# Sensitivity and Bias in Face-Emotion Labeling: Replication and Extension to Youth With Irritability and Anxiety

## TL;DR

This study examines how youth with irritability or anxiety interpret facial expressions and finds that anger, not anxiety, is linked to increased brain activity when seeing angry faces.

## Contribution

The study extends prior work by exploring neural responses in youth with irritability and anxiety during face-emotion labeling.

## Key findings

- Youth with higher irritability showed increased motor cortex activation when viewing angry faces.
- No significant link was found between anxiety or irritability and bias in interpreting ambiguous faces.
- Age-related increases in sensitivity to face-emotions were successfully replicated.

## Abstract

Pediatric anxiety and irritability are common, impairing, co-occurring symptoms. Biases in interpreting ambiguous face-emotions have been linked to both phenotypes. Here, we assessed whether biases represent a shared cognitive and neural profile. In addition, we attempted replication of prior age associations and group behavioral differences in face-emotion labeling.

In a cross-sectional functional magnetic resonance imaging study at a research facility at the National Institute of Mental Health, we used a variant of a drift diffusion model to decompose perceptual and cognitive components of binary happy–angry decisions to ambiguous face-emotions. A total of 95 participants (mean age = 14.11, SD = 3.07, range = 8-22, male = 50.9%) contributed to the analyses. In all, 65 participants did not complete the scan or meet data quality thresholds. Participants had a primary diagnosis of disruptive mood dysregulation disorder (DMDD; n = 27), attention-deficit/hyperactivity disorder (n = 23), oppositional defiant disorder (n = 2), anxiety disorder (n = 19), or no current diagnosis (n = 24), resulting in a wide range of anxiety and irritability symptom levels.

No significant associations between the computational modeling parameter indexing bias and dimensionally assessed anxiety or irritability emerged (r[84] < −0.15, p > .05). Parent- and child-rated irritability, but not anxiety, was associated with increased neural responses to overtly angry faces, most notably in the motor cortex (voxel-wise p < .005). We successfully replicated prior age-associated increases in sensitivity and differences in bias between youth with DMDD and controls.

Increased neural engagement of the bilateral motor cortex likely reflects increased vigor in responding to overtly angry faces, possibly indexing approach behavior. Replication of prior findings increases confidence in the robustness of these associations.

Youth experiencing high levels of anger or anxiety are thought to interpret ambiguous facial expressions as hostile. In this study, 95 youth aged 8 to 22 years completed a task that assessed their interpretations of facial expressions while measuring brain activation. Youth with higher levels of anxiety or anger did not interpret faces as more hostile. However, when responding to angry faces, youth with higher levels of anger showed increased activation in areas of the brain involved in coordinating actions, which may translate to more aggressive responses in daily life.