Eye movements, not reaction times, reveal anticipatory attentional bias in childhood social anxiety disorder.

backgroundSocial anxiety disorder (SAD) is characterized by attentional biases that may contribute to its persistence. While adult models emphasize self-focused and hypervigilant attention, there is limited understanding of how these processes operate in children. This study examined internal and external attentional biases in children with SAD during anticipation of a social stress task-a period when anxiety is typically elevated.

methodsForty-two children with a primary SAD diagnosis and 46 healthy controls (HC), aged 9-14 years, completed a reaction time (RT) task with internal (bodily) and external (visual) probes during anticipation of a speech task, while facing a peer video audience. RTs to probes and eye movements toward audience faces were recorded.

resultsRTs did not differ between groups. Exploratory analyses revealed that age correlated negatively with RTs in both groups, suggesting developmental effects on processing speed, although no group differences in this relationship were found. Eye-tracking revealed that children with SAD exhibited more frequent and longer fixations on audience faces during the initial phase of the task compared to HCs.

conclusionsAlthough RT tasks alone may not detect attentional biases in children with SAD, eye-tracking indicated heightened attention to socially salient cues during anticipation. These findings highlight the importance of multimodal assessment to capture subtle hypervigilance in pediatric SAD.