Abstract
Impaired functional connectivity within and between largescale brain networks has been linked to diverse forms of psychiatric illness (1).Despite converging evidence supporting a model of network dysfunction for psychopathology, additional work is needed before this knowledge can be applied translationally.In the current issue of Biological Psychiatry: Global Open Science, we consider Perino et al.'s (2) restingstate functional connectivity study of pediatric anxiety disorders in the context of large-scale network models of psychopathology [e.g., (3)] and provide an outline of the steps needed to overcome the current barriers to clinical translation.Pediatric anxiety disorders are highly prevalent and predict the development of further mental health problems in adulthood (4).While traditionally conceptualized as disorders of excessive fear, models of anxiety now propose that basic cognitive processes may be affected in anxiety pathology as well.For example, there is evidence to support that increased attention toward salient stimuli coupled with deficient cognitive control may drive anxiety symptoms (5), and that these abnormalities are present from young ages in those who are predisposed to anxiety (6).These cognitive processes are thought to be subserved by distinct functional neural networks, including the ventral attention network (VAN), the cinguloopercular network (CON), and the frontoparietal network, which are involved in rapid orienting toward novel stimuli, detecting the need for cognitive control, and implementing cognitive control, respectively (7).These canonical networks have been related to cognition in healthy and clinical populations, though they have been understudied in those with pediatric anxiety.Linking anxiety-associated cognitive processes to underlying neural networks may guide the targeting of novel interventions for pediatric anxiety.Perino et al.(2) provide insight into how alterations of attention functioning, as well as resting-state brain networks, may be related to anxiety symptoms in children.In their previous work, Perino et al. (8) reported that anxiety symptoms measured dimensionally were associated with greater involuntary attention capture of nonaffective cues, as well as greater activation of the inferior frontal gyrus, a key node of the VAN.In the current study, Perino et al. (2) extend this work by showing that both pediatric anxiety and attention capture are associated with greater CON-VAN connectivity at rest.The authors suggest that enhanced CON-VAN connectivity in pediatric anxiety may stem from a history of excessive coactivation during which greater VAN sensitivity to attention capture is communicated to the CON.Interestingly, the authors also report that anxiety is associated with alterations within the CON, as well as between the CON, visual network, and default mode network.Given that the CON may serve as a Biological Psychiatry: GOS KDF is a board member for the AIM foundation for youth mental health and is testing cognitive training technology contributed by Akili Interactive Labs, Inc., as a treatment for pediatric anxiety.All other authors report no biomedical financial interests or potential conflicts of interest.