Cognitive Biases in Child Psychopathology
Kimberly A. Arditte and Jutta Joormann
Individual differences in cognitive processes, such as attention, memory, and interpretation, are known to play a critical role in the experience and regulation of emotion (Gross, 2007; Lazarus, 1994). Indeed, cognitive theories of emotion propose that one’s cognitive appraisal, or interpretation, of a situation determines one’s emotional response (Lazarus & Folkman, 1984). Consequently, modifying cognition is a primary route through which emotion is regulated. Imagine a child standing alone at the playground, watching a game of pickup basketball, and hoping to join in with his peers. What this child attends to (Is he watching the bully on the court or his three other friends who are playing?), how he remembers similar past experiences (Is he thinking of that time he successfully joined in last week?), and the way he interprets ambiguous environmental cues (“What did that kid mean when he asked if I was good at basketball?”) may directly relate to this child’s emotional response to the situation.
Transdiagnostic theory looks to explain disparate psychological conditions via common mechanisms (Taylor & Clark, 2009). Biases in cognitive processing have been documented within a number of clinical disorders, including anxiety, mood, substance use, and eating disorders (Benas & Gibb, 2011; Bowler, Bowler, & James, 2011; Mathews & MacLeod, 2005). Also central to these disorders is an inability to effectively regulate emotions and mood states (Kring & Sloan, 2010). Recent accounts of emotional disorders have proposed that the presence of cognitive biases contributes to difficulties in emotion regulation, which then leads to the onset, maintenance, and/or recurrence of psychological disorders (Joormann & D’Avanzato, 2010). Experimental research has supported this hypothesis, demonstrating, for example, that the induction of a bias in attention toward negative material leads to increased emotional reactivity in response to an acute stressor (e.g., MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002).
The goal of this chapter is to examine the evidence for the existence of cognitive biases among children and adolescents across a range of psychological disorders. Relative to the adult literature, little attention has been paid to this area of research. Yet understanding the role of cognitive biases within these younger populations may have important implications for both theory and treatment. For example, elucidating the developmental trajectory of cognitive biases, particularly in conjunction with the onset of other symptoms, may allow us to better understand the causal mechanisms underlying the development of psychological disorders. In addition, the identification of biased cognitive processes across disorders may allow a point of entry for transdiagnostic treatments for children and adolescents.
Unfortunately, given the confines of this chapter, it would be impossible to adequately cover the existing theory and research on every cognitive bias for every psychological disorder. Given this, we do not intend this chapter to be an exhaustive review. Rather, we have chosen to focus on three of the most commonly studied cognitive processes (attention, memory, and the interpretation of ambiguous stimuli) as they relate to mood and anxiety disorders. These processes have all been previously identified as transdiagnostic (Harvey, Watkins, Mansell, & Shafran, 2004) and may be particularly so among mood and anxiety disorders, which have been shown to be highly comorbid and to share a number of vulnerability factors (Dozois, Seeds, & Collins, 2009). According to cognitive accounts, maladaptive schemata, or core beliefs about oneself, the world, or the future, underlie anxiety and mood disorders (e.g., Beck & Clark, 1997; Beck, Rush, Shaw, & Emery, 1979). Individuals experiencing depression or anxiety are more likely to attend to, remember, or interpret ambiguous stimuli or situations in a manner that is congruent with these schemata. For example, individuals with anxiety disorders may maintain a hyperoperative danger schema (Beck, Emery, & Greenberg, 1985). Filtering information through such a schema is thought to lead individuals with anxiety to interpret ambiguous information in a threatening manner, even in cases in which threat is not present. However, the interpretation of ambiguous situations as threatening will likely exacerbate symptoms of anxiety and may maintain them by eliciting avoidance behavior, thereby reinforcing threat-related cognitions (Creswell, Schniering, & Rapee, 2005). Similarly, people may attend to, encode, or recall information in a manner congruent with negative schemata, feeding into a cycle of exacerbated psychological symptoms, further activated schemata, and increasingly biased cognitive processes. In this way, biases in attention, memory, and interpretation are each proposed to play an important role in the onset, maintenance, and recurrence of emotional disorders.
In the following sections, we provide summaries of the extant child and adolescent literature for each of the three above-mentioned cognitive biases. Within these summaries, we have used the labels child and adolescent as authors of specific studies have used them. Generally, research examining cognitive biases has focused on children ranging from 8 to 12 years of age and adolescents ranging from 13 to 18 years of age.