Context-dependent gaze patterns in children with social anxiety disorder during repeated peer-evaluative stress: A naturalistic eye-tracking study

Childhood social anxiety disorder (SAD) has been linked to altered attention to socially relevant cues, but findings on gaze behavior in youth remain mixed, particularly in naturalistic social-evaluative contexts. We examined whether children with SAD differ from healthy controls (HC) in gaze to peer faces during repeated peer-evaluative speech tasks. Children aged 9-14 years with SAD (n = 37) and HC (n = 41) completed two peer-evaluative speech tasks while gaze behavior was recorded with mobile eye-tracking. Before the second speech, participants were randomly assigned either to parental support or self-instruction during the anticipation phase. Fixation probability and fixation duration on audience faces were analyzed across the first four minutes of each speech. During the first speech, no significant group differences were observed for fixation probability or fixation duration. During the second speech, children with SAD showed lower fixation probability than HC, whereas no group differences emerged for fixation duration. Exploratory analyses suggested that fixation probability during the second speech varied by support condition and age. These findings suggest that gaze differences in childhood SAD may be subtle and context-dependent rather than uniformly evident across social-evaluative situations. In this sample, reduced fixation probability was observed during the second speech task only. Further research with larger samples and designs that disentangle repeated exposure from task- or stimulus-specific factors is needed.