Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis)

Abstract

Social anxiety disorder (SAD) may develop secondary to childhood attention deficit/hyperactivity (ADHD) in a subgroup of the patients with SAD. Patients pass through a number of identifiable stages of developmental pathways to SAD as they grow up. Patients with ADHD have maladaptive behaviours in social settings due to the symptoms of ADHD. These behaviours are criticized by their parents and social circle; they receive insults, humiliation and bullying. After each aversive incident, the individual feels shame and guilt. A vicious cycle emerges. The patients then develop social fears and a cognitive inhibition that occurs in social situations. The inhibition increases gradually as the fear persists and the individual becomes withdrawn. Patients start to monitor themselves and to focus on others' feedback. Finally, performative social situations become extremely stimulating for them and may trigger anxiety/panic attacks. If this hypothesis is proven, treatment of 'patients with SAD secondary to ADHD' should focus on the primary disease.

The relationship of social anxiety disorder symptoms with probable attention deficit hyperactivity disorder in Turkish university students; impact of negative affect and personality traits of neuroticism and extraversion

“…In their latest study Koyuncu et al (2016b) suggested that SAD may develop secondary to childhood ADHD in a subgroup of the patients with SAD. Patients with ADHD may develop maladaptive coping behaviours in social settings due to the symptoms of ADHD.…”

“…The inhibition increases gradually as the social fears persist and the individual becomes withdrawn. Koyuncu et al (2016b) concluded that, according to this hypothesis, ADHD as the primary disease should be the focus of treatment for these subgroup of patients with SAD. Our result is consistent with this hypothesis that, both probable ADHD and symptom severity of ADHD were related with symptom severity of social anxiety in the present study, even after controlling neuroticism and extraversion, suggesting that although high neuroticism and low extraversion are related with social anxiety symptoms, ADHD may be related with social anxiety symptoms apart from these relationships.…”

“…In their third study, Koyuncu et al (2016a) found higher rates of emotional traumatic experiences and impulsivity along with more severe symptoms of depression, anxiety and social anxiety in the group of SAD patients (n=123) with childhood ADHD than in SAD patients without ADHD in childhood. In their latest study, Koyuncu et al (2016b) suggested that SAD may develop secondary to childhood ADHD in a subgroup of the patients with SAD.…”

Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges

“…Attention-deficit/hyperactivity disorder (ADHD), another childhood disorder that extends over adulthood, is an overlooked condition that has high rates of comorbidity with SAD 31. Only recently increasing evidence suggests that the relationship between the two disorders is closer than that was thought before.…”

“…Overlapping symptoms may also increase the risk of misdiagnosis 30. Second, as one disorder can cause the emergence of another or worsen its clinical course, detecting and treating the comorbidity increase the opportunity for early intervention 31. Third, comorbidity may result in worse treatment outcomes.…”