ADHD in Children
Visual Abstract
Effect of anxiety on cognition, behavior, and stimulant response in ADHD
ADHD: Anxiety and Stimulant Response
S R Pliszka
Summarized by:
July 17, 2023
study source
J Am Acad Child Adolesc Psychiatry
Nov 1989
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What they studied
Researchers studied a group of children with ADHD to see how having anxiety with ADHD differed from having only ADHD.
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What they found
Those with anxiety and ADHD showed less impulsivity and were less disruptive at school than those with ADHD alone. They had slower reaction times and less impulsiveness and were less likely to respond to Ritalin.
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What this means
This was one of the first studies to find clear differences between those with ADHD and anxiety and those with ADHD alone.
Effect of anxiety on cognition, behavior, and stimulant response in ADHD
Background and Methods
Anxiety disorders are common among those with ADHD. Studies have shown that it can affect how we experience ADHD:
Researchers in the study wanted to find out how having an anxiety disorder with ADHD differs from having ADHD alone. Researchers studied 79 children with ADHD and tested them for anxiety, conduct disorder, and oppositional defiant disorder.
They then ran tests of behavior, cognition, and responses to medication to see if any results differed between those with ADHD alone and those with ADHD along with another condition.
Study Quote
The effect of the comorbidity of overanxious disorder (ANX) in attention deficit hyperactivity disorder (ADHD) on laboratory measures of behavior, cognition, and stimulant response was examined. Seventy-nine children who met DSM-III-R criteria for ADHD were tested further for an oppositi...
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Results
In one test, researchers tested response time while distracted. How well could someone perform on a test in a distracting environment?
Those with anxiety and ADHD struggled more on the test as distractions on the test display increased. They took longer to scan the display used in the test than those without anxiety, suggesting that anxiety may increase reaction time in distracting environments for those with ADHD.
Those with ADHD and anxiety took longer to respond on a simulated distraction test.
There were also differences in medication response. While stimulants work for many with ADHD, they don’t work for everyone.
The study results showed that those with anxiety might be less likely to respond to Ritalin than those with only ADHD.
Those with anxiety and ADHD were less likely to respond to Ritalin than those with only ADHD.
However, this pattern was not universal. Around a third of those with ADHD and anxiety benefited from Ritalin. Other studies have also shown that medication can work well for many with anxiety.
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There was no evidence that subjects with ANX worsened on stimulant. A number of these subjects were placebo responders; that is, their ratings declined from baseline, but they did as well on placebo as on stimulant. About a third of the comorbid group were determined to have responded well to stimulant, and continued treatment with methylphenidate.
Those with ADHD and anxiety were less likely to have conduct disorder. None of the subjects in the study with ADHD had conduct disorder, while a third of those without anxiety and only ADHD had conduct disorder.
Based on teachers' ratings at school, those with anxiety and ADHD showed less attention and hyperactivity in the classroom, consistent with the lower rates of conduct disorder.
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These data show there is considerable heterogeneity among subjects with ADHD depending on the presence or absence of an ANX. The presence of a comorbid ANX tended to attenuate the teacher ratings of inattention and overactivity, as well as those of oppositional behavior and defiance, though the ratings clearly remained in the disturbed range.
Study Quote
Subjects with comorbid ANX showed less impulsiveness on a laboratory measure of behavior and had longer, sluggish reaction times on the Memory Scanning Test than those without ANX. ADHD subjects with comorbid ANX were less frequently diagnosed as CD. Forty-three of the subjects completed...
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Conclusions
This study was one of the first to show that having ADHD and anxiety leads to different symptoms and effects than having ADHD alone. In a way, having both conditions together leads to different experiences and maybe a distinct subtype of ADHD.
Subsequent studies have backed up these findings and have similarly found differences between those with ADHD and anxiety and those with ADHD alone.
Study Quote
The results suggest that ADHD with comorbid ANX may represent children with primary anxiety who develop secondary inattentiveness, or they may represent a different subtype of ADHD, perhaps similar to the condition of attention deficit disorder without hyperactivity under DSM-III.