ADHD in Children
Visual Abstract
Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)
Effect of Anxiety on ADHD Treatment
John S. March, James M. Swanson, L. Eugene Arnold, Betsy Hoza, C. Keith Conners, Stephen P. Hinshaw, Lily Hechtman, Helena C. Kraemer, Laurence L. Greenhill, Howard B. Abikoff, L. Glen Elliott, Peter S. Jensen, Jeffrey H. Newcorn, Benedetto Vitiello, Joanne Severe, Karen C. Wells, and William E. Pelham
March 14, 2023
study source
J Abnorm Child Psychol
Dec 2000
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What they studied
Researchers examined the relationship between ADHD, anxiety and the effectiveness of different treatment types.
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What they found
Having anxiety and other disorders affects treatment response. A combination of medication and behavioral therapy worked best for children with ADHD and anxiety.
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What this means
When evaluating and treating ADHD, it’s important to test for other conditions, as different treatments work better with different conditions.
Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD
Objective & Methods
ADHD and anxiety are closely related conditions:
There is some evidence that the level of anxiety in a child with ADHD affects the chances that a child will respond to different types of ADHD treatment.
The study wanted to find out more about the effect of anxiety and ADHD treatment response and to see whether conduct disorder played a role in ADHD treatment response as well.
Study Quote
Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were ...
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Results
In this study of children with ADHD, anxiety was quite common. Consistent with previous studies, around a third of participants had an anxiety disorder and ADHD.
Of those with ADHD, and anxiety, 2/3 also had conduct disorder or oppositional defiant disorder.
The MTA study found that around a third of children with ADHD in the study had an anxiety disorder. Of these, 2/3rds also had a behavioral disorder, such as conduct disorder or oppositional defiant disorder.
Conduct disorder is a common disorder in ADHD characterized by a lack of respect for other's rights and feelings.
Conduct disorder is a psychiatric condition that includes aggression to people and animals, destruction of property, serious violations of rules, and deceitfulness or theft.
In terms of therapy, researchers studied medication, therapy, behavioral therapy, and a combination of medication and behavioral therapy.
While all three therapies worked for those with ADHD and anxiety, there were significant differences.
A combination of medication and behavioral therapy was significantly more effective than medication or behavioral therapy alone.
Medication alone was more effective than behavioral therapy alone.
A clinical trial found that anxiety affected treatment response to ADHD. While all three treatment types studied were effective, a combination of medication and behavioral therapy worked the best. The p-values below represent the differences between the therapy and the next-ranked therapy.
Of note, there was no evidence that medication for ADHD made the anxiety worse, an effect that some experts are concerned about.
Study Quote
Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for ...
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Conclusions
Based on the results of this study, researchers concluded that it’s important to consider anxiety and conduct when diagnosing and treating ADHD. Having different disorders can affect how well certain treatments can work.
Study Quote
When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.