Top

Published in:

01-04-2013 | Original Contribution

Comorbid anxiety and neurocognitive dysfunctions in children with ADHD

Authors: J. Monique Bloemsma, Frits Boer, Renée Arnold, Tobias Banaschewski, Stephen V. Faraone, Jan K. Buitelaar, Joseph A. Sergeant, Nanda Rommelse, Jaap Oosterlaan

Published in: European Child & Adolescent Psychiatry | Issue 4/2013

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.

Available only for authorised users

Cosgrove VE, Rhee SH, Gelhorn HL, Boeldt D, Corley RC, Ehringer MA, Young SE, Hewitt JK (2011) Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. J Abnorm Child Psychol 39:109–123PubMedCrossRef

Pliszka SR, Carlson CL, Swanson JM (1999) ADHD with comorbid disorders: clinical assessment and management. Guilford Press, New York

Pliszka SR (2000) Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 3:525–540

Tannock R (2000) Attention-deficit/hyperactivity disorder with anxiety disorders. In: Brown TE (ed) Attention-deficit disorders and comorbidities in children, adolescents, and adults. American Psychiatric Press, Wasington DC, pp 125–170

Jarret MA, Ollendick TH (2008) A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clin Psychol Rev 28:1266–1280CrossRef

Manassis K (2007) When attention-deficit/hyperactivity disorder co-occurs with anxiety disorders: effects on treatment. Exp Rev Neurother 7:981–988CrossRef

Pliszka SR (1989) Effect of anxiety on cognition, behavior, and stimulant response in ADHD. J Am Acad Child Adolesc Psychiatry 28:882–887PubMedCrossRef

Pliszka SR (1991) Attention deficit hyperactivity disorder: a clinical review. Am Fam Physician 43:1267–1275PubMed

Pliszka SR (1992) Comorbidity of attention-deficit hyperactivity disorder and overanxious disorder. J Am Acad Child Adolesc Psychiatry 31:197–203PubMedCrossRef

10.

Biederman J, Faraone SV, Keenan K (1991) Familial association between attention deficit disorder and anxiety disorder. Am J Psychiatry 148:251–256PubMed

11.

Biederman J, Faraone SV, Chen W (1993) Social adjustment inventory for children and adolescents: concurrent validity in ADHD children. J Am Acad Child Adolesc Psychiatry 32:1059–1106PubMedCrossRef

12.

Buitelaar JK, van der Gaag RJ, Swaab-Barneveld H et al (1995) Prediction of clinical response to methylphenidate in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 34:1025–1032PubMedCrossRef

13.

Blouin B, Maddeaux C, Firestone JS, van Stralen J (2010) Predicting response of ADHD symptoms to methylphenidate treatment based on comorbid anxiety. J Atten Dis 4:414–419CrossRef

14.

Taylor E, Schachar R, Thorley G et al (1987) Which boys respond to stimulant medication? A controlled trial of methylphenidate in boys with disruptive behavior. Psychol Med 17:121–143PubMedCrossRef

15.

Diamond IR, Tannock R, Schachar RJ (1999) Response to methylphenidate in children with ADHD and comorbid anxiety. J Am Acad Child Adolesc Psychiatry 38:402–409PubMedCrossRef

16.

Jensen PS, Hinshaw SP, Kraemer HC et al (2001) ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 40:147–158PubMedCrossRef

17.

Garcia SP, Guimarães J, Zampierie JF, Martinez JF, Polanczyk G, Rohde LA (2009) Response to methylphenidate in children and adolescents with ADHD: does comorbid anxiety disorder matter? J Neural Transm 116:631–636PubMedCrossRef

18.

Swanson JM, Cantwell DP (1986) Computerized assessment of children: cognitive tests, questionnaires and interviews. Paper presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, Los Angeles, California

19.

Logan GD (1994) A users guide to the stop signal paradigm. In: Dagenbach D, Carr TH (eds) Inhibitory processes in attention, memory, and language. Academic Press, San Diego, pp 189–239

20.

Logan GD, Cowan WB (1984) On the ability to inhibit thought and action: a theory of an act of control. Psychol Rev 91:295–327CrossRef

21.

Manassis K, Tannock R, Barbosa J (2000) Dichotic listening and response inhibition in children with comorbid anxiety disorders and ADHD. J Am Acad Child Adolesc Psychiatry 39:1152–1159PubMedCrossRef

22.

Oosterlaan J, Sergeant JA (1998) Behavioral inhibition and response re-engagement in attention-deficit/hyperactivity disorder, disruptive, anxious, and normal children. Behav Brain Res 94:33–43PubMedCrossRef

23.

Tannock R, Ickowicz A, Schachar R (1995) Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 34:886–896PubMedCrossRef

24.

Bedard AC, Tannock R (2008) Anxiety, methylphenidate response, and working memory in children with ADHD. J Atten Dis 11:546–557CrossRef

25.

Vloet TD, Konrad k et al (2010) Impact of anxiety disorders on attentional functions in children with ADHD. J Affect Disord 124:283–290PubMedCrossRef

26.

Rommelse NNJ, Oosterlaan J, Buitelaar J, Faraone SV, Sergeant JA (2007) Time reproduction in children with ADHD and their non-affected siblings. J Am Acad Child Adolesc Psychiatry 46:582–590PubMedCrossRef

27.

Rommelse NNJ, Altink ME, De Sonneville LMJ, Buschgens CJM, Buitelaar J, Oosterlaan J, Sergeant JA (2007) Are motor inhibition and cognitive flexibility dead ends in ADHD? J Abnorm Child Psych 35:957–967CrossRef

28.

Rommelse NNJ, Altink ME, Oosterlaan J, Buschgens CJM, Buitelaar J, De Sonneville LMJ, Sergeant JA (2007) Motor control in children with ADHD and non-affected siblings: deficits most pronounced using left hand. J Child Psychol Psychiatry 48:1071–1079PubMedCrossRef

29.

Rommelse NNJ, Altink ME, Oosterlaan J, Beem L, Buschgens CJM, Buitelaar J, Sergeant JA (2008) Speed, variability, and timing of motor output in ADHD: which measures are useful for endophenotypic research? Behav Genet 38:121–132PubMedCrossRef

30.

Rommelse NNJ, Altink ME, Martin NC, Buschgens CJM, Faraone SV, Buitelaar JK, Sergeant JA, Oosterlaan J (2008) Relation between endophenotype and phenotype in ADHD. Behav Brain Funct 4:4PubMedCrossRef

31.

Oosterlaan J, Sergeant JA (1998) Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the Stop-task. J Child Psychol Psychiatry 39:411–425PubMedCrossRef

32.

Mourik R, Oosterlaan J, Sergeant JA (2005) The Stroop revisited: a meta-analysis of interference control in AD/HD. J Child Psychol Psychiatry 46:150–165PubMedCrossRef

33.

Martinussen R, Hayden J, Hogg-Johnson S, Tannock R (2005) A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44:377–384PubMedCrossRef

34.

van Meel CS, Oosterlaan J, Heslenfeld DJ, Sergeant JA (2005) Motivational effects on motor timing in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44:451–460PubMedCrossRef

35.

Barkley RA, Koplowitz S, Anderson T, McMurray MB (1997) Sense of time in children with ADHD: effects of duration, distraction, and stimulant medication. J Int Neuropsych Soc 3:359–369

36.

Teicher MH, Ito Y, Glod CA, Barber NI (1996) Objective measurement of hyperactivity and attentional problems in ADHD. J Am Acad Child Adolesc Psychiatry 35:334–342PubMedCrossRef

37.

Kalff AC, de Sonneville LMJ, Hurks P, Hendriksen JGM, Kroes M, Feron JM, Steyaert J, van Zeben TMCB, Vles JSH, Jolles J (2005) Speed, speed variability, and accuracy of information processing in 5/6-year-old children at risk of ADHD. J Int Neuropsychol Soc 11:173–183PubMedCrossRef

38.

Pennington BF, Ozonoff S (1996) Executive functions and developmental psychopathology. J Child Psychol Psychiatry 37:51–87PubMedCrossRef

39.

March JS, Swanson JM, Arnold LE et al (2000) Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD. J Abnorm Child Psych 28:527–541CrossRef

40.

Comer JS, Kendall PC (2004) A symptom-level examination of parent-child agreement in the diagnosis of anxious youths. J Am Acad Child Adolesc Psychiatry 43:878–886PubMedCrossRef

41.

American Psychiatric Association (1994) Diagnostic and Statistical Manual for Mental Disorders, 4th edn. American Psychiatric Press, Washington, DC

42.

Brookes K, Xu X, Chen W, Zhou K, Neale B, Lowe N, Anney R, Franke B, Gill M, Ebstein R, Buitelaar J, Sham P, Campbell D, Knight J, Andreou P, Altink M, Arnold R, Boer F, Buschgens C, Butler L, Christiansen H, Feldman L, Fleischman K, Fliers E, Howe-Forbes R, Goldfarb A, Heise A, Gabriels I, Korn-Lubetzki I, Marco R et al (2006) The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 other genes. Mol Psychiatry 11:934–953PubMedCrossRef

43.

Taylor EA (1986) Childhood hyperactivity. Br J Psychiatry 149:562–573PubMedCrossRef

44.

Conners CK, Sitarenious G, Parker JDA, Epstein JN (1998) The Revised Conners’ Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26:257–268PubMedCrossRef

45.

Conners CK, Sitarenious G, Parker JDA, Epstein JN (1998) The Revised Conners’ Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26:279–291PubMedCrossRef

46.

Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586PubMedCrossRef

47.

March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565PubMedCrossRef

48.

March JS, Sullivan K, Parker J (1999) Test–retest reliability of the multidimensional anxiety scale for children. J Anxiety Disord 13:349–358PubMedCrossRef

49.

Nigg JT (2000) On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychol Bull 126:220–246PubMedCrossRef

50.

De Sonneville LMJ (1999) Amsterdam Neuropsychological Task: a computer-aided assessment program. In: Den Brinker BPLM, Beek PJ, Brand AN, Maarse SJ, Mulder LJM (eds) Cognitive ergonomics, clinical assessment and computer-assisted learning. Computers in psychology, vol 6, pp 204–217

51.

Barkley RA (1998).Time perception application, (version 1.0) (Computer software). University of Massachussetts Medical Center, Chesapeake Technology

52.

Wechsler D (2000) WAIS-III Nederlandstalige bewerking Technische handleiding. The Psychological Corporation, London

53.

Tabachnick BG, Fidell LS (2001) Using multivariate analysis. Allyn and Bacon, Boston

54.

Jöreskog KG, Sörbom D (2001) LISREL 8.50: user’s reference guide. Scientific Software International, Chicago

55.

Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55CrossRef

56.

Baddeley A (2003) Working memory: looking back and looking forward. Nat Rev Neurosi 4:829–839CrossRef

57.

Quay HC (1988) The behavioral reward and inhibition system in childhood behavior disorder. In: Bloomingdale LM (ed) Attention deficit disorder, vol 3. Pergamon Press, Oxford

58.

Quay HC (1993) The psychology of undersocialized aggressive conduct disorder: a theoretical perspective. Dev Psychopathol 5:165–180CrossRef

59.

Johnson DA, Roethig-Johnston K, Middleton J (1988) Development and evaluation of an attentional test for head injured children—1. Information processing capacity in a normal sample. J Child Psychol Psychiatry 29:199–208PubMedCrossRef

60.

Achenbach TM, McConaughy SH, Howell CT (1987) Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 101:213–232PubMedCrossRef

61.

Grills AE, Ollendick TH (2002) Issues in parent–child agreement: the case of structured diagnostic interviews. Clin Child Fam Psychol Rev 5:57–83PubMedCrossRef

62.

Weems CF, Feaster DJ, Horigian VE, Robbins MS (2011) Parent and child agreement on anxiety disorder symptoms using the DISC predictive scales. Assessment 18:213–216PubMedCrossRef

Title: Comorbid anxiety and neurocognitive dysfunctions in children with ADHD
Authors: J. Monique Bloemsma
Frits Boer
Renée Arnold
Tobias Banaschewski
Stephen V. Faraone
Jan K. Buitelaar
Joseph A. Sergeant
Nanda Rommelse
Jaap Oosterlaan
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: European Child & Adolescent Psychiatry / Issue 4/2013
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-012-0339-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comorbid anxiety and neurocognitive dysfunctions in children with ADHD

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

Is there a future for restricted elimination diets in ADHD clinical practice?

The relationship between Asperger’s syndrome and schizophrenia in adolescence

The ability of CBCL DSM-oriented scales to predict DSM-IV diagnoses in a referred sample of children and adolescents

Depression with psychotic features in a child with SLE: successful therapy with psychotropic medications—case report

Pervasive refusal syndrome among inpatient asylum-seeking children and adolescents: a follow-up study

Erratum to: Teachers’ assessments of children aged eight predict life satisfaction in adolescence