The Balance N1 Is Larger in Children With Anxiety and Associated With the Error-Related Negativity.

Background: The error-related negativity (ERN) is a brain response evoked by mistakes in cognitive tasks that is enhanced with anxiety and can predict the subsequent onset or exacerbation of anxiety in children and adolescents. A physical disturbance to standing balance evokes a brain response called the balance N1 that resembles the ERN in scalp topography and in response to a variety of moderating factors. We recently found that the balance N1 and ERN correlate in amplitude across small samples of adults. Methods: In the current study, we tested the effect of anxiety on the balance N1 in children (ages 9-12 years) with and without diagnosed anxiety disorders (38 children with generalized anxiety, social anxiety, and/or obsessive-compulsive disorder and 50 children without these disorders). We measured the balance N1 in response to sudden release of support from a forward leaning posture, the ERN in response to mistakes on a Go/NoGo task, and anxiety symptoms using child- and parent-report forms of the Screen for Child Anxiety and Related Emotional Disorders. Results: Both the balance N1 and the ERN were larger in the anxious group. The balance N1 was also associated with both the ERN and parent report of child anxiety symptom severity across individuals. Conclusions: The higher measurement reliability of the balance N1 than the ERN and greater experimental control over errors suggest that balance paradigms may provide a more powerful method for investigating individual differences in error-related brain activity related to anxiety.