Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Abstract

Competing hypotheses for explaining the role of anxiety in the relation between attention-deficit/hyperactivity disorder (ADHD) symptoms and childhood aggression were evaluated. Two studies tested whether anxiety exacerbated, attenuated, or had no effect on the relation between ADHD and aggression subtypes among psychiatrically hospitalized children. In Study 1 (N = 99), children who scored above clinical cut-off levels for anxiety only, ADHD only, and co-occurring ADHD and anxiety were compared on aggression subtypes (i.e., reactive, proactive, overt, and relational aggression). In Study 2, the moderating role of anxiety on the relation between ADHD and aggression subtypes was examined with a larger sample (N = 265) and with continuous variables. No support was found for either the attenuation or exacerbation hypothesis, and results remained consistent when separately examining hyperactivity/impulsivity and inattention symptoms of ADHD. Although ADHD symptoms were significantly associated with all aggression subtypes, this association did not remain when including symptoms of oppositional defiant disorder.

Differential Association of Youth Attention-Deficit/Hyperactivity Disorder and Anxiety With Delinquency and Aggression

“…Although Becker et al (2011) and Humphreys et al (2012) included multiple measures of conduct problems (i.e., overt=relational aggression vs. ODD=CD symptoms), we contend that the multidimensionality of conduct problems may be differentially sensitive to comorbid ADHD þ anxiety, thus contributing to variability in previous studies. In overt or physical aggression, the threat of punishment is often proximal and salient and therefore more easily perceived.…”

“…Similarly, anxiety aggravated behavioral dysregulation in 162 children with ADHD (Sorensen, Plessen, Nicholas, & Lundervold, 2011). Alternatively, anxiety was unrelated to aggression in two independent samples of children with ADHD only, anxiety only, and ADHD þ anxiety (Becker, Luebbe, Stoppelbein, Greening, & Fite, 2011). In a study of 502 boys and girls ages 7-10, children with ADHD only and children with ADHD þ anxiety showed comparable levels of rule-breaking behavior (Abikoff et al, 2002); among 368 children and adolescents, anxiety disorders in the context of ADHD were unrelated to aggression (Connor, Chartier, Preen, & Kaplan, 2010).…”

Impact of mentoring on socio‐emotional and mental health outcomes of youth with learning disabilities and attention‐deficit hyperactivity disorder

“…This impaired self-esteem may in turn become a risk factor for developing additional mental health disorders (Burden, 2008;Elbaum & Vaughn, 2001;Terras et al, 2009). Indeed, youth with LD/ADHD have higher rates of both anxiety (Becker, Luebbe, Stoppelbein, Greening, & Fite, 2012;Mugnaini et al, 2009;Nelson & Harwood, 2011) and depression (Becker et al, 2012;Maag & Reid, 2006) compared to their counterparts without a diagnosis.…”

Reciprocal Developmental Relations Between ADHD and Anxiety in Adolescence: A Within-Person Longitudinal Analysis of Commonly Co-Occurring Symptoms

“…Anxiety also appears to be a particularly common comorbidity in females with ADHD (Levy et al, 2005;Williamson & Johnston, 2015) . When evaluated in terms of symptom levels rather than diagnoses, ADHD-anxiety associations have been reported in the range of r=.12 to .54 depending on the combination of informants and measures, again with stronger associations for females than for males (Baldwin & Dadds, 2008;Becker et al, 2012;Jarrett, 2016).…”