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

Abstract

Although attention-deficit/hyperactivity disorder (ADHD) is independently associated with both anxiety and conduct problems, it is unclear how co-occurring ADHD + anxiety are associated with different forms of conduct problems. That is, there is relatively little evidence how ADHD and co-occurring anxiety, relative to ADHD only and anxiety only, are associated with aggression and delinquency. Controlling for age, sex, oppositional defiant disorder diagnostic status and total psychopathology, we compared children with anxiety only, ADHD only, ADHD + anxiety, and a clinic-referred comparison group on measures of conduct problems. Three hundred eighty ethnically diverse boys and girls ages 5 to 17 (M = 11.62) were evaluated using a semistructured diagnostic interview for ADHD and anxiety; aggressive and delinquent behavior were evaluated using the Child Behavior Checklist. Children with anxiety only (n = 119) did not differ from clinic-referred comparisons (i.e., no DSM-IV diagnosis; n = 95) on aggression or delinquency; children with ADHD only (n = 130) were significantly more aggressive and delinquent than children with anxiety only. Children with ADHD + anxiety (n = 36) were significantly less aggressive than children with ADHD only, but they did not differ with respect to delinquency. These preliminary data suggest that ADHD, in the presence of anxiety, may be associated with significantly less aggression but not less delinquency. We discuss these findings from a developmental psychopathology framework and stress the need for further study to support possible implications for intervention and prevention.

Developmental Relations Between ADHD Symptoms and Reactive Versus Proactive Aggression Across Childhood and Adolescence

“…Finally, many of the arguments of the current study also apply to the impulsive behaviours observed in conduct disorder (CD) and oppositional defiant disorder (ODD), both also strongly correlated with ADHD symptoms (e.g. Falk et al, 2015). Therefore, a potentially interesting extension to the current study would be to conduct analogous tests of the developmental relations between the impulsive versus non-impulsive behaviours beyond aggression associated with CD and ODD.…”

Does Anxiety Modify the Risk for, or Severity of, Conduct Problems Among Children With Co-Occurring ADHD: Categorical and Dimensional and Analyses

“…In a large community-based sample of children, Cuffe et al (2015) found that trouble with police, school suspensions, and school expulsion were equally associated with ADHD and ADHD with an ANX/mood disorder. Falk et al (2015; see above) also found that children with ADHD and co-occurring ANX were neither more nor less delinquent that those with ADHD alone. During free play, Pollack et al (2016; see above) found no difference in observed negative verbal/physical behavior among children with ADHD alone or ADHD with ANX.…”

Testing the exacerbation and attenuation hypotheses of the role of anxiety in the relation between ADHD and reactive/proactive aggression: A 10-year longitudinal study

“…Becker et al, 2012;Bloemsma et al, 2013;Falk et al, 2015;Sørensen et al, 2011). For example , Falk et al (2015) found evidence consistent with attenuation. In a sample of 380 youth aged 5 to 17, they found that those with both ADHD and anxiety showed significantly lower levels of aggression than those with ADHD only.…”

“…Among the small number of studies that have reported relevant data, results are mixed with respect to which, if either, is supported (e.g. Becker et al, 2012;Bloemsma et al, 2013;Falk et al, 2015;Sørensen et al, 2011). For example , Falk et al (2015) found evidence consistent with attenuation.…”