Anxiety symptoms interact with approach motivations in adolescent risk-taking

Background: Adolescence is a critical period of brain and behavioral development during which anxiety disorders often onset. While anxiety is associated with avoidance, adolescent approach motivations and associated neural circuitry may interact with anxiety to influence behavioral and symptom trajectories. This knowledge is crucial for understanding which individuals develop more significant anxiety in adolescence and to inform targeted interventions. Methods: We investigated 3 preregistered aims in a sample of diverse adolescents as they completed a decision-making task involving risk-taking and inhibitory control during fMRI. First, we tested whether approach motivations moderate the association between anxiety and task behavior. Next, we tested the competing influence of anxiety and approach motivations on neural connectivity between the amygdala, ventral striatum (VS), and prefrontal cortex (PFC) during risky decision-making. Finally, we examined how anxiety and approach motivations relate to intrinsic connectivity between these regions at rest. Results: Approach motivations moderated the association between anxiety and task behavior such that youth with high anxiety and low approach were risk-averse and inhibited, while youth with high anxiety and high approach were risk-taking and impulsive. Approach motivations were associated with reduced amygdala-PFC and VS-PFC connectivity during risk-taking paralleled by increased connectivity between these regions at rest, whereas anxiety was associated with heightened amygdala-PFC connectivity during risk-taking and showed an interaction with age on amygdala-PFC connectivity at rest. Conclusions: This study sheds light on the interplay between approach motivations and anxiety on decision-making and neural functioning in adolescence and highlights the importance of considering adolescent brain and behavioral development across multiple domains.