Attention to threat, attentional control and early signs of anxiety in preschool children.

It is impossible for us to process all that goes on in the world around us. Instead we pay attention to specific things like the clouds in the sky or the sound of a dog barking. Sometimes we purposefully control what we pay attention to and other times things seem to 'grab' our attention. By acting as a filter, attention plays a fundamental role in shaping our experience of the world. Even if two individuals are exposed to exactly the same environment, their subjective experience can vary considerably, depending on which aspects of the environment they pay attention to. Psychological theory suggests that individuals who have a tendency to pay attention to things that are threatening are more likely to experience anxiety and might be more vulnerable to emotional problems during times of stress. There is already some research supporting this idea but it is all based on work with adults or older children.

It is very common for young children to feel fearful or anxious from time to time. However, some children feel so anxious that they cannot do some of the things they would like to do such as approaching a group of children to make friends or staying away from home overnight. Even young children can show early signs of anxiety. Most of these children will go on to become confident and happy, but some go on to have problems with anxiety in later childhood and more long-term social and emotional problems. One of the aims of this research is to see whether attention towards threat, or children's ability to control their attention, helps predict longer-term problems with anxiety. The research will make use of exciting new technologies, adapted especially for children, which allow us to capture what children are looking at and record their brain activity whilst they look at pictures. As well as these simple computer-based games, the research also includes some tasks that parents and children complete together. These are to help us to understand whether parents are able to affect what their child pays attention to. This could be important for helping children who are at risk of developing anxiety problems.

This research is important for two main reasons: first, because it may help us to identify children who are likely to experience emotional problems; secondly, it may help us to design new programmes that we can use to decrease the chances of these children having ongoing problems with anxiety. This would not only improve the quality of life of the children in question and reduce the emotional burden on their parents, but it would decrease the cost of long-term mental health problems.

Around 10% of children experience clinically significant anxiety at some point during their childhood and many more experience elevated anxiety symptoms, particularly during times of change or stress. Anxiety problems during childhood and adolescence place a significant financial burden on society, with the societal cost of families with a clinically anxious child estimated to be 21 times higher than for families from the general population. Furthermore, child anxiety is linked to long-term mental health problems, academic underperformance and substance abuse. Given the costs associated with mental health problems, early intervention has recently been prioritised in the cross-government policy No Health Without Mental Health. The aim of the proposed project is to provide research outputs that directly inform the development of evidence-based early intervention.

The most important potential impact of this research is in improving the quality of life of young children via an enhanced understanding of developmental pathways to anxiety and consequential improvements to early intervention. An emerging body of research suggests that attention to threat may be important for the development of anxiety and that it can be changed using relatively brief interventions. This technique, known as attentional bias modification (ABM), has had some positive effects on anxiety symptoms in adults and older children. It is plausible that an analogous programme could modify attentional biases in younger children and that this modification could decrease early anxiety and risk for longer-term anxiety problems. However, there is currently no literature on which to base the development of this type of intervention for young children.

By providing insights into the development of anxiety problems, the research has clear potential to impact a range of beneficiaries. Academically, the research will inform theoretical understanding of the development of anxiety disorders and the role of attention to threat and attentional control in anxiety. In addition, the research outputs will be of interest to academics and clinicians working to develop evidence-based treatments and prevention programmes for anxiety disorders.

The outputs from the research have the potential to enhance early-intervention for child anxiety, either directly through the PIs own work or indirectly, via the work of other academics and clinicians who may use the research. Thus, the project has the capacity to benefit:
1) Children showing early signs of anxiety and their families. By decreasing children's anxiety levels and their risk for long-term mental health problems, the research could impact the quality of life of children and their families.
2) Clinicians working with anxious children. By providing new ways of approaching early intervention and decreasing the caseload of children requiring time-intensive therapy for anxiety disorders.
3) Other professionals working with children, such as teachers. Children often show heightened anxiety at times of change such as the transition to school and changing schools. By facilitating the identification of children at risk and managing that risk, the number of children who are at-risk for anxiety in response to these transitions will decrease. Thus, the proposed research can facilitate smooth transitions, easing the burden on teachers.

The final group of potential research users are public bodies such as the National Institute for Health and Care Excellence (NICE) who produce evidence-based guidance and advice for health practitioners. Before recommendations for guidelines and policy can be made however, potential interventions based on the outcomes of the proposed research would need to be developed and evaluated. Thus, impact for policy represents a long-term goal.

The specific activities that will be undertaken to achieve this impact are described in detail in the Pathways to Impact attachment.