Research Domain Criteria (RDoC) Constructs of Acute and Potential Threat Differentially Associate With Pediatric Anxiety.

Objective: To address problems with the current categorical diagnostic classification system for mental health, the National Institute of Mental Health created the Research Domain Criteria (RDoC) initiative, which encourages researchers to link dimensionally assessed psychological constructs with transdiagnostic psychopathology to expedite discovery of biological mechanisms and clinical translation. Two constructs that were theorized by the RDoC to be pertinent to anxiety symptoms across categorical anxiety disorders and the spectrum of severity are acute threat (AT; fear of a present danger) and potential threat (PT; anxiety about a distant or uncertain danger). However, these constructs are often conflated in research and lack valid self-report measures, especially among youth. Method: The present study examined how self-reported AT and PT distinctly associate with the following: (1) dimensional anxiety symptom severity, and (2) neural response to threat, among youth 7 to 17 years of age with clinically significant anxiety (ie, anxiety disorder diagnosis, n = 119) and those with subclinical to no anxiety (ie, no anxiety disorder diagnosis, n = 41). AT and PT scores were derived from 3 self/parent-report measures of youth anxiety; expert consensus was used to designate each item as indexing either AT or PT, followed by a generation of AT and PT general factor scores from bifactor models fit to clinical experts' ratings. Anxiety severity was assessed with a structured clinical interview using the Pediatric Anxiety Rating Scale. Neural response to threat was measured using the Emotional Faces Shifted Attention Task, performed during functional magnetic resonance imaging. Finally, AT and PT factor scores were tested as predictors of clinical anxiety severity and neural activation to threat. Results: AT factor scores positively associated with clinically assessed anxiety severity and right posterior insula response to threat faces across the whole sample. PT factor scores also associated with greater clinician-measured anxiety severity, but only among participants with subclinical to no anxiety, and did not associate with brain activity. Conclusion: Results support the RDoC theory that AT and PT are distinct and clinically relevant constructs that can be assessed via youth self-report. Understanding how AT and PT uniquely relate to anxiety severity may contribute to the development of targeted anxiety treatment and prevention for youth by elucidating which domains of functioning specifically contribute to disorder heterogeneity or symptom severity. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group.