Scientists finds altered attention-related brain connectivity in youth with anxiety

A new study published in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging highlights how brain connectivity patterns differ in children and adolescents diagnosed with generalized anxiety disorder. Researchers found that young people with this condition showed stronger connectivity within a specific brain network that helps detect unexpected events. This heightened connection appeared to fade in those who recovered from the disorder over time, suggesting a potential brain-based marker linked to anxiety symptoms.

Generalized anxiety disorder often begins during childhood or adolescence and is marked by persistent, uncontrollable worry across many areas of life. It can interfere with academic, social, and emotional development and is associated with a greater risk for other mental health challenges later on. Despite its early onset, little is known about how this condition may affect the developing brain.

“Generalized anxiety disorder emerges in childhood or adolescence for some individuals, but lot of what we know about brain connectivity comes from adult studies,” said study authors Sam A. Sievertsen of the Oregon Health & Science University and Jennifer Forsyth of the University of Washington.

The current study aimed to fill that gap by exploring how the brains of youth with generalized anxiety disorder differ in terms of functional connectivity. This refers to how brain regions communicate with each other while the person is at rest. Using brain imaging data from the Adolescent Brain Cognitive Development (ABCD) study—a large, ongoing project following nearly 12,000 youth across the United States—the researchers compared connectivity patterns in children with generalized anxiety disorder to those without any psychiatric diagnoses. They also looked at whether these patterns changed as the children’s symptoms changed over a two-year period.

“The ABCD Study offered us a unique opportunity to look at thousands of youth and assess how large-scale brain networks differ in those who meet criteria for Generalized anxiety disorder at this earlier age from those who do not,” the researchers explained.

The researchers focused on six large-scale brain networks known to be involved in attention, emotion, and self-awareness, as well as six subcortical regions deep in the brain that play important roles in motivation, memory, and emotional processing. They analyzed resting-state brain scans from 164 youth who had been diagnosed with generalized anxiety disorder and compared them to scans from over 3,000 youth without any diagnosed mental health conditions.

The team used a statistical model to examine how strongly brain areas within each network were connected and how these networks communicated with the subcortical regions. They also tested whether these connectivity patterns were different in youth with other conditions that often co-occur with generalized anxiety, such as depression or other anxiety disorders.

One of the clearest findings was that youth with generalized anxiety disorder had slightly stronger connectivity within the brain’s ventral attention network. This network is involved in automatically redirecting attention to sudden or important changes in the environment. Stronger connectivity in this network may reflect a heightened sensitivity to potentially threatening or unexpected events—a feature often reported by individuals with anxiety.

“We were struck by the ventral attention network being the signal most specific to youth with generalized anxiety disorder in our study,” Sievertsen and Forsyth told PsyPost. “There were other subcortical region-cortical network connectivity differences in generalized anxiety disorder, but they were less pronounced and less unique to generalized anxiety disorder compared to other diagnoses like depression.”

Interestingly, this connectivity difference appeared to change with the clinical course of the disorder. Among youth who no longer met the criteria for generalized anxiety disorder two years later, the heightened ventral attention network connectivity was reduced. In contrast, those who continued to meet criteria for the disorder showed no significant change.

“Hyperconnectivity went away in youth when their anxiety remitted, implying this pattern shifts with generalized anxiety disorder symptoms,” the researchers said. “The effects we saw were modest and based on observational data, so we can’t say that this causes or is caused by generalized anxiety disorder – but it suggests that the strength of this network’s connectivity is associated with it and should be examined further.”

Beyond this core finding, the researchers also observed stronger connectivity between certain cortical networks and subcortical regions in youth with generalized anxiety disorder. These included the amygdala, which plays a key role in processing emotional stimuli; the caudate and putamen, which are involved in goal-directed behavior and reward processing; and parts of the brain associated with monitoring internal states and maintaining alertness. These connections were generally stronger in the anxiety group compared to healthy controls.

However, not all connectivity differences were specific to generalized anxiety disorder. In some cases, the same connectivity patterns were seen in youth with other conditions, such as depression or separation anxiety. For example, stronger connections between the brain’s control network and the caudate or amygdala were found in multiple groups. This suggests that while some brain changes may be linked to generalized anxiety disorder in particular, others may reflect broader alterations related to mood or anxiety symptoms more generally.

The researchers also examined whether these brain differences were associated with the severity of anxiety symptoms, based on parent and youth reports. They found no strong associations between connectivity measures and symptom severity scores. This may suggest that these brain differences are more closely tied to diagnostic status than to specific levels of worry or fear. Alternatively, it could reflect limitations in how symptom severity was measured or the complexity of linking brain patterns with fluctuating emotional states.

The study was not designed to test treatment effects directly, but most children with generalized anxiety disorder had received some form of mental health care by the two-year follow-up. The researchers did not find strong links between treatment history and brain connectivity changes, though they note that more detailed information about the type and duration of therapy or medication would be needed to better assess this question.

This work has some limitations to consider. “The effect sizes in our study were modest and the clinical groups were still relatively small, so these differences should not be considered diagnostic or biomarkers by any means,” Sievertsen and Forsyth explained. “We also relied on parent-reported diagnoses because they best match clinician interviews at this age, which was helpful, but future work would benefit from using multi-informant or clinician assessments and more than two time points of data.”

Still, this study represents one of the largest efforts to map brain connectivity differences in children with generalized anxiety disorder. Its findings suggest that stronger connections in the ventral attention network may play a role in the condition’s symptoms and could be explored as a potential biomarker in future research. Long-term, the researchers hope to investigate whether this pattern can help predict who develops anxiety, who recovers, and who responds best to treatment.

“A key area of study now is to investigate whether the stronger connectivity we observed really forecasts who is experiencing generalized anxiety disorder, who recovers, or who benefits most from therapy – questions that growing longitudinal datasets and other clinical cohorts are poised to help test,” Sievertsen and Forsyth told PsyPost. “Future studies could pair resting scans with tasks designed to provoke worry, use diagnoses confirmed by both youth and clinicians, track children across more developmental checkpoints, and hone in on finer brain regions and brain-age models to help test the signal we observed and what it someday may mean for the clinic.”

“We really appreciate the families and youth who participated in this research. We also hope that others will build on these findings and help move us toward more precise mental-health care for youth with generalized anxiety disorder.”

The study, “Resting State Cortical Network and Subcortical Hyperconnectivity in Youth With Generalized Anxiety Disorder in the ABCD Study,” was authored by Sam A. Sievertsen, Jinhan Zhu, Angela Fang, and Jennifer K. Forsyth.