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Comorbid anxiety and neurocognitive dysfunctions in children with ADHD

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Abstract

Previous research established that children with ADHD and comorbid anxiety have a later age of ADHD onset, show less off-task and hyperactive behavior, and have more school problems than children with ADHD alone. Comorbid anxiety appears to ameliorate behavioral inhibition deficits, worsen working memory problems, and lengthen reaction times in ADHD. This study investigated the effect of comorbid anxiety on a broad range of neurocognitive functions and includes child-, parent- and teacher reports of anxiety. The sample consisted of 509 children in the age range 5–19 years, including 238 children with a diagnosis of ADHD combined subtype and 271 normal control children. Children were tested on a broad battery of neurocognitive tasks that proved highly sensitive to ADHD in previous work. Linear Structural Equation Modeling (SEM) was used to estimate the effect of comorbid anxiety on the neurocognitive functions. Child reported anxiety was associated with slower motor speed and response speed and better behavioral inhibition. Teacher reported anxiety was related to worse time production. Parent reported anxiety was not significantly associated with any of the neurocognitive functions. Compared to parent and teacher reports of anxiety, child reported comorbid anxiety shows foremost the largest associations with the neurocognitive dysfunctions observed in children with ADHD. This stresses the importance of including child self-reported anxiety assessments in clinical and research practice.

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Conflict of interest

Tobias Banaschewski served in an advisory or consultancy role for Bristol Myers-Sqibb, Develco Pharma, Lilly, Medice, Novartis, Shire and Viforpharma. He received conference attendance support and conference support or received speaker’s fee by Lilly, Janssen McNeil, Medice, Novartis and Shire. He is/has been involved in clinical trials conducted by Lilly and Shire. The present work is unrelated to the above grants and relationships. Stephen Faraone received consulting income and research support from Shire and Alcobra and research support from the National Institutes of Health (NIH) in the past year. In previous years, he received consulting fees or was on Advisory Boards or participated in continuing medical education programs sponsored by: Shire, McNeil, Janssen, Novartis, Pfizer and Eli Lilly. Stephen Faraone receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health and Oxford University Press: Schizophrenia: The Facts. Jan Buitelaar has been in the past 3 years a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Bristol-Myer Squibb, Shering Plough, UCB, Shire, Novartis and Servier. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties. Joseph Sergeant has been member of the advisory board of Eli Lilly and Company and Shire. He has been speaker for Janssen-Cilag, Eli Lilly and Company and Shire. He has received educational grants from Novartis, Janssen-Cilag, Shire and Ely Lilly and Company. He has a research contract with Eli Lilly and Company. Jaap Oosterlaan has been member of the advisory board of Shire and has received investigator initiated grants from Shire and Ely Lilly and Company. Renée Arnold served in an advisory board for Shire. She received conference attendance support or speaker’s fee by Janssen Cilag, Medice and Shire. The present work is unrelated to the above grants and relationships. The other authors report no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands

    J. Monique Bloemsma, Joseph A. Sergeant & Jaap Oosterlaan

  2. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany

    Tobias Banaschewski

  3. Academic Medical Centre, de Bascule, Amsterdam, The Netherlands

    J. Monique Bloemsma & Frits Boer

  4. Triversum, Centre for Child and Adolescent Psychiatry, Alkmaar, The Netherlands

    Renée Arnold

  5. Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen V. Faraone

  6. Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands

    Jan K. Buitelaar & Nanda Rommelse

  7. Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands

    Jan K. Buitelaar

  8. Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands

    Nanda Rommelse

  9. Linnaeusparkweg 71, 1098 CS, Amsterdam, The Netherlands

    Frits Boer

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  1. J. Monique Bloemsma
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  2. Frits Boer
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  3. Renée Arnold
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  4. Tobias Banaschewski
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  6. Jan K. Buitelaar
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  7. Joseph A. Sergeant
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  8. Nanda Rommelse
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  9. Jaap Oosterlaan
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Corresponding author

Correspondence to Frits Boer.

Appendix

Appendix

See Tables 2, 3 and 4

Table 2 Correlations between latent variables (theoretical model)
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Table 3 Regression coefficients between latent variables (theoretical model)
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Table 4 Correlations between anxiety and severity of ADHD symptoms
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Bloemsma, J.M., Boer, F., Arnold, R. et al. Comorbid anxiety and neurocognitive dysfunctions in children with ADHD. Eur Child Adolesc Psychiatry 22, 225–234 (2013). https://doi.org/10.1007/s00787-012-0339-9

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  • DOI: https://doi.org/10.1007/s00787-012-0339-9

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