Journal of Cognitive Psychotherapy: An International Quarterly

Volume 29, N um ber 3 • 2015

Information-Processing Biases in
Children and Adolescents:
An Introduction to the Special Issue

Jamie A. Micco, PhD

Massachusetts General Hospital, Boston
Harvard Medical School, Boston, Massachusetts

This special issue focuses on new developments in research on information-processing biases

in children and adolescents. Prior research suggests that attention and interpretation biases in
response to emotional stimuli may be associated with the etiology and maintenance of anx­
iety and depression in youth. Although our understanding of youth biases has burgeoned over
the past decade, questions remain regarding mixed findings across studies, heterogeneity of
biases across individuals, specific factors that contribute to and maintain biases, and how best
to maximize the efficacy of interventions designed to modify biases. Through the use of inno­
vative methods and technology, the articles in this special issue illustrate progress being made
toward filling these gaps in our knowledge and showcase some of the exciting new develop­
ments in this area of research.

Keywords: information processing biases; cognitive biases; children; adolescents; anxiety;

depression

lthough most children and adolescents with anxiety or depressive disorders benefit from

A existing interventions, a large minority do not (Treatment of Adolescent Depression Study

Team, 2004; Walkup et al., 2008). With the goal of fine-tuning treatments or developing
new interventions, researchers have increasingly devoted themselves to the identification of novel
factors that may be associated with the etiology and maintenance of youth psychopathology.
Information-processing biases are among those factors that may increase vulnerability to, or
maintain, anxiety and depression. Based on prior cognitive models of emotional disorders (Crick
& Dodge, 1994; Kendall, 1985), Daleiden and Vasey (1997) developed an information-processing
model specific to childhood anxiety and related disorders, which has served as a framework for
subsequent research on cognitive biases at each stage of the model. In the Encoding stage, atten­
tion is automatically oriented to a stimulus, followed by either sustained attention to the stim­
ulus or disengagement from it. At this stage, youth may present with a biased tendency toward,
or away from, threatening or potentially threatening stimuli (i.e., attention bias to threat). Next,
in the Interpretation stage, the child takes the encoded information and makes meaning of what
he or she has perceived. Those with anxiety or depression tend to select negative or threatening
interpretations (vs. neutral or positive) of information that is ambiguous or neutral in valence
(i.e., interpretation bias). Later stages of the model involve selection of a behavioral response;

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168 Micco

for those children with anxiety and depression, this response is influenced by the perception and
interpretation of threat, which may lead to a behavioral tendency of avoidance versus approach.
This sequence of information processing and subsequent behavioral responses go on to reinforce
the child’s belief that he or she is not able to cope with the situation, which in turn maintains
attention and interpretation biases in response to future situations.
Studies have generally supported this theoretical model: (a) on average, youth with high trait
or clinical anxiety are more likely than youth without anxiety to attend to threatening informa­
tion (or in some cases, to avoid attending to threatening information; Puliafico & Kendall, 2006);
(b) youth with depression tend to preferentially attend to sad stimuli (Hankin, Gibb, Abela, &
Flory, 2010); and (c) anxious and depressed youth are likely to interpret ambiguous situations as
more threatening and their coping abilities as less adequate when compared to healthy control
youth (e.g., Barrett, Rapee, Dadds, & Ryan, 1996; Bogels & Zigterman, 2000; Dalgleish et al., 1997;
Micco & Ehrenreich, 2008). Based on these findings, interventions to remediate cognitive biases
have been developed. These include cognitive bias modification for attention (CBM-A), typi­
cally employing dot probe technology to reinforce attention toward neutral or positive emotional
stimuli, and cognitive bias modification for interpretation (CBM-I), which involves reinforcing
selection of positive interpretations of ambiguous or potentially threatening vignettes (for over­
view, see Woud & Becker, 2014).
However, although knowledge of attention and interpretation biases in anxious and de­
pressed youth has burgeoned over the past decade, several questions remain. Specifically, there
is a great deal of heterogeneity across outcomes of information-processing studies and across
anxious/depressed individuals. For example, we do not yet have a definitive answer for why some
anxious children have an attention bias toward threat, whereas others are biased away or else
have no bias at all. Similarly, why do many studies show that anxious youth interpret ambiguity
as threatening, whereas others fail to find differences in interpretation bias between anxious and
nonanxious youth. Furthermore, we do not yet have convincing evidence that these biases pre­
cede development of anxiety or depressive disorders, and we have only a vague notion of how
information-processing biases themselves develop or are maintained. Possible contributing fac­
tors that have been explored (to name a few) include parental cognitive biases, anxiety severity,
executive control skills, and psychosocial stressors, although longitudinal research is needed to
confirm their temporal association with youth biases. Finally, although CBM-A and CBM-I have
largely been efficacious for anxious and depressed adults (Hallion 8c Ruscio, 2011), outcomes are
less consistent for youth, perhaps because of methodological differences across studies and an in­
complete understanding of the dose needed to maximize efficacy.
The latest research is beginning to provide answers to these gaps in our knowledge, using
cutting-edge technology (e.g., eye tracking, functional magnetic resonance imaging, psychophys-
iological data) and new methods (e.g., approach-avoidance tasks, variable stimuli presentation
times) while controlling for important demographic and clinical variables, all in an effort to more
finely hone our understanding of these individual differences and mixed responses to CBM.
This special issue of Journal of Cognitive Psychotherapy will showcase some of the exciting
new developments in this area of research. First, Roy, Dennis, and Masia Warner provide a com­
prehensive, critical review of the current state of research on attention biases in anxious children
and adolescents. They highlight the importance of multimethod assessment across automatic and
strategic attentional stages of information processing while considering age and severity of anx­
iety, and they urge researchers to more thoroughly examine causes of heterogeneity in attention
bias before continuing to develop and evaluate attention bias modification programs.
The next two articles present empirical studies that follow closely from Roy and colleague’s
recommendations. Carmona and colleagues examine age as a moderator of attention bias
in clinically anxious youth, finding that older youth show a significant bias away from threat,
whereas younger youth have a nonsignificant bias toward threat with developmental implications
 Information-Processing Biases in Children and Adolescents 169

for intervention. Vahlsing, Hilt, and Jacobson examine two psychophysiological measures in
association with attention to emotional stimuli (angry, sad, and happy faces) among a com­
munity sample of preadolescents: resting sinus arrhythmia (RSA) and pupil dilation. Their in­
triguing findings suggest that lower RSA is associated with greater bias to sad faces and to angry
faces (when pupil dilation is lower), although pupil dilation on its own had no association with
attention bias. Physiological data from studies such as this could help to identify those youth who
are most likely to benefit from CBM-A.
The fourth article, presented by Kuckertz, Carmona, Chang, Piacentini, and Amir, exam­
ines automatic behavioral tendencies in response to emotional faces in a small sample of clini­
cally anxious youth and their parents using a novel approach-avoidance task. A combination of
factors—parental report of child anxiety and both parental and child tendency to avoid emo­
tional stimuli— accounted for a large proportion of children’s anxiety severity, with implications
for developing training programs that facilitate approach behaviors in anxious youth.
The final two articles focus on interpretation biases. Farrell, Hourigan, Waters, and Harrington
extend prior work from non-OCD samples of children by examining interpretation biases to­
ward threat among children with clinical OCD and their mothers, compared to a healthy control
group of children. The authors innovatively varied the level of potential threat across scenarios
and found that although mothers of children with OCD make more threatening interpretations
regardless of scenario valence, this was not true for children with OCD themselves (who were,
on the other hand, more likely than controls to judge the scenarios as difficult). The results raise
the question of whether cognitive biases are content specific (i.e., children with OCD show bias
only in response to OCD-relevant scenarios). Finally, Fu, Du, Au, and Lau evaluate the efficacy of
a one-session CBM-I for a Chinese sample of adolescents selected for high and low anxiety; the
authors replicated prior findings that interpretation bias can be modified (particularly among
high-anxious youth), although such modification had no effect on subsequent affect, at least in
the immediate aftermath of training.
The results of the empirical studies in this special issue are intriguing, although largely pre­
liminary given smaller sample sizes and variable sample types. However, these articles thoroughly
set the stage for larger studies using sophisticated methods to delineate what factors contribute to
information-processing biases, how such biases contribute to emotional disorders, and how best
to tailor bias modification interventions to each individual child and adolescent.

R eferences
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170 Micco

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Correspondence regarding this article should be directed to Jamie A. Micco, PhD, Child CBT Program,
Massachusetts General Hospital, 151 Merrimac Street, 3rd Floor, Boston, MA 02114. E-mail: jmicco@mgh
.harvard.edu
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