Anxiety may alter the role of fronto-striatal circuitry in adolescent risky decision-making

Background: Anxiety disorders often emerge in adolescence and are associated with risk aversion. Risk aversion is at odds with the typical adolescent propensity for heightened sensation-seeking and can interfere with learning and contribute to further anxiety development. Methods: We investigated the neural and behavioral correlates of risk avoidance in 137 diverse early adolescents (MAge=11.3, SDAge=1.41; 61 girls) during a decision-making task involving risk-taking and cognitive control during fMRI. Voluntary cautious choice was compared to successful response inhibition to isolate the neural systems underlying risk avoidance and identify their relation to risk-taking and anxiety in adolescents. Results: Risk-taking frequency was not related to anxiety severity; however, higher anxious youth spent relatively longer making voluntary cautious choices than inhibiting when instructed. All youth showed widespread neural activation in decision-making and salience network regions when making cautious choices. Greater recruitment of the left inferior frontal gyrus during cautious choice was associated with greater risk-taking in high anxious youth and greater risk avoidance in low anxious youth, while greater striatal connectivity during cautious choice was associated with heightened risk-taking in those with low anxiety and risk avoidance in those with high anxiety. Conclusions: Relative to non-anxious adolescents, anxious adolescents take longer to make decisions in the face of approach-avoidance conflict and demonstrate unique brain-behavior associations during decision-making. Together, results from this study identify a unique role of fronto-striatal circuitry in risky decision-making among adolescents who struggle with anxiety.