ADHD and Anxiety: Clinical Significance and Treatment Implications

Abstract

In comparison to the DSM formulation of ADHD, we have proposed that ADHD in adults should be divided into Inattentive and Emotional Dysregulation Presentations. Under both systems, there is potential overlap with generalized anxiety disorder (GAD). We compared data from four distinct populations: ADHD clinical trials, GAD clinical trials, an ADHD clinic, and a forensic clinic. Approximately 25% of patients in each population had comorbid ADHD and anxiety. Comorbid subjects reported more childhood ADHD symptoms and higher scores on ADHD scales and were more likely to fit criteria for ADHD Emotional Dysregulation Presentation or DSM-IV combined type. Comorbid subjects did not drop out at a higher rate and showed significant drug-placebo differences on ADHD symptoms, including Emotional Dysregulation. Conversely, although symptoms of anxiety decreased, there was no drug-placebo difference in improvement.

Attention‐deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients

“…Although there is some indication that ADHD may be associated with increased symptom severity in anxiety outpatients and that anxiety severity is associated with suicidal behavior more generally, in the current study we controlled for psychopathology severity. Given the fact that ADHD may be common (>20%) in patients/adults with anxiety, the results of this study suggest that the role of ADHD/ADHD symptomatology should be a focus for future research in adult outpatients with anxiety disorders and that clinicians should be made aware that ADHD might be associated with an increased risk for negative outcomes in outpatients with anxiety.…”

Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

“…Anxiety Comorbid anxiety disorders occur in about 15% of children and 47% of adults with ADHD, 4,8 and they cause greater ADHD-related impairment. 175 Stimulants may be useful in treating ADHD in children and adults with co-occurring anxiety, 175,176 especially in cases where the ADHD symptoms contribute to anxiety and emotional distress. Although individual responses differ, we find that methylphenidate is less likely than amphetamine to induce anxiety; smooth-release formulations (ie, where both the peak and offset are smooth, such that medication will gradually absorb into the system, rest at peak levels, and gradually decline) also often induce less anxiety.…”

Early motor signs of attention-deficit hyperactivity disorder: a systematic review

“…To be diagnosed with ADHD, symptoms of the disorder must be observed in two or more settings and have negative effects on fundamental aspects of the child's daily activities. Cooccurring psychiatric conditions are frequently observed, including oppositional defiant disorder (ODD), conduct disorder, anxiety disorders, depression, autism spectrum disorder (ASD) and learning disabilities [4][5][6][7][8][9]. Children with ADHD also often face difficulties in everyday life, including in their social relationships, academic performance and achievements, and low self-esteem [10].…”