Assessing Behavioral Threat Avoidance in Pediatric Anxiety with Naturalistic Games

Introduction: Behavioral avoidance exacerbates anxiety symptoms. Capturing and identifying maladaptive avoidance patterns holds clinical utility. However, effective assessment tools which provide unique information on behavior beyond self-report are needed. Here, we assess the replicability of an interactive game to distinguish between clinically anxious and healthy youth’s behavioral avoidance. Methods: 115 youth (8-17 years old) completed the Yale Interactive Kinect Environment Software (YIKES) paradigm, whereby behavioral avoidance of negative and non-negative faces is captured. Our primary, preregistered analyses used mixed ANOVA models to test differences in behavioral avoidance by diagnostic status, clinician-reported avoidance, and self-reported social anxiety symptoms. Secondary, non-preregistered analyses pooled data across two published studies (n =189 youth). Results: Primary analyses found no association between anxiety symptoms and avoidance. However, a secondary, pooled analysis indicated a positive association between self-reported social anxiety symptom severity and avoidance of negative faces (r = .25, p < .001). Discussion: Here, we provide mixed evidence that an interactive game captures behavioral avoidance associated with anxiety. No associations with clinician-rated measures emerged. Behavioral avoidance was correlated with self-reported social anxiety in a secondary analysis. Given this preliminary clinical link and the advantages of the interactive game, further work building on this paradigm is warranted.