Research Review: Is anxiety associated with negative interpretations of ambiguity in children and adolescents? A systematic review and meta‐analysis

Abstract

Background: The tendency to interpret ambiguity as threat (negative interpretation) has been implicated in cognitive models of anxiety. A significant body of research has examined the association between anxiety and negative interpretation, and reviews suggest there is a robust positive association in adults. However, evidence with children and adolescents has been inconsistent. This study aimed to provide a systematic quantitative assessment of the association between anxiety and negative interpretation in children and adolescents. Method: Following systematic searches and screening for eligibility, 345 effects sizes from 77 studies were meta-analysed. Results: Overall a medium positive association was found between anxiety and negative interpretation in children and adolescents (d = .62). Two variables significantly moderated this effect. Specifically, the association increased in strength with increasing age and when the content of ambiguous scenarios matched the anxiety subtype under investigation. Conclusions: Results extend findings from adult literature by demonstrating an association in children and adolescents with evidence for content specificity in the association. Age effects imply a role for development. Results raise considerations for when and for whom clinical treatments for anxiety focusing on interpretation bias are appropriate. The vast majority of studies included in the review have used correlational designs and there are a limited number of studies with young children. The results should be considered with these limitations in mind.

Interpretation Bias in Online and Offline Social Environments and Associations with Social Anxiety, Peer Victimization, and Avoidance Behavior

“…Third, we caution that the current findings cannot necessarily be generalized to younger age groups. A recent review of the relation between offline interpretation bias and anxiety in children and adolescents showed that the strength of this relationship increases with increasing age (Stuijfzand et al 2018). It is therefore possible that the relative contributions of online and offline interpretation bias to social anxiety in younger populations would be different to those reported here.…”

What are They Thinking? Examining Complex Links Among Social Withdrawal, Maladaptive Cognitions, and Internalizing Problems in Children and Emerging Adults

“…Of particular note, the indirect effects of shyness on both social anxiety and depressive symptoms were stronger via threatening cognitions than via negative cognitions in both samples. This suggests that a considerable portion of the variance in these associations was accounted for by the strong associations between shyness and cognitions, despite robust empirical evidence linking cognitions to internalizing problems (Bar-Haim et al, 2007;Everaert et al, 2017;Stuijfzand et al, 2017). Together, these findings suggest that shyness may indeed serve as a considerable risk factor for maladaptive cognitive patterns and provide preliminary evidence to suggest that shyness may be useful as an early marker for cognitive risk.…”

“…There is also evidence to suggest that maladaptive cognitions may exert a stronger influence on both anxiety and depression in later adolescence (Stuijfzand, Creswell, Field, Pearcey, & Dodd, 2017). For example, Weems and colleagues (2001) Finally, evidence of gender differences in cognitions is limited and somewhat inconsistent.…”

“…Moreover, there is at least some evidence to suggest that emotional difficulties may display cognitive content specificity in childhood (Ambrose & Rholes, 1993;Dagleish et al, 2003;Lau & Waters, 2017;Schniering & Rapee, 2004;Stuijfzand et al, 2017).…”

“…It is important to note that the inconsistencies in the literature across ages may suggest that development plays a role in these associations (Stuijfzand et al, 2017). As such, it may not be appropriate to apply cognitive models derived from the adult empirical literature to children -at least not without considering additional relevant developmental factors.…”