.17, .09]
3. Behavioral EC (4)
205
-0.03
0.76
.25**
-.05
[.11, .37]
[-.19, .09]
4. Happy Bias (7)
108
7.72
65.15
-.11
-.07
.07
[-.29, .08]
[-.26, .13]
[-.13, .26]
5. Questionnaire EC (7)
190
5.23
0.58
.28**
-.06
.05
-.21*
[.15, .41]
[-.21, .10]
[-.10, .21]
[-.39, -.02]
6. Behavioral EC (7)
168
0.53
0.17
.25**
-.08
.19*
-.11
.17*
[.11, .39]
[-.23, .08]
[.04, .34]
[-.30, .09]
[.02, .32]
7. Externalizing (7)+
190
2.75
1.32
-.23**
.20**
-.09
.22*
-.43**
-.20*
[-.36, -.09]
[.05, .35]
[-.24, .07]
[.03, .40]
[-.54, -.30]
[-.34, -.04]
8. Externalizing (9)+
186
2.67
1.46
-.25**
.13
-.09
.35**
-.40**
-.13
.81**
[-.38, -.11]
[-.02, .28]
[-.24, .07]
[.15, .52]
[-.52, -.25]
[-.29, .03]
[.74, .86]
Note. * indicates p < .05; ** indicates p < .01; *** 1 = female and 0 = male; + = square-root transformed; N = number of participants;
M = mean; SD = standard deviation; EC = effortful control. Values in square brackets indicate the 95% confidence interval for each
correlation.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
25
Aim 3: Examining the moderating role of attention to reward in the longitudinal pathways
between exuberance (age 3) and effortful control (age 4) to externalizing and attention
problems (age 9)
When evaluating if the early effects of early exuberance and effortful control were
moderated by attention bias, results revealed that the model for males was different from the
model for females, as evidenced by significantly poorer fit when constraining regression
coefficients to be equal across groups, ∆χ2(8) = 28.31, p < .001, supporting separate models by
gender. Table 2 includes the model parameters for both males and females. In the model for
females, the model explained 11.6% of the variance and none of the main effects or interactions
were statistically significant.
In contrast, the model for males explained 53.7% of the variance and revealed significant
interactions between exuberance and attention bias, b = 0.03, p = 0.04, as well as effortful
control and attention bias, b =!-0.01, p < 0.001. As shown in Figure 2, probing the first
interaction of the model involving early exuberance and attention bias to reward using simple
slope analysis revealed that the predictive effect of early exuberance was only significant for
males who displayed a large attention bias to reward, b = 2.01, p = 0.02; whereas it was not
significant for males with an average attention bias to reward, b = 0.56, p = 0.31, or a small
attention bias from reward (i.e., bias away), b = -0.89, p = 0.32. These results were consistent
with our prediction and indicated that males who were high in exuberance and with a large bias
to reward displayed the highest externalizing and attention problems later in childhood.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
26
Table 2. Results of the regression model predicting externalizing and attention problems at 9
years for females and males separately.
95% CI
Parameters (age in years)
b
SE
p
Lower
Upper
Female Model
Intercept
2.292
0.478
0.000
1.355
3.229
Maternal Ethnicity
-0.171
0.329
0.603
-0.817
0.474
Maternal Education
0.164
0.241
0.495
-0.308
0.637
Accuracy (7)
-0.004
0.010
0.674
-0.024
0.015
Happy Bias (7)
0.003
0.003
0.288
-0.002
0.008
Exuberance (3)
0.824
0.438
0.060
-0.035
1.682
Effortful Control (4)
0.056
0.272
0.837
-0.478
0.590
Happy Bias x Exuberance
0.014
0.009
0.127
-0.004
0.031
Happy Bias x Effortful Control
0.006
0.005
0.230
-0.004
0.015
Male Model
Intercept
2.361
0.352
0.000
1.672
3.051
Maternal Ethnicity
0.447
0.334
0.182
-0.209
1.102
Maternal Education
-0.353
0.210
0.093
-0.764
0.058
Accuracy (7)
0.040
0.016
0.014
0.008
0.071
Happy Bias (7)
0.017
0.003
0.000
0.011
0.023
Exuberance (3)
0.138
0.597
0.817
-1.033
1.308
Effortful Control (4)
-0.043
0.208
0.834
-0.451
0.364
Happy Bias x Exuberance
0.025
0.012
0.040
0.001
0.048
Happy Bias x Effortful Control
-0.014
0.003
0.000
-0.020
-0.008
Note: Maternal ethnicity was coded as Non-Hispanic Caucasian = 1 and Other = 0.
Maternal education was coded as High school graduate = 0, College Graduate = 1, Graduate school
graduate = 2, and Other = missing.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
27
!!
Figure 2. Simple slopes for the interaction between attention bias to reward and early exuberance
predicting externalizing and attention problems for males. Bias away was defined as -1SD and
bias toward as +1SD from the mean.
As displayed in Figure 3, probing the second interaction of the model involving early
effortful control and attention bias to reward indicated that the negative effect of early effortful
control on externalizing and attention problems was only significant for males who displayed a
large attention bias to reward, b = -1.09, p < 0.001; while it was not significant for males with an
average attention bias to reward, b = -0.28, p = 0.14, or a small attention bias from reward (i.e.,
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
28
bias away), b = 0.53, p = 0.07. In other words, consistent with prediction, males with the highest
levels of externalizing and attention problems at age nine were the ones who displayed low
effortful control at age 4 and a large attention bias to reward in childhood.
!
Figure 3. Simple slopes for the interaction between attention bias to reward and early effortful
control predicting externalizing and attention problems for males. Bias away was defined as -
1SD and bias toward as +1SD from the mean.
Discussion
The current study examined the relations between attention bias to reward and its relation
to behavioral problems in the externalizing domain. This was done by evaluating three sets of
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
29
questions (Figure 1). First, we replicated the direct concurrent relations between attention bias to
reward and externalizing and attention problems. Second, we extended these findings by testing
the relations between attention bias to reward and behavioral measures of early exuberance, early
effortful control, and concurrent effortful control, as well as later behavioral problems. Finally,
we examined the role of attention to reward in the longitudinal pathways between early
exuberance and effortful control to predict externalizing and attention problems at age nine.
Generally, results suggest that attention bias to reward is positively related to behavioral
problems marked by impulsive behavior such as externalizing and attention problems. In
addition, results suggest that attention bias to reward may act a moderator of early risk in
males—aiding the identification of children at the highest risk for later behavioral problems.
The first goal of the current study was to replicate previous reports of concurrent
associations between attention bias towards reward, externalizing problems and attention
problems, and parent-reported effortful control. Results were in line with our hypotheses such
that attention bias to reward was concurrently related to greater externalizing and attention
problems and lower levels of parent-reported effortful control. These findings replicate previous
studies that find that attention bias to reward is related to greater externalizing and attention
problems (Cremone et al., 2018; He et al., 2017; Morales, Pérez-Edgar, et al., 2016), and lower
parent-reported effortful control (Cole et al., 2016; Morales, Pérez-Edgar, et al., 2016).
The second goal of the current study was to extend these findings. This was done in two
ways: 1) we examined longitudinal associations with attention bias by testing its relation with
later behavioral problems and 2) we evaluated if similar relations held when using different
sources of evidence (i.e., behavioral measures), as well as whether early risk factors are
longitudinally associated with attention bias to reward. When testing longitudinal relations, as
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
30
hypothesized, higher levels of attention bias to reward were associated with more externalizing
and attention problems two years later. These results imply, for the first time, that attention bias
to reward is longitudinally related to externalizing and attention problems.
On the other hand, contrary to our expectations, we did not find relations between
behavioral measures of concurrent effortful control, early exuberance, early effortful control, and
attention bias to reward in middle childhood. These results do not support previous studies (Cole
et al., 2016) and our concurrent findings with parent-reported effortful control in middle
childhood. Similarly, these results do not support a previous study that found that parent-reports
of early exuberance and effortful control were longitudinally associated with attention bias to
reward (Morales, Pérez-Edgar, et al., 2016). It is possible that method differences (e.g.,
behavioral measures or parent report) may have contributed to divergent findings across studies
as different sources of evidence provide unique information (Kagan & Fox, 2006). For instance,
parents may provide a unique view of the child across multiple occasions and contexts (Rothbart
& Bates, 2006). However, parent reports may be subject to systematic biases such as parents’
interpretations of observed behavior which may vary by parents’ characteristics (Kagan & Fox,
2006). The reason for the differences observed with attention bias is beyond the scope of the
current study. However, future studies should continue to use multiple sources of information in
order to better understand when these sources converge or diverge.
In addition, it is not uncommon to fail to find longitudinal predictions from early
behaviors to outcomes of interest several years later. For instance, the often-reported longitudinal
predictions between early exuberance and early effortful control to later externalizing and
attention problems were not significant either in several previous studies, especially if the early
predictors are behavioral observations and not parent-reports (e.g., Degnan et al., 2011; Murray
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
31
& Kochanska, 2002; Rhoades et al., 2009). It is possible that unexamined moderators may also
account for this heterogeneity. This fact highlights the importance of examining how different
(risk) factors may interact with each other to create developmental trajectories of risk and/or
resilience.
Our third aim tested if attention bias to reward in middle childhood moderated the effects
of early exuberance and early effortful control on later outcomes. Results revealed that
significant effects were found only for males. Specifically, attention bias to reward moderated
the longitudinal relations between known early risk factors for behavioral problems, exuberance
and effortful control, and later externalizing and attention problems – such that these early risk
factors were most predictive of behavioral problems for males with a large attention bias to
reward. This suggests that attention bias to reward, as a proximal risk factor for behavioral
problems, may help with the identification of children at the highest risk for later behavioral
problems. Moreover, it implies that different risk factors such as gender, early temperament, and
attention bias may interact to predict the highest risk.
Overall, the findings support perspectives of behavioral problems in the externalizing
domain that highlight the role of distinct reward processing in externalizing and attention
problems (Frick et al., 2003; Gatzke-Kopp et al., 2009; Luman et al., 2005, 2012; O’Brien &
Frick, 1996). Specifically, individuals high on the externalizing spectrum have a heightened
attention bias to reward, which by selectively processing the positive and rewarding cues may
interpret situations as better, more pleasurable and attractive. This could lead to the observed
behavioral and neural findings that individuals high in externalizing and attention problems tend
to be more impulsive by persevering toward rewards even in the presence of adverse outcomes
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
32
as well as displaying a preference toward immediate rewards over larger delayed rewards (Frick
et al., 2003; Gatzke-Kopp et al., 2009; Luman et al., 2005, 2012; O’Brien & Frick, 1996).
It is worth noting that our data also provide further evidence for the possible dissociation
of the effects of attention bias to rewards, depending on different factors such as the individual’s
predispositions and experiences. On the one hand, the findings of the current study along with
previous studies (Cole et al., 2016; Cremone et al., 2018; He et al., 2017; Morales, Pérez-Edgar,
et al., 2016), suggest that within normative samples, attention bias to reward may be associated
with impulsive tendencies (i.e., low effortful control and high approach tendencies) and, at the
extreme, behavioral problems in the externalizing domain.
On the other hand, attention bias to reward is related, potentially causally, to increased
positive affect and reduced internalizing problems (Britton et al., 2013; Grafton et al., 2012;
Heeren et al., 2012; Shechner et al., 2012; Taylor et al., 2011; Waters et al., 2013; White et al.,
2017). Moreover, infants abandoned to institutional care, but randomly assigned into high-
quality foster care displayed a bias towards reward in middle childhood, compared to post-
institutionalized children not in foster care (Troller-Renfree et al., 2016; Troller-Renfree,
McDermott, Nelson, Zeanah, & Fox, 2015). Within post-institutionalized children, attention bias
towards reward was concurrently related to better outcomes such as more social engagement and
prosocial behavior, fewer externalizing and internalizing problems, and less social withdrawal
(Troller-Renfree et al., 2016, 2015). These findings suggest that in some contexts attention bias
to reward may act as a protective factor against psychopathology, especially internalizing
disorders/behaviors. Thus, the role/function and/or downstream effects of attention bias may
change depending on individual differences such as temperamental predispositions (e.g.,
exuberance vs. behavioral inhibition) as well as developmental experiences and context (e.g.,
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
33
early deprivation). This highlights the utility of examining several factors in order to understand
how their combination can produce different developmental pathways and better explain the
observed multifinality from early risk factors.
The findings and interpretations of the current study should be considered in light of
several limitations. The sample lacks socioeconomic as well as racial and ethnic diversity.
Although representative of the local area, our community sample consisted primarily of well-
educated Caucasian families. As such, the characteristics of the sample should be considered
when generalizing the current findings to other populations. Moreover, externalizing and
attention problems were examined in a normative sample. Although our measures of these
problems had variability, results may differ in a clinical or combined clinical/community sample.
Another limitation is that the current study had missing data. In addition to the missing data due
to the study’s longitudinal design, the study suffered from data loss due to poor performance in
behavioral tasks such as the dot-probe task, which particularly impacted males and children with
low effortful control. Although we utilized statistical approaches to use all available data and
mitigate bias due to missing data, this should be considered when generalizing the current
results.
In addition, the fact that a large number of 7-year olds had difficulties performing this
version of the dot-probe tasks suggests that easier versions of the task should be used with young
children (e.g., Morales, Pérez-Edgar, et al., 2015; Pérez-Edgar et al., 2011). Finally, although the
current study considerably improves and extends previous studies by evaluating the longitudinal
relations between attention bias and behavioral problems, the relations are correlational in nature.
As such, it is not possible to fully determine the directionality of the relations. Future studies,
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
34
should examine the socioemotional impacts of experimentally manipulating attention by training
individuals to attend towards or away from reward.
In conclusion, this study replicates previous findings that suggest that attention bias to
reward predicts behavioral problems marked by impulsive behavior such as externalizing and
attention problems. Specifically, we find that attention bias to reward is associated concurrently
and—for the first time—longitudinally with externalizing and attention problems in middle
childhood. Moreover, it is concurrently associated with lower levels of effortful control. Finally,
attention bias to reward moderates the longitudinal relations between known early risk factors for
behavioral problems (exuberance, and effortful control) and later externalizing and attention
problems – such that these early risk factors are most predictive of behavioral problems for
males with a large attention bias to reward. This suggests that attention bias to reward, as a
proximal risk factor for behavioral problems, may help with the identification of children at the
highest risk for later behavioral problems and potentially aid the development of novel
treatments (e.g., attention bias modification).
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
35
References
Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms and profiles:
An integrated system of multi-informant assessment. Burlington, VT: University of
Vermont Department of Psychiatry.
Aiken, L. S., West, S. G., & Reno, R. R. (1991). Multiple Regression: Testing and Interpreting
Interactions. SAGE.
Armstrong, J. M., Goldstein, L. H., & The MacArthur Working Group on Outcome Assessment.
(2003). The MacArthur Health and Behavior Questionnaire (HBQ 1.0). (D. J. Kupfer,
Ed.). University of Pittsburgh: MacArthur Foundation Research Network on
Psychopathology and Development.
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H.
(2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-
analytic study. Psychological Bulletin, 133(1), 1–24. https://doi.org/10.1037/0033-
2909.133.1.1
Bongers, I. L., Koot, H. M., Van der Ende, J., & Verhulst, F. C. (2003). The normative
development of child and adolescent problem behavior. Journal of Abnormal Psychology,
112(2), 179.
Britton, J. C., Bar-Haim, Y., Clementi, M. A., Sankin, L. S., Chen, G., Shechner, T., … Pine, D.
S. (2013). Training-associated changes and stability of attention bias in youth:
Implications for Attention Bias Modification Treatment for pediatric anxiety.
Developmental Cognitive Neuroscience, 4, 52–64.
https://doi.org/10.1016/j.dcn.2012.11.001
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
36
Buss, K. A., Kiel, E. J., Morales, S., & Robinson, E. (2014). Toddler Inhibitory Control, Bold
Response to Novelty, and Positive Affect Predict Externalizing Symptoms in
Kindergarten: Inhibitory Control, Positive Affect, and Externalizing. Social Development,
23(2), 232–249. https://doi.org/10.1111/sode.12058
Campbell, S. B., Spieker, S., Burchinal, M., Poe, M. D., & NICHD Early Child Care Research
Network. (2006). Trajectories of aggression from toddlerhood to age 9 predict academic
and social functioning through age 12. Journal of Child Psychology and Psychiatry,
47(8), 791–800.
Carlson, S. M., & Moses, L. J. (2001). Individual Differences in Inhibitory Control and
Children’s Theory of Mind. Child Development, 72(4), 1032–1053.
Cole, C. E., Zapp, D. J., Fettig, N. B., & Pérez-Edgar, K. E. (2016). Impact of attention biases to
threat and effortful control on individual variations in negative affect and social
withdrawal in very young children. Journal of Experimental Child Psychology, 141, 210–
221. https://doi.org/10.1016/j.jecp.2015.09.012
Cremers, H. R., Veer, I. M., Spinhoven, P., Rombouts, S. A. R. B., & Roelofs, K. (2015). Neural
sensitivity to social reward and punishment anticipation in social anxiety disorder.
Frontiers in Behavioral Neuroscience, 8. https://doi.org/10.3389/fnbeh.2014.00439
Cremone, A., Lugo-Candelas, C. I., Harvey, E. A., McDermott, J. M., & Spencer, R. M. C.
(2018). Positive emotional attention bias in young children with symptoms of ADHD.
Child Neuropsychology, 0(0), 1–9. https://doi.org/10.1080/09297049.2018.1426743
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information-
processing mechanisms in children’s social adjustment. Psychological Bulletin, 115(1),
74–101. https://doi.org/10.1037/0033-2909.115.1.74
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
37
Degnan, K. A., Hane, A. A., Henderson, H. A., Moas, O. L., Reeb-Sutherland, B. C., & Fox, N.
A. (2011). Longitudinal stability of temperamental exuberance and social–emotional
outcomes in early childhood. Developmental Psychology, 47(3), 765–780.
https://doi.org/10.1037/a0021316
Derryberry, D., & Reed, M. A. (1994). Temperament and attention: Orienting toward and away
from positive and negative signals. Journal of Personality and Social Psychology, 66(6),
1128–1139. http://dx.doi.org.ezaccess.libraries.psu.edu/10.1037/0022-3514.66.6.1128
Derryberry, D., & Reed, M. A. (1996). Regulatory processes and the development of cognitive
representations. Development and Psychopathology, 8(01), 215–234.
https://doi.org/10.1017/S0954579400007057
Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by
attentional control. Journal of Abnormal Psychology, 111(2), 225–236.
https://doi.org/10.1037/0021-843X.111.2.225
Duncan, G. J., Engel, M., Claessens, A., & Dowsett, C. J. (2014). Replication and robustness in
developmental research. Developmental Psychology, 50(11), 2417–2425.
http://dx.doi.org.ezaccess.libraries.psu.edu/10.1037/a0037996
DuPaul, G. J., Morgan, P. L., Farkas, G., Hillemeier, M. M., & Maczuga, S. (2016). Academic
and social functioning associated with attention-deficit/hyperactivity disorder: latent class
analyses of trajectories from kindergarten to fifth grade. Journal of Abnormal Child
Psychology, 44(7), 1425–1438.
Eisenberg, N., Valiente, C., Spinrad, T. L., Cumberland, A., Liew, J., Reiser, M., … Losoya, S.
H. (2009). Longitudinal relations of children’s effortful control, impulsivity, and negative
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
38
emotionality to their externalizing, internalizing, and co-occurring behavior problems.
Developmental Psychology, 45(4), 988–1008. https://doi.org/10.1037/a0016213
Eldar, S., Ricon, T., & Bar-Haim, Y. (2008). Plasticity in attention: Implications for stress
response in children. Behaviour Research and Therapy, 46(4), 450–461.
https://doi.org/10.1016/j.brat.2008.01.012
Else-Quest, N. M., Hyde, J. S., Goldsmith, H. H., & Van Hulle, C. A. (2006). Gender
Differences in Temperament: A Meta-Analysis. Psychological Bulletin, 132(1), 33–72.
https://doi.org/10.1037/0033-2909.132.1.33
Enders, C., & Bandalos, D. (2001). The Relative Performance of Full Information Maximum
Likelihood Estimation for Missing Data in Structural Equation Models. Structural
Equation Modeling: A Multidisciplinary Journal, 8(3), 430–457.
https://doi.org/10.1207/S15328007SEM0803_5
Essex, M. J., Boyce, W. T., Goldstein, L. H., Armstrong, J. M., Kraemer, H. C., Kupfer, D. J., &
Group, M. A. B. W. (2002). The confluence of mental, physical, social, and academic
difficulties in middle childhood. II: Developing the MacArthur Health and Behavior
Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry,
41(5), 588–603.
Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn,
J. H. (2018). Practitioner Review: Emotional dysregulation in attention-
deficit/hyperactivity disorder–implications for clinical recognition and intervention.
Journal of Child Psychology and Psychiatry.
Fox, N. A., Henderson, H. A., Rubin, K. H., Calkins, S. D., & Schmidt, L. A. (2001). Continuity
and Discontinuity of Behavioral Inhibition and Exuberance: Psychophysiological and
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
39
Behavioral Influences across the First Four Years of Life. Child Development, 72(1), 1–
21. https://doi.org/10.1111/1467-8624.00262
Frewen, P., Dozois, D., Joanisse, M., & Neufeld, R. (2008). Selective attention to threat versus
reward: Meta-analysis and neural-network modeling of the dot-probe task. Clinical
Psychology Review, 28(2), 307–337. https://doi.org/10.1016/j.cpr.2007.05.006
Frick, P. J., Cornell, A. H., Bodin, S. D., Dane, H. E., Barry, C. T., & Loney, B. R. (2003).
Callous-unemotional traits and developmental pathways to severe conduct problems.
Developmental Psychology, 39(2), 246.
Gatzke-Kopp, L. M., Beauchaine, T. P., Shannon, K. E., Chipman, J., Fleming, A. P., Crowell, S.
E., … Johnson, L. C. (2009). Neurological Correlates of Reward Responding in
Adolescents With and Without Externalizing Behavior Disorders. Journal of Abnormal
Psychology, 118(1), 203. https://doi.org/10.1037/a0014378
Gerstadt, C. L., Hong, Y. J., & Diamond, A. (1994). The relationship between cognition and
action: performance of children 312–7 years old on a stroop- like day-night test.
Cognition, 53(2), 129–153. https://doi.org/10.1016/0010-0277(94)90068-X
Grafton, B., Ang, C., & MacLeod, C. (2012). Always Look on the Bright Side of Life: The
Attentional Basis of Positive Affectivity: Attentional basis of positive affectivity.
European Journal of Personality, 26(2), 133–144. https://doi.org/10.1002/per.1842
Hay, D. F., van Goozen, S. H., Mundy, L., Phillips, R., Roberts, S., Meeuwsen, M., … Perra, O.
(2017). If You Go Down to the Woods Today: Infants’ Distress During a Teddy Bear’s
Picnic in Relation to Peer Relations and Later Emotional Problems. Infancy, 22(4), 552–
570.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
40
He, J., Degnan, K. A., McDermott, J. M., Henderson, H. A., Hane, A. A., Xu, Q., & Fox, N. A.
(2010). Anger and approach motivation in infancy: Relations to early childhood
inhibitory control and behavior problems. Infancy, 15(3), 246–269.
He, J., Li, P., Wu, W., & Zhai, S. (2017). Exuberance, attention bias, and externalizing behaviors
in Chinese preschoolers: A longitudinal study. Social Development, 26(3), 520–529.
Heeren, A., Reese, H. E., McNally, R. J., & Philippot, P. (2012). Attention training toward and
away from threat in social phobia: Effects on subjective, behavioral, and physiological
measures of anxiety. Behaviour Research and Therapy, 50(1), 30–39.
https://doi.org/10.1016/j.brat.2011.10.005
Kagan, J., & Fox, N. A. (2006). Biology, Culture, and Temperamental Biases. In W. Damon &
R. M. Lerner (Eds.), Handbook of Child Psychology (Vol. 3, pp. 167–225). Hoboken, NJ,
USA: John Wiley & Sons, Inc. Retrieved from
http://doi.wiley.com/10.1002/9780470147658.chpsy0304
Kochanska, G., & Knaack, A. (2003). Effortful Control as a Personality Characteristic of Young
Children: Antecedents, Correlates, and Consequences. Journal of Personality, 71(6),
1087–1112. https://doi.org/10.1111/1467-6494.7106008
Lemerise, E. A., & Arsenio, W. F. (2000). An integrated model of emotion processes and
cognition in social information processing. Child Development, 71(1), 107–118.
Lemery, K. S., Essex, M. J., & Smider, N. A. (2002). Revealing the Relation between
Temperament and Behavior Problem Symptoms by Eliminating Measurement
Confounding: Expert Ratings and Factor Analyses. Child Development, 73(3), 867–882.
https://doi.org/10.1111/1467-8624.00444
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
41
Luking, K. R., Pagliaccio, D., Luby, J. L., & Barch, D. M. (2016). Reward Processing and Risk
for Depression Across Development. Trends in Cognitive Sciences, 20(6), 456–468.
https://doi.org/10.1016/j.tics.2016.04.002
Luman, M., Oosterlaan, J., & Sergeant, J. A. (2005). The impact of reinforcement contingencies
on AD/HD: A review and theoretical appraisal. Clinical Psychology Review, 25(2), 183–
213. https://doi.org/10.1016/j.cpr.2004.11.001
Luman, M., van Meel, C. S., Oosterlaan, J., & Geurts, H. M. (2012). Reward and Punishment
Sensitivity in Children with ADHD: Validating the Sensitivity to Punishment and
Sensitivity to Reward Questionnaire for Children (SPSRQ-C). Journal of Abnormal
Child Psychology, 40(1), 145–157. https://doi.org/10.1007/s10802-011-9547-x
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal
of Abnormal Psychology, 95(1), 15–20. https://doi.org/10.1037/0021-843X.95.1.15
Miller, N. V., Degnan, K. A., Hane, A. A., Fox, N. A., & Chronis-Tuscano, A. (2018). Infant
temperament reactivity and early maternal caregiving: independent and interactive links
to later childhood attention-deficit/hyperactivity disorder symptoms. Journal of Child
Psychology and Psychiatry.
Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., … Caspi,
A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety.
Proceedings of the National Academy of Sciences of the United States of America,
108(7), 2693–2698. https://doi.org/10.1073/pnas.1010076108
Monk, C. S., Klein, R. G., Telzer, E. H., Schroth, E. A., Mannuzza, S., Moulton, J. L., … Ernst,
M. (2008). Amygdala and Nucleus Accumbens Activation to Emotional Facial
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
42
Expressions in Children and Adolescents at Risk for Major Depression. American
Journal of Psychiatry, 165(1), 90–98. https://doi.org/10.1176/appi.ajp.2007.06111917
Morales, S., Beekman, C., Blandon, A. Y., Stifter, C. A., & Buss, K. A. (2015). Longitudinal
associations between temperament and socioemotional outcomes in young children: The
moderating role of RSA and gender. Developmental Psychobiology, 57(1), 105–119.
https://doi.org/10.1002/dev.21267
Morales, S., Fu, X., & Pérez-Edgar, K. E. (2016). A developmental neuroscience perspective on
affect-biased attention. Developmental Cognitive Neuroscience, 21, 26–41.
https://doi.org/10.1016/j.dcn.2016.08.001
Morales, S., Pérez-Edgar, K., & Buss, K. (2016). Longitudinal relations among exuberance,
externalizing behaviors, and attentional bias to reward: the mediating role of effortful
control. Developmental Science, 19(5), 853–862. https://doi.org/10.1111/desc.12320
Morales, S., Pérez-Edgar, K. E., & Buss, K. A. (2015). Attention Biases Towards and Away
from Threat Mark the Relation between Early Dysregulated Fear and the Later
Emergence of Social Withdrawal. Journal of Abnormal Child Psychology, 43(6), 1067–
1078. https://doi.org/10.1007/s10802-014-9963-9
Murray, K. T., & Kochanska, G. (2002). Effortful control: factor structure and relation to
externalizing and internalizing behaviors. Journal of Abnormal Child Psychology, 30(5),
503–514.
Nigg, J. T., Goldsmith, H. H., & Sachek, J. (2004). Temperament and Attention Deficit
Hyperactivity Disorder: The Development of a Multiple Pathway Model. Journal of
Clinical Child & Adolescent Psychology, 33(1), 42–53.
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
43
O’Brien, B. S., & Frick, P. J. (1996). Reward dominance: Associations with anxiety, conduct
problems, and psychopathy in children. Journal of Abnormal Child Psychology, 24(2),
223–240. https://doi.org/10.1007/BF01441486
O’Doherty, J., Winston, J., Critchley, H., Perrett, D., Burt, D. ., & Dolan, R. . (2003). Beauty in a
smile: the role of medial orbitofrontal cortex in facial attractiveness. Neuropsychologia,
41(2), 147–155. https://doi.org/10.1016/S0028-3932(02)00145-8
Offord, D. R., Boyle, M. H., Szatmari, P., Rae-Grant, N. I., Links, P. S., Cadman, D. T., …
Woodward, C. A. (1987). Ontario Child Health Study: II. Six-Month Prevalence of
Disorder and Rates of Service Utilization. Archives of General Psychiatry, 44(9), 832–
836. https://doi.org/10.1001/archpsyc.1987.01800210084013
Open Science Collaboration. (2015). Estimating the reproducibility of psychological science.
Science, 349(6251), aac4716. https://doi.org/10.1126/science.aac4716
Pérez-Edgar, K. E., Bar-Haim, Y., McDermott, J. M., Chronis-Tuscano, A., Pine, D. S., & Fox,
N. A. (2010). Attention biases to threat and behavioral inhibition in early childhood shape
adolescent social withdrawal. Emotion, 10(3), 349–357. https://doi.org/10.1037/a0018486
Pérez-Edgar, K. E., Reeb-Sutherland, B. C., McDermott, J. M., White, L. K., Henderson, H. A.,
Degnan, K. A., … Fox, N. A. (2011). Attention Biases to Threat Link Behavioral
Inhibition to Social Withdrawal over Time in Very Young Children. Journal of Abnormal
Child Psychology, 39(6), 885–895. https://doi.org/10.1007/s10802-011-9495-5
Pfeifer, M., Goldsmith, H. H., Davidson, R. J., & Rickman, M. (2002). Continuity and Change in
Inhibited and Uninhibited Children. Child Development, 73(5), 1474–1485.
https://doi.org/10.1111/1467-8624.00484
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
44
Polak-Toste, C. P., & Gunnar, M. R. (2006). Temperamental Exuberance: Correlates and
Consequences. In P. J. Marshall & N. A. Fox (Eds.), The development of social
engagement: Neurobiological perspectives (pp. 19–45). New York, NY, US: Oxford
University Press.
Putnam, S. P., & Rothbart, M. K. (2006). Development of short and very short forms of the
Children’s Behavior Questionnaire. Journal of Personality Assessment, 87(1), 102–112.
Putnam, S. P., & Stifter, C. A. (2005). Behavioral Approach–Inhibition in Toddlers: Prediction
From Infancy, Positive and Negative Affective Components, and Relations With
Behavior Problems. Child Development, 76(1), 212–226. https://doi.org/10.1111/j.1467-
8624.2005.00840.x
R Development Core Team. (2008). R: A language and environment for statistical computing.
R Foundation for Statistical Computing, Vienna, Austria. Retrieved from http://www.R-
project.org.
Revelle, W. R. (2017). psych: Procedures for personality and psychological research.
Rhoades, B. L., Greenberg, M. T., & Domitrovich, C. E. (2009). The contribution of inhibitory
control to preschoolers’ social–emotional competence. Journal of Applied Developmental
Psychology, 30(3), 310–320. https://doi.org/10.1016/j.appdev.2008.12.012
Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling and more. Version
0.5–12 (BETA). Journal of Statistical Software, 48(2), 1–36.
Rothbart, M. K., & Bates, J. E. (2006). Temperament. In W. Damon & R. M. Lerner (Eds.),
Handbook of Child Psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc. Retrieved
from http://doi.wiley.com/10.1002/9780470147658.chpsy0304
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
45
Rubin, K. H., Burgess, K. B., Dwyer, K. M., & Hastings, P. D. (2003). Predicting preschoolers’
externalizing behaviors from toddler temperament, conflict, and maternal negativity.
Developmental Psychology, 39(1), 164–176. https://doi.org/10.1037/0012-1649.39.1.164
Satorra, A., & Bentler, P. M. (2001). A scaled difference chi-square test statistic for moment
structure analysis. Psychometrika, 66(4), 507–514.
Schneider, W., Eschman, A., & Zuccolotto, A. (2002). E-Prime: User’s guide. Psychology
Software Incorporated.
Shechner, T., Britton, J. C., Pérez-Edgar, K., Bar-Haim, Y., Ernst, M., Fox, N. A., … Pine, D. S.
(2012). Attention biases, anxiety, and development: toward or away from threats or
rewards? Depression and Anxiety, 29(4), 282–294. https://doi.org/10.1002/da.20914
Stifter, C. A., Putnam, S., & Jahromi, L. (2008). Exuberant and Inhibited Toddlers: Stability of
Temperament and Risk for Problem Behavior. Development and Psychopathology,
20(02), 401–421. https://doi.org/10.1017/S0954579408000199
Tackett, J. L. (2010). Toward an Externalizing Spectrum in DSM-V: Incorporating
Developmental Concerns: Developmental Externalizing Spectrum. Child Development
Perspectives, 4(3), 161–167. https://doi.org/10.1111/j.1750-8606.2010.00138.x
Tamir, M., & Robinson, M. D. (2007). The Happy Spotlight: Positive Mood and Selective
Attention to Rewarding Information. Personality and Social Psychology Bulletin, 33(8),
1124–1136. https://doi.org/10.1177/0146167207301030
Taylor, C. T., Bomyea, J., & Amir, N. (2011). Malleability of attentional bias for positive
emotional information and anxiety vulnerability. Emotion, 11(1), 127–138.
https://doi.org/10.1037/a0021301
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
46
Todd, R. M., Cunningham, W. A., Anderson, A. K., & Thompson, E. (2012). Affect-biased
attention as emotion regulation. Trends in Cognitive Sciences, 16(7), 365–372.
https://doi.org/10.1016/j.tics.2012.06.003
Tottenham, N., Tanaka, J. W., Leon, A. C., McCarry, T., Nurse, M., Hare, T. A., … Nelson, C.
(2009). The NimStim set of facial expressions: Judgments from untrained research
participants. Psychiatry Research, 168(3), 242–249.
https://doi.org/10.1016/j.psychres.2008.05.006
Troller-Renfree, S., McDermott, J. M., Nelson, C. A., Zeanah, C. H., & Fox, N. A. (2015). The
effects of early foster care intervention on attention biases in previously institutionalized
children in Romania. Developmental Science, 18(5), 713–722.
https://doi.org/10.1111/desc.12261
Troller-Renfree, S., McLaughlin, K. A., Sheridan, M. A., Nelson, C. A., Zeanah, C. H., & Fox,
N. A. (2016). The beneficial effects of a positive attention bias amongst children with a
history of psychosocial deprivation. Biological Psychology.
https://doi.org/10.1016/j.biopsycho.2016.04.008
Vidal-Ribas, P., Pickles, A., Tibu, F., Sharp, H., & Hill, J. (2017). Sex differences in the
associations between vagal reactivity and oppositional defiant disorder symptoms.
Journal of Child Psychology and Psychiatry, 58(9), 988–997.
Waters, A. M., Pittaway, M., Mogg, K., Bradley, B. P., & Pine, D. S. (2013). Attention training
towards positive stimuli in clinically anxious children. Developmental Cognitive
Neuroscience, 4, 77–84. https://doi.org/10.1016/j.dcn.2012.09.004
White, L. K., Degnan, K. A., Henderson, H. A., Pérez-Edgar, K., Walker, O. L., Shechner, T., …
Fox, N. A. (2017). Developmental Relations Among Behavioral Inhibition, Anxiety, and
ATTENTION BIAS TO REWARD AND BEHAVIORAL PROBLEMS!
!
47
Attention Biases to Threat and Positive Information. Child Development, 88(1), 141–155.
https://doi.org/10.1111/cdev.12696
White, L. K., McDermott, J. M., Degnan, K. A., Henderson, H. A., & Fox, N. A. (2011).
Behavioral inhibition and anxiety: the moderating roles of inhibitory control and attention
shifting. Journal of Abnormal Child Psychology, 39(5), 735–747.
https://doi.org/10.1007/s10802-011-9490-x
Wickham, H. (2016). ggplot2: elegant graphics for data analysis. Springer.