(PS3-24) Perfectionism Mediates the Longitudinal Association Between Error-Related Negativity and Anxiety in Children

Anxiety disorders are the most prevalent class of psychological disorders among children (Bitsko et al., 2022). As such, early identification of potential mechanisms underlying anxiety is crucial for informing future interventions. Elevations in error-related negativity (ERN) reflect heightened brain activity when making errors and have been associated with both current and future anxiety in youth (Meyer et al., 2015), though the mechanisms explaining this remain unclear. ERN is a neural marker of performance monitoring and may relate to other characteristics of rigidity and self-criticism surrounding mistakes. Indeed, perfectionism, a trait-level sensitivity to error characterized by overly critical self-evaluation, is associated with greater ERN (Stahl et al., 2015) and anxiety (Antony et al., 1998), though no study has tested the relation between ERN, perfectionism, and anxiety in youth simultaneously. The current study employed a longitudinal design to test whether perfectionism mediates the relation between ERN and anxiety across childhood, such that higher ERN leads to higher perfectionism, which in turn leads to higher anxiety. We also explored whether perfectionism mediated the link between ERN and anxiety sensitivity (AS), the fear of anxiety-related sensations, as AS may represent risk for clinical levels of distress by intensifying preexisting anxiety.

Participants were 90 mother-child dyads (children 60.0% male, 87.8% White, 97.8% non-Hispanic) recruited for socioeconomic diversity, with 70.0% reporting below-adequate income according to income-to-needs ratios. Dyads completed lab visits when children were 5-6 (Time 1), 7-8 (Time 2), and 10-13 years old (Time 3). At Time 1, children completed an EEG flanker task (Brooker & Buss, 2014) to elicit ERN. At Time 2, mothers reported on children’s perfectionism using the Child and Adolescent Perfectionism Scale (Flett et al., 1997). At Time 3, children completed self-report measures of anxiety (Revised Child Anxiety and Depression Scale; Chorpita et al., 2000) and AS (Child Anxiety Sensitivity Index; Silverman et al., 1991).

Mediation models were examined in PROCESS (Hayes, 2013) using imputed data. The indirect effect of ERN on anxiety via perfectionism was significant (indirect effect = 0.25, SE = 0.15, 95% CI [0.04, 0.61]). The direct effect of ERN on anxiety remained significant after accounting for perfectionism (direct effect = -0.94, SE = 0.33, 95% CI [-1.60, -0.28]). In the model testing the effect of ERN on AS via perfectionism the indirect effect of ERN on anxiety sensitivity via perfectionism was significant (indirect effect = 0.045, SE = 0.03, 95% CI [0.01, 0.12]). The direct effect of ERN on AS became nonsignificant after accounting for perfectionism (direct effect = 0.03, SE = 0.08, 95% CI [-0.12, 0.19]).

Consistent with hypotheses, the results of our mediation models suggest that perfectionism may be a mechanism linking neural error monitoring to anxiety and AS. It may be that as children develop, physiological sensitivity to error represented by ERN begins to be reflected cognitively as perfectionistic self-criticism. As such, cognitive-behavioral interventions with anxious children may benefit from focusing on perfectionism as an intervention target.