[Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different?] / Kasuistik einer früh im Lebensverlauf an Morbus Addison erkrankten 14 Jahre alten Patientin bei Verdachtsdiagnose einer Anorexia nervosa.

Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.

[Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders]. / Minderjährige in klinischen Prüfungen: Ethische Abwägungen ihres Einbezugs am Beispiel der indizierten Prävention psychotischer Erkrankungen.

Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.

Prevalence of cognitive impairments and strengths in the early course of psychosis and depression.

BACKGROUND: Studies investigating cognitive impairments in psychosis and depression have typically compared the average performance of the clinical group against healthy controls (HC), and do not report on the actual prevalence of cognitive impairments or strengths within these clinical groups. This information is essential so that clinical services can provide adequate resources to supporting cognitive functioning. Thus, we investigated this prevalence in individuals in the early course of psychosis or depression. METHODS: A comprehensive cognitive test battery comprising 12 tests was completed by 1286 individuals aged 15-41 (mean age 25.07, s.d. 5.88) from the PRONIA study at baseline: HC (N = 454), clinical high risk for psychosis (CHR; N = 270), recent-onset depression (ROD; N = 267), and recent-onset psychosis (ROP; N = 295). Z-scores were calculated to estimate the prevalence of moderate or severe deficits or strengths (>2 s.d. or 1-2 s.d. below or above HC, respectively) for each cognitive test. RESULTS: Impairment in at least two cognitive tests was as follows: ROP (88.3% moderately, 45.1% severely impaired), CHR (71.2% moderately, 22.4% severely impaired), ROD (61.6% moderately, 16.2% severely impaired). Across clinical groups, impairments were most prevalent in tests of working memory, processing speed, and verbal learning. Above average performance (>1 s.d.) in at least two tests was present for 40.5% ROD, 36.1% CHR, 16.1% ROP, and was >2 SDs in 1.8% ROD, 1.4% CHR, and 0% ROP. CONCLUSIONS: These findings suggest that interventions should be tailored to the individual, with working memory, processing speed, and verbal learning likely to be important transdiagnostic targets.

[Communicating about Parental Cancer with Minor Children: Necessity, Burden, and Issues from a Parent's Perspective]. / Kommunikation über die elterliche Krebserkrankung mit minderjährigen Kindern: Notwendigkeit, Belastung und Themen aus Elternsicht.

BACKGROUND: In addition to coping with their own stresses, parents of minor children with cancer face the difficult task of communicating the diagnosis and its effects to their children. The aim of this study is to examine parents' perceptions of conversations with their children and to identify key topics for psychosocial support. METHODS: Using a questionnaire, N=82 cancer patients with N=162 minor children were asked about their experiences when talking to their children about the disease. RESULTS: Communication about the disease was perceived as necessary by most parents. This was especially the case for older children. With 143 out of 162 children (88.3%), the conversation was held. Of the 82 parents interviewed, 16.5% felt no burden as a result of the talks, 15.2% reported a very high burden. The feeling of not being able to protect the children was perceived as particularly stressful. DISCUSSION: Most parents consider communication with the children to be important and seek it. However, many find this difficult, e. g. because they actually want to protect their children. Additional stress can be caused by questions from the children to which the parents cannot give an answer. CONCLUSION: Psychosocial support can be helpful here. Experiences discussed by parents can help other parents in similar situations.

Healthcare Professionals' Conflicts When Treating Transgender Youth: Is It Necessary to Prioritize Protection Over Respect?

Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.

[The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany]. / Psychische Belastung bei unbegleiteten und begleiteten Flüchtlingen im Kindes- und Jugendalter in Deutschland.

The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany Abstract. Abstracts: Objective: This articles investigates the psychological distress and stressful life events in unaccompanied minor refugees (UMR) in adolescence and accompanied minor refugees (AMR) in childhood and adolescence living in Germany. Additionally, it analyzes the predictors of psychological distress in the adolescents. Method: We assessed 170 children and adolescents (adolescents: n = 56 UMR, n = 72 AMR; children: n = 42 AMR) using questionnaires on emotional and behavioral problems and stressful life events. In addition, we questioned the adolescents on PTSS (adolescents: self-report; children: caregiver report). Results: 45.8 % UMR (adolescents), 42.4 % AMR (adolescents), and 56.1 % AMR (children) showed emotional and behavioral problems. On average, we identified 7 stressful life events in UMR (adolescents) and 4 in AMR (adolescents, children). UMR (adolescents) reported more emotional problems, more PTSS, and more stressful life events than did AMR (adolescents). 43.8 % UMR (adolescents) and 27.9 % AMR (adolescents) reported PTSS. The number of stressful life events was found to be the most robust predictor for emotional and behavioral problems as well as PTSS in adolescents. Conclusions: The results indicate the need for psychological interventions of refugee minors in Germany.

COVID-19: Effects of Pandemic Related Restrictions on Physical Activity, Screen Time, and Mental Well-being in German adolescents.

Objective: To describe the impact of the COVID-19 pandemic-related restrictions (PR) in April and May 2020 on physical activity (PA), sedentary screen time (SST), and mental well-being (MWB) in German adolescents, and to analyze associations between these variables. Methods: The Münster District Government invited all secondary school students (aged 11-17) in the region to take part in the online survey that assessed PA, SST, and MWB. For data analysis, we calculated descriptive statistics and ran linear regression analysis. Results: 1,038 students (627 [60.4%] female; 14.18 [± 1.97] years) were included in the analysis. During the PR, a marked decline in overall PA (p < .001) and a significant increase (p < .001) in SST were observed. One-third of the students reported worrying more and being less satisfied with their lives since PR. A decrease in life satisfaction (ß = -.524, p < .001) as well as an increase in general worrying (ß = -.336, p = .015) were associated with a decrease in PA during PR. Conclusion: The results show that the restrictions led to a decrease in physical activity, which may have detrimental effects on the students' mental and physical health.

[Trans* Youth and Young Adults in Healthcare: A Qualitative Study About Experiences, Challenges, andWishes]. / Trans* Jugendliche und junge Erwachsene im Gesundheitswesen: Eine qualitative Interviewstudie über Erfahrungen, Herausforderungen undWünsche.

The number of adolescents who present themselves to the healthcare system due to the aspect of trans* is rising internationally as well as nationally. Studies, especially from the international area, point next to appropriate treatment situations increasingly to aversively experienced situations.These are characterized by lack of knowledge of the professionals, incorrect naming and pronoun naming as well as inappropriate questions and comments. In order to shed light on the situation in Germany, semi-structured interviews were conducted with ten adolescents and evaluated using qualitative content analysis. Overall, a balanced ratio of positive, appropriate and negative, aversive experiences emerged. Themes were gender-sensitive language, ways of interacting, support/networking and knowledge. The adolescents named parental support and connection to self-help groups as supportive instances in dealing with the healthcare system, but also mentioned structural hurdles such as long waiting times. Overall, the adolescents had a positive outlook on the future and would like to see a sensitization of healthcare workers. Educationalmeasures and further training should be implemented in order to meet these wishes and to ensure needs-based care for trans* adolescents.

[Parents Health Care Experiences of a Child or Adolescent with Gender Incongruence and Gender Dysphoria: A Qualitative Study]. / Erfahrungen im Gesundheitswesen von Sorgeberechtigten eines Kindes oder Jugendlichen mit Geschlechtsinkongruenz und Geschlechtsdysphorie: Eine qualitative Studie.

In general, little is known about the experiences of parents of a transgender child or adolescent when seeking health care services. In addition, there is little research on how parents interact with their child in the health care system. International studies show high vulnerability and psychological distress among those children and adolescents who assign themselves to a gender other than the one assigned at birth. Parental support represents a protective factor related to mental health. The aim of this study is to investigate parental interaction processes in medical-psychological treatment settings. For this purpose, guided qualitative interviews were conducted throughout Germany with twelve fathers and mothers of transgender children/adolescents. Most parents faced a number of challenges and barriers to their children's health care. A lack of knowledge and insecurities on the part of the health care practitioners up to psychopathologization of identity were ascertainable. At the same time, accepting, affectionate and supportive encounters were evident from the reports. Furthermore, it was found that the parents took an essential protective and supportive stance towards their children in the treatments. For improved health care, sensitization and education regarding gender variance in childhood and adolescence is necessary for health care practitioners in the health care system. The study can contribute to expanding the scientific discourse on life biographies of young trans* people and their parents.

Increased early motivational response to food in adolescent anorexia nervosa revealed by magnetoencephalography.

BACKGROUND: It remains unclear to what extent reduced nutritional intake in anorexia nervosa (AN) is a consequence of a reduced motivational response to food. Although self-reports typically suggest AN patients have a reduced appetitive response, behavioral and neurophysiological measures have revealed evidence for both increased and reduced attentional biases towards food stimuli. The mechanisms influencing food perception in AN, might be clarified using time-sensitive magnetoencephalography (MEG) to differentiate the early (more automatic processing) stages from the late (more controlled) stages. METHODS: MEG was recorded in 22 partially weight-restored adolescent AN patients and 29 age- and gender-matched healthy control (HC) participants during a rapid serial visual presentation paradigm using 100 high-calorie food, 100 low-calorie food, and 100 non-food pictures. Neural sources of event-related fields were estimated using the L2-Minimum-Norm method and analyzed in early (50-300 ms) and late (350-500 ms) time intervals. RESULTS: AN patients rated high-calorie food as less palatable and reported overall less food craving than HC participants. Nevertheless, in response to food pictures AN patients showed relative increased neural activity in the left occipito-temporal and inferior frontal regions in the early time interval. No group differences occurred in the late time interval. CONCLUSIONS: MEG results speak against an overall reduced motivational response to food in AN. Instead, relative increased early food processing in the visual cortex suggests greater motivated attention. A greater appetitive response to food might be an adaptive mechanism in a state of undernourishment. Yet, this relative increased food processing in AN was no longer present later, arguably reflecting rapid downregulation.

Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity.

Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.

Is a mother's recalled parental rearing behavior, her attributions of her child's behavior, and her psychopathology associated with her mother-child relationship quality?

BACKGROUND: The mother-child relationship quality (MCRQ) may represent a transgenerational transmission mechanism of mental health problems. In this context, we examine the mother's recalled parental rearing behavior, actual attributions of her child's behavior, and her current psychopathology. METHOD: A clinical sample of mother-child dyads was assessed with the Questionnaire for the Assessment of Recalled Parental Rearing Behavior, the Parent Cognition Scale, and the Symptom Checklist at the Child Psychiatric Family Day Hospital for preschool children in Münster, Germany, at admission. MCRQ was assessed with the Parent-Infant Relationship Global Assessment Scale, a structured interview with the child (Strukturiertes Interview zur Erfassung der Kind-Eltern-Interaktion), and the Multiperspective Parent-Child Relationship Questionnaire. RESULTS: Multiple regression analyses showed no direct association between the mother's recalled parental rearing behavior and any measure of the MCRQ. However, maternal dysfunctional attributions about her child's behavior and her actual psychopathology showed the expected negative associations with the multiperspective measures of MCRQ. The relationship quality assessments did not correlate significantly with each other. CONCLUSION: The divergent measures of MCRQ, which seem to assess different aspects, are a barrier to investigate the association between the mother's recalled parental rearing behavior and MCRQ. However, low MCRQ is associated with increased maternal psychopathology and maternal dysfunctional attributions on child behavior.

["If One Feels Better Like That "]. / "Wenn man sich so besser fühlt ".

"If One Feels Better Like That …". Adolescent Sibling Relationship in the Context of Transgender Development A transgender development in youth can influence the relationship of concerned youth and their siblings. While in most surveys, the focus lies on transgender adolescents, both sides shall be interviewed here to capture the situation of siblings and to relate the results. For this purpose, guide interviews with ten transgender adolescents and twelve of their siblings were analysed in accordance to Grounded Theory. In most cases, participants were satisfied with the sibling relationship. After the coming-out of the transgender adolescent they showed both positive and negative reactions that, however, changed to respect and acceptance by time without exception. Doubt, compassion and grief were short lived and often replaced by joy for the transgender adolescent. Transgender youth were mostly satisfied with the reaction of their sibling though the amount of support varied. The time of coming-out and transition often led to an improvement in sibling relationship, more closeness and family cohesion. In general, siblings seem to be immediately concerned by transgenderism in adolescence. In clinical practice, they should thus be included from the beginning. By taking into account their situation, negative developments can be prevented, and the sibling relationship become usable as a resource.

[The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population]. / Die emotionale Kompetenz der Mutter und die klinische Qualität der Mutter-Kind-Beziehung in einer vorschulpsychiatrischen Inanspruchnahmepopulation.

The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population The quality of mother-child interaction and relationship is an essential risk factor for the development of mental disorders at preschool age. We examine maternal emotional competence and maternal level of psychopathology as predictors for the quality of mother-child relationship. At the beginning of their treatment a clinical sample of mother-child-dyads at the Child Psychiatric Family Day Hospital in Münster was assessed concerning the emotional competence of mothers (EKF), the maternal psychopathology (SCL) and the mother-child relationship quality, the latter with three different instruments reflecting the mother's, the child's and the therapist's perspective (PIR-GAS, SKEI, M-PCR). The mothers showed decreased results in the EKF scales emotional regulation, recognition of emotions and in the EKF-overall-score and presented a higher level of maternal psychopathology compared to the normal population. There is a direct relation between emotional regulation and the M-PCR scales affective bond and functional-conflict. Besides the direct influence of the maternal psychopathology, the expected moderator effect of emotional expressiveness and the M-PCR scale functional-conflict, reported by mothers, was apparent. Certain aspects of the emotional competence of mothers and their psychopathology show an influence on mother-child relationship quality. The method and the perspective of assessment are crucial to the results.

Impaired predictability: enhanced fluctuations in the parenting behaviour of mothers of pre-school children with clinical diagnoses across three different play tasks.

Fluctuations in parenting behaviour are thought to be important for the development of child psychopathology. This study focusses on fluctuations in the parenting behaviour of mothers with 3-6-year-old children with a clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) (N = 39) and compared them with a control group of mothers with children without a clinical diagnosis (N = 41). In a laboratory setting, we compared the quality of mother-child interactions between both groups using three increasingly challenging co-operation tasks. At first, the mother and child interacted via a free play task. They then co-operated within a constructional play task and finally within a challenging problem-solving task. We analysed the mothers' parenting behaviour using the Laboratory Parenting Assessment Battery (LAB-PAB) and children's problem behaviours by means of their mothers' rating using the Child Behavior Checklist 1 ½-5 (CBCL). The results corroborated our hypotheses. Mothers of the group of children with clinical diagnoses had a lower parenting quality and higher fluctuations in parenting behaviour across situations compared with the non-clinical group. Further analysis revealed that specific fluctuations in maternal involvement and hostility uniquely predicted child psychopathology, measured with the CBCL, showing incremental validity of fluctuations in maternal involvement, when controlling for parenting quality and maternal difficulties in emotion regulation, measured with the Difficulties in Emotional Regulation scale. The results are discussed in terms of their implications for clinical interventions, as well as theoretical implications and future research.

[Multifamily Therapy with Anorectic Children and Adolescents in a Day Care Clinic]. / Multifamilientherapie mit anorektischen Kindern und Jugendlichen im tagesklinischen Rahmen.

Multifamily Therapy with Anorectic Children and Adolescents in a Day Care Clinic The treatment of children and adolescents suffering from anorexia nervosa represents an enormous challenge for therapists and families as well. After release form inpatient hospital treatment, there frequently is a period of renewed weight loss and a return to anorectic comportment and thought patterns. In view of what may be understood as a relapse, feelings of guilt and shame on the part of both the patients and their parents can be triggered. This often supports dysfunctional relationship dynamics within the affected families. Maintaining anorexia nervosa may be facilitated by being a suitable strategy to solve problems of the family system. Multifamily therapy aims at breaking this cycle and ensuring a stable transition from inpatient to outpatient settings of therapy. It requires an intensive and continuous involvement of the patients' parents in the therapy. Six families participating in a closed group are accompanied over one year by two multifamily therapists during the post inpatient phase. During this period, the parents remain responsible for their children. In the course of a day hospital intervention taking fifteen single days over a year, the parents develop a sense of competence in dealing with the disease. Thereby, the patients get the opportunity to overcome the anorectic isolation and pseudo-autonomy through experiencing their parents as able to understand them and their illness. In this contribution we present first results of a pilot study that suggest effectiveness of this therapy method.

[Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting]. / Wirksamkeit analytischer Psychotherapie bei Kindern und Jugendlichen mit klinischen Angstsyndromen im naturalistischen Behandlungssetting.

Effectiveness of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Psychopathology in a Naturalistic Treatment Setting The aim of the study was to evaluate naturalistic out-patient psychoanalytic youth psychotherapy in Germany. The study was a partly controlled effectiveness trial. While the first treatment interval (25 sessions, 6.13 months) was compared with a wait-list control group (5 supportive sessions, 2.94 months), the effects of long-term psychoanalytical treatment were analyzed using a time-series design. 86 children and adolescents (aged 4 to 21 years) and their parents who entered psychoanalytic therapy in private practices participated in this study. The wait-list control group comprised 35 patients. Questionnaires were administered at the beginning and the end of treatment, as well as 6 and 12 month follow-up (FU). Patients received on average 94.04 therapy sessions (range 8 to 300) over 25.70 months. Data analyses were carried out with multilevel mixed linear models on the intention-to-treat (ITT) sample. The patients in the intervention group reported moderate symptom improvements at the end of therapy (d = .57), these effects are stable at the 1-year follow-up and increase from the patient perspective (d = .80). When comparing the first therapy interval with the (minimal treatment) wait-list control group, both groups improved significantly with small effect sizes and no significant group differences. The results suggest that long-term psychoanalytic therapy is successful in alleviating anxiety pathology and improving quality of life for youth with anxiety disorders, and that improvements remain stable across a 1-year follow-up period.

Anxiety and depression in working-age cancer survivors: a register-based study.

BACKGROUND: Anxiety and depression can be a long-term strain in cancer survivors. Little is known about the emotional situation of cancer survivors who have to deal with work- and family-related issues. The purpose of this study was to investigate anxiety and depression in working-age cancer survivors and associated factors. METHODS: A register-based sample of 3370 cancer survivors (25 to 55 years at time of diagnosis) diagnosed up to six years prior to the survey was recruited from two German cancer registries. Demographic and medical characteristics as well as self-reported measures were used. RESULTS: Overall, approximately 40% of the survivors reported moderate to high anxiety scores and approximately 20% reported moderate to high depression scores. Compared to the general population, working-age cancer survivors were more anxious but less depressed (p < .001). Subgroups with regard to time since diagnosis did not differ in anxiety or depression. Anxiety and depression in cancer survivors were associated with various variables. Better social support, family functioning and physical health were associated with lower anxiety and depression. CONCLUSIONS: Overall, we found higher anxiety levels in cancer survivors of working-age than in the general population. A considerable portion of cancer survivors reported moderate to high levels of anxiety and depression. The results indicate the need for psychosocial screening and psycho-oncological support e.g. in survivorship programs for working-age cancer survivors. Assessing the physical health, social support and family background might help to identify survivors at risk for higher emotional distress.

Hypervigilance-avoidance in children with anxiety disorders: magnetoencephalographic evidence.

BACKGROUND: An altered pattern of threat processing is deemed critical for the development of anxiety disorders (AD). According to the hypervigilance-avoidance hypothesis, AD patients show hypervigilance to threat cues at early stages of processing but avoid threat cues at later stages of processing. Consistently, adults with AD show enhanced neurophysiological responses to threat in early time windows and reduced responses to threat in late time windows. The presence of such a hypervigilance-avoidance effect and its underlying neural sources remain to be determined in clinically anxious children. METHODS: Twenty-three children diagnosed with an AD and 23 healthy control children aged 8-14 years saw faces with angry and neutral expressions while whole-head magnetoencephalography (MEG) was recorded. Neural sources were estimated based on L2-Minimum Norm inverse source modeling and analyzed in early, midlatency, and late time windows. RESULTS: In visual cortical regions, early threat processing was relatively enhanced in patients compared to controls, whereas this relation was inverted in a late interval. Consistent with the idea of affective regulation, the right dorsolateral prefrontal cortex revealed relatively reduced inhibition of early threat processing but revealed enhanced inhibition at a late interval in patients. Both visual-sensory and prefrontal effects were correlated with individual trait anxiety. CONCLUSIONS: These results support the hypothesis of early sensory hypervigilance followed by later avoidance of threat in anxiety disordered children, presumably modulated by early reduced and later enhanced prefrontal inhibition. This neuronal hypervigilance-avoidance pattern unfolds gradually with increasing trait anxiety, reflecting a progressively biased allocation of attention to threat.