Childhood anxiety disorders can be viewed as “gateway” conditions because they signal increased risk for various mental illnesses. Indeed, childhood anxiety disorders predict a two-to-three fold increased risk for adult disorders, particularly anxiety disorders and major depressive disorder (MDD) [1
]. Nevertheless, many anxious children mature to become healthy adults, free of psychopathology [2
]. As a result, there is a need to understand the factors that distinguish between the subgroups of anxious children that have relatively high and low risk for adverse outcomes.
Long-term adverse outcomes may vary based on patterns of information processing and associated neural responses engaged when confronting threats that signal impending danger. Specifically, anxious individuals exhibit threat biases at multiple levels of information processing, including aspects of attention orienting, cognitive appraisal, and learning [5
]. In addition, neuroimaging studies conducted in separate samples of children, adolescents, and adults implicate similar brain regions in tasks measuring these anxiety-related information-processing biases [7
]. This work raises questions on the degree to which neural responding to threats at one point in life predicts outcome at later points in life. As such, neuroimaging may eventually be used to identify subgroups of anxious children most likely to develop chronic conditions.
Two prior reviews set the stage for the current review. One review focused on integrating clinical and basic perspectives on anxiety [5
]; the other focused on using neuroscience to inform therapeutics [6
]. The current review focuses more narrowly on neurocognitive influences on fear learning, a topic not addressed in these past reviews. The goal here is to illustrate how a narrow focus on the interface among attention, threat appraisal, and fear learning can generate novel insights for outcome prediction. This review proceeds in three stages. The first section broadly summarizes data on amygdala function, as it relates to learning and attention; the second section then focuses more narrowly on one specific information-processing function, threat appraisal. The final section introduces a novel imaging paradigm to investigate the neural correlates of threat appraisal during extinction recall.