When Anxiety Complicates ADHD

Children with ADHD and two or more anxiety disorders struggle more

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Children with attention deficit hyperactivity disorder may also have other disorders, such as anxiety. It's important to understand how these disorders together affect children.

A recent study investigated how children functioned and how their quality of life was affected if they had both ADHD and anxiety.

Anxiety disorders can include social phobia, generalized anxiety disorder, separation anxiety, post-traumatic stress disorder, obsessive compulsive disorder and panic disorder.

The results showed that children with ADHD and two or more anxiety disorders had a poorer quality of life, poorer functioning and more peer problems than those with one or no anxiety disorders.

"Discuss your child's anxiety with a psychologist or psychiatrist."

The study, led by Emma Sciberras, DPsych, of the Murdoch Children's Research Institute in Parkville, Australia, looked at the impact of anxiety disorders on children with ADHD.

The authors wrote than an estimated half of all children with ADHD suffered from anxiety. However, Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences, said that most estimates for anxiety disorders are closer to one third of all children with ADHD.

The researchers studied 392 Australian children, aged 5 to 13, who had ADHD and were assessed for anxiety disorders.

The children were also assessed for their quality of life, their behavior, their daily functioning, their school attendance and problems they might have with their peers.

The information was collected from surveys with the children's parents and teachers.

Then the researchers compared the findings for children who had no anxiety disorders, one anxiety disorder or at least two anxiety disorders.

The results were adjusted to account for possible differences due to the severity of the child's ADHD, their medication use, other medical or health problems they might have and their age, sex and race/ethnicity.

Just over a third of the children (39 percent) had at least two anxiety disorders in addition to ADHD, and just over another third (36 percent) had no anxiety disorders.

Those with at least two anxiety disorders had a poorer quality of life and more problems with behavior and daily functioning than the children with no anxiety.

Among the 26 percent of children who had one anxiety disorder, there was no difference in functioning compared to those with no anxiety.

The researchers therefore concluded that it was only children with ADHD and at least two anxiety disorders who fared more poorly than those with only ADHD and one or no anxiety disorders.

"These authors have once again demonstrated that children with ADHD all too often have additional diagnoses that can complicate their progress and best treatment," Dr. Elliott said. "Anxiety is certainly one such common condition, especially in children with the mainly inattentive subtype of ADHD."

Although the authors in this study suggested that anxiety is not studied enough in children with ADHD, Dr. Elliott noted that quite a bit of research has been done in this area.

"When multiple diagnoses are present or even suspected, parents should look for assistance with professionals who specialize in complicated ADHD, because treatments are apt to be more complex and require several different strategies for optimal results," Dr. Elliott said.

The study was published April 21 in the journal Pediatrics. The authors reported no potential conflicts of interest.

The research was funded by the Australian National Health and Medical Research Council, the Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children's Research Institute.

Review Date: 
April 20, 2014
Last Updated:
April 24, 2014