Neural Response to Monetary and Social Feedback in Childhood: Processing Reward and Loss in Relation to Peer Outcomes and Anxiety Symptoms.

Anxiety disorders are the most prevalent psychiatric conditions in childhood and are associated with social functioning impairment. How youth process rewards may contribute to the development of social impairment in childhood anxiety. Although aberrant reward processing is a well-established mechanism of psychopathology, associations with anxiety remain inconsistent and limited, especially in childhood. This study investigated neural response to monetary and social reward feedback in relation to anxiety and peer functioning in children. Children (N=106; Age=8.12±.68 years) completed the Doors Task and the Island Getaway Task while electroencephalogram (EEG) recordings assessed event-related potentials (ERPs) to wins and losses. Parents completed questionnaires assessing child anxiety, depression, and peer relations. Contrary to pre-registered hypotheses, we found a significant Valence (reward versus loss) by Condition (monetary versus social) interaction. Specifically, children exhibited greater neural response to monetary loss than reward, but showed the opposite pattern in the social condition, with greater neural response to social reward than loss. Higher child- and parent-reported total and generalized anxiety predicted significantly greater neural response to monetary reward, but not monetary loss or social feedback. As hypothesized, anxiety symptoms significantly moderated the association between neural response and peer relations, demonstrating that for highly anxious children, a greater neural response to social loss predicted worse peer relations. Findings demonstrate differences in neural response to monetary and social feedback processing. Moreover, the distinct vulnerability to social rejection might impair peer functioning in anxious children, suggesting that clinical interventions targeting social rejection processing may effectively improve peer outcomes in childhood anxiety.