Skip to main content
Log in

ADHD and Anxiety Disorder Comorbidity in Children and Adults: Diagnostic and Therapeutic Challenges

  • Anxiety Disorders (A Pelissolo, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

In this review, we focus on overlapping features of ADHD and anxiety disorders, and will discuss how an anxiety disorder comorbidity leads to diagnostic and treatment challenges in patients with ADHD, in consideration of the accumulated available knowledge.

Recent Findings

The presence of overlapping symptoms, changes in the diagnostic criteria, and the use of divergent diagnostic tools and informant effects can complicate the diagnosis of this comorbidity. Due to the ongoing debate about the etiology, psychopathology, and diagnostic features of the association between ADHD and anxiety disorders, choosing appropriate treatment options emerges as a challenge.

Summary

A novel methodology, standardized interview tools, and new statistical analysis methods are needed to define the phenotype of this co-occurrence more clearly. It is important to uncover the developmental nature of this comorbidity with follow-up studies that may explain the etiology and underlying neurobiological basis, and ultimately lead to more effective treatment approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  2. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942–8. https://doi.org/10.1176/ajp.2007.164.6.942.

    Article  PubMed  Google Scholar 

  3. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56:345–65. https://doi.org/10.1111/jcpp.12381.

    Article  PubMed  Google Scholar 

  4. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurother J Am Soc Exp Neurother. 2012;9:490–9. https://doi.org/10.1007/s13311-012-0135-8.

    Article  Google Scholar 

  5. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994-1001. https://doi.org/10.1542/peds.2014-3482.

    Article  PubMed  Google Scholar 

  6. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–23. https://doi.org/10.1176/ajp.2006.163.4.716.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The descriptive epidemiology of DSM-IV adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord. 2017;9:47–65. https://doi.org/10.1007/s12402-016-0208-3.

    Article  PubMed  Google Scholar 

  8. Lara C, Fayyad J, de Graaf R, Kessler RC, Aguilar-Gaxiola S, Angermeyer M, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry. 2009;65:46–54. https://doi.org/10.1016/j.biopsych.2008.10.005.

    Article  PubMed  Google Scholar 

  9. Kessler RC, Green JG, Adler LA, Barkley RA, Chatterji S, Faraone SV, et al. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Arch Gen Psychiatry. 2010;67:1168–78. https://doi.org/10.1001/archgenpsychiatry.2010.146.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Biederman J, Petty CR, Evans M, Small J, Faraone SV. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res. 2010;177:299–304. https://doi.org/10.1016/j.psychres.2009.12.010.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Biederman J, Petty CR, Clarke A, Lomedico A, Faraone SV. Predictors of persistent ADHD: an 11-year follow-up study. J Psychiatr Res. 2011;45:150–5. https://doi.org/10.1016/j.jpsychires.2010.06.009.

    Article  PubMed  Google Scholar 

  12. •• Pallanti S, Salerno L. The burden of adult ADHD in comorbid psychiatric and neurological disorders. Springer International Publishing; 2020. https://doi.org/10.1007/978-3-030-39051-8. This is a chapter of a book describing the diagnostic and treatment challenges associated with ADHD and anxiety disorder comorbidity.

  13. Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999;56:1088–96. https://doi.org/10.1001/archpsyc.56.12.1088.

  14. Jarrett MA, Ollendick TH. A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clin Psychol Rev. 2008;28:1266–80. https://doi.org/10.1016/j.cpr.2008.05.004.

    Article  PubMed  Google Scholar 

  15. de la Barra FE, Vicente B, Saldivia S, Melipillan R. Epidemiology of ADHD in Chilean children and adolescents. Atten Defic Hyperact Disord. 2013;5:1–8. https://doi.org/10.1007/s12402-012-0090-6.

    Article  PubMed  Google Scholar 

  16. Yüce M, Zoroglu SS, Ceylan MF, Kandemir H, Karabekiroglu K. Psychiatric comorbidity distribution and diversities in children and adolescents with attention deficit/hyperactivity disorder: a study from Turkey. Neuropsychiatr Dis Treat. 2013;9:1791–9. https://doi.org/10.2147/ndt.s54283.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mancini C, Van Ameringen M, Oakman JM, Figueiredo D. Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders. Psychol Med. 1999;29:515–25. https://doi.org/10.1017/s0033291798007697.

    Article  CAS  PubMed  Google Scholar 

  18. Van Ameringen M, Mancini C, Simpson W, Patterson B. Adult attention deficit hyperactivity disorder in an anxiety disorders population. CNS Neurosci Ther. 2011;17:221–6. https://doi.org/10.1111/j.1755-5949.2010.00148.x.

    Article  PubMed  Google Scholar 

  19. Prevatt F, Dehili V, Taylor N, Marshall D. Anxiety in college students with ADHD: relationship to cognitive functioning. J Atten Disord. 2012;19:222–30. https://doi.org/10.1177/1087054712457037.

    Article  PubMed  Google Scholar 

  20. Reimherr FW, Marchant BK, Gift TE, Steans TA. ADHD and anxiety: clinical significance and treatment implications. Curr Psychiatry Rep. 2017;19:109. https://doi.org/10.1007/s11920-017-0859-6.

    Article  PubMed  Google Scholar 

  21. Schatz DB, Rostain AL. ADHD with comorbid anxiety: a review of the current literature. J Atten Disord. 2006;10:141–9. https://doi.org/10.1177/1087054706286698.

    Article  PubMed  Google Scholar 

  22. Milberger S, Biederman J, Faraone SV, Murphy J, Tsuang MT. Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. Am J Psychiatry. 1995;152:1793–9. https://doi.org/10.1176/ajp.152.12.1793.

    Article  CAS  PubMed  Google Scholar 

  23. Weiss M, Gibbins C, Hunter JD. Attention-deficit hyperactivity disorder and anxiety disorders in adults. In: Kan CC, Buitelaar JK, Asherson P, editors. ADHD in adults. Cambridge: Cambridge University Press; 2011. p. 130–7. https://doi.org/10.1017/CBO9780511780752.012.

  24. Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry. 1999;40:57–87.

    Article  CAS  PubMed  Google Scholar 

  25. •• Pliszka SR. ADHD and anxiety: clinical implications. J Atten Disord. 2019;23:203–5. https://doi.org/10.1177/1087054718817365. This is a review that discusses the current literature on ADHD and anxiety disorder comorbidity and contains important information about diagnosis and treatment challenges.

  26. Thapar A, Cooper M, Eyre O, Langley K. What have we learnt about the causes of ADHD? J Child Psychol Psychiatry. 2013;54:3–16. https://doi.org/10.1111/j.1469-7610.2012.02611.x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Michelini G, Eley TC, Gregory AM, McAdams TA. Aetiological overlap between anxiety and attention deficit hyperactivity symptom dimensions in adolescence. J Child Psychol Psychiatry. 2015;56:423–31. https://doi.org/10.1111/jcpp.12318.

    Article  PubMed  Google Scholar 

  28. Perrin S, Last CG. Relationship between ADHD and anxiety in boys: results from a family study. J Am Acad Child Adolesc Psychiatry. 1996;35:988–96. https://doi.org/10.1097/00004583-199608000-00009.

    Article  CAS  PubMed  Google Scholar 

  29. Braaten EB, Beiderman J, Monuteaux MC, Mick E, Calhoun E, Cattan G, et al. Revisiting the association between attention-deficit/hyperactivity disorder and anxiety disorders: a familial risk analysis. Biol Psychiatry. 2003;53:93–9. https://doi.org/10.1016/s0006-3223(02)01434-8.

    Article  PubMed  Google Scholar 

  30. Segenreich D, Paez MS, Regalla MA, Fortes D, Faraone SV, Sergeant J, et al. Multilevel analysis of ADHD, anxiety and depression symptoms aggregation in families. Eur Child Adolesc Psychiatry. 2015;24:525–36. https://doi.org/10.1007/s00787-014-0604-1.

    Article  PubMed  Google Scholar 

  31. Tannock R. Attention deficit disorders with anxiety disorders. In: Brown TE, editor. Attention-deficit disorders and comorbidities in children, adolescents and adults. New York: American Psychiatric Press; 2000. p. 125–75.

    Google Scholar 

  32. Nigg JT, Goldsmith HH, Sachek J. Temperament and attention deficit hyperactivity disorder: the development of a multiple pathway model. J Clin Child Adolesc Psychol. 2004;33:42–53. https://doi.org/10.1207/S15374424JCCP3301_5.

    Article  PubMed  Google Scholar 

  33. • Murray AL, Caye A, McKenzie K, Auyeung B, Murray G, Ribeaud D, et al. Reciprocal developmental relations between ADHD and anxiety in adolescence: a within-person longitudinal analysis of commonly co-occurring symptoms. J Atten Disord. 2020:1087054720908333. https://doi.org/10.1177/1087054720908333. This study examines the reciprocal developmental relationship between ADHD and anxiety disorder comorbidity.

  34. Tai Y-M, Gau C-S, Gau SS-F, Chiu H-W. Prediction of ADHD to anxiety disorders: an 11-year national insurance data analysis in Taiwan. J Atten Disord. 2013;17:660–9. https://doi.org/10.1177/1087054712437581.

  35. • Koyuncu A, Ince E, Ertekin E, Çelebi F, Tükel R. Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder. ADHD Atten Deficit Hyperact Disord. 2019;11:343–51. https://doi.org/10.1007/s12402-018-00283-3. This is a comprehensive review of the relationship between ADHD and anxiety disorder. In addition, social anxiety disorder secondary to ADHD is also discussed considering the current literature.

  36. Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chen L, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. 1996;53:437–46. https://doi.org/10.1001/archpsyc.1996.01830050073012.

    Article  CAS  PubMed  Google Scholar 

  37. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816–8. https://doi.org/10.1176/appi.ajp.157.5.816.

    Article  CAS  PubMed  Google Scholar 

  38. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM, et al. Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med. 2006;36:167–79. https://doi.org/10.1017/S0033291705006410.

    Article  PubMed  Google Scholar 

  39. Biederman J, Petty CR, Monuteaux MC, Fried R, Byrne D, Mirto T, et al. Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. Am J Psychiatry. 2010;167:409–17. https://doi.org/10.1176/appi.ajp.2009.09050736.

    Article  PubMed  Google Scholar 

  40. March JS, Swanson JM, Arnold LE, Hoza B, Conners CK, Hinshaw SP, et al. Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA). J Abnorm Child Psychol. 2000;28:527–41. https://doi.org/10.1023/a:1005179014321.

    Article  CAS  PubMed  Google Scholar 

  41. Jensen PS, Martin D, Cantwell DP. Comorbidity in ADHD: implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry. 1997;36:1065–79. https://doi.org/10.1097/00004583-199708000-00014.

    Article  CAS  PubMed  Google Scholar 

  42. Koyuncu A, Ertekin E, Yüksel Ç, Aslantaş Ertekin B, Çelebi F, Binbay Z, et al. Predominantly inattentive type of ADHD is associated with social anxiety disorder. J Atten Disord. 2015;19:856–64. https://doi.org/10.1177/1087054714533193.

    Article  PubMed  Google Scholar 

  43. • Koyuncu A, Çelebi F, Ertekin E, Kök BE, Tükel R. Clinical effects of ADHD subtypes in patients with social anxiety disorder. J Atten Disord. 2019;23:1464–9. https://doi.org/10.1177/1087054715617533. This is a study examining the clinical significance of childhood ADHD subtypes in patients with social anxiety disorder.

  44. Çelebi F, Ünal D. Self esteem and clinical features in a clinical sample of children with ADHD and social anxiety disorder. Nord J Psychiatry. 2021;75:286–91. https://doi.org/10.1080/08039488.2020.1850857.

    Article  PubMed  Google Scholar 

  45. •• Koyuncu A, Alkın T, Tükel R. Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis). Early Interv Psychiatry. 2018;12:269–72. https://doi.org/10.1111/eip.12372. This is a developmental hypothesis on social anxiety disorder secondary to childhood ADHD. A 3-stage prodrome period has been described from ADHD to the development of social anxiety.

  46. Jarrett MA, Wolff JC, Davis TE III, Cowart MJ, Ollendick TH. Characteristics of children with ADHD and comorbid anxiety. J Atten Disord. 2016;20:636–44. https://doi.org/10.1177/1087054712452914.

    Article  PubMed  Google Scholar 

  47. Pliszka SR. Effect of anxiety on cognition, behavior, and stimulant response in ADHD. J Am Acad Child Adolesc Psychiatry. 1989;28:882–7. https://doi.org/10.1097/00004583-198911000-00012.

    Article  CAS  PubMed  Google Scholar 

  48. Pliszka SR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J Clin Psychiatry. 1998;59(Suppl 7):50–8.

    PubMed  Google Scholar 

  49. Tannock R, Ickowicz A, Schachar R. Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry. 1995;34:886–96. https://doi.org/10.1097/00004583-199507000-00012.

    Article  CAS  PubMed  Google Scholar 

  50. Sumner C, Sher L, Sutton V, Bakken R, Paczkowski M, Trzepacz P, et al. Atomoxetin treatment for pediatric patients with ADHD and comorbid anxiety. Neuropediatrics. 2006;37:TP74.

  51. Geller D, Donnelly C, Lopez F, Rubin R, Newcorn J, Sutton V, et al. Atomoxetine treatment for pediatric patients with attention-deficit/hyperactivity disorder with comorbid anxiety disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:1119–27. https://doi.org/10.1097/chi.0b013e3180ca8385.

    Article  PubMed  Google Scholar 

  52. Adler LA, Liebowitz M, Kronenberger W, Qiao M, Rubin R, Hollandbeck M, et al. Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. Depress Anxiety. 2009;26:212–21. https://doi.org/10.1002/da.20549.

    Article  CAS  PubMed  Google Scholar 

  53. Golubchik P, Sever J, Weizman A. Methylphenidate treatment in children with attention deficit hyperactivity disorder and comorbid social phobia. Int Clin Psychopharmacol. 2014. https://doi.org/10.1097/YIC.0000000000000029.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Koyuncu A, Çelebi F, Ertekin E, Kahn DA. Extended-release methylphenidate treatment and outcomes in comorbid social anxiety disorder and attention-deficit/hyperactivity disorder: 2 case reports. J Psychiatr Pract. 2015;21:225–31. https://doi.org/10.1097/PRA.0000000000000070.

    Article  PubMed  Google Scholar 

  55. Koyuncu A, Çelebi F, Ertekin E, Kök BE, Tükel R. Extended-release methylphenidate monotherapy in patients with comorbid social anxiety disorder and adult attention-deficit/hyperactivity disorder: retrospective case series. Ther Adv Psychopharmacol. 2017;7:241–7. https://doi.org/10.1177/2045125317714193.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Hutchison SL, Ghuman JK, Ghuman HS, Karpov I, Schuster JM. Efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in patients with common comorbidities in children, adolescents and adults: a review. Ther Adv Psychopharmacol. 2016;6:317–34. https://doi.org/10.1177/2045125316647686.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Snircova E, Marcincakova-Husarova V, Hrtanek I, Kulhan T, Ondrejka I, Nosalova G. Anxiety reduction on atomoxetine and methylphenidate medication in children with ADHD. Pediatr Int. 2016;58:476–81. https://doi.org/10.1111/ped.12847.

    Article  CAS  PubMed  Google Scholar 

  58. Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics. 2009;124:71–8. https://doi.org/10.1542/peds.2008-3347.

    Article  PubMed  Google Scholar 

  59. Roth RM, Wishart HA, Flashman LA, Riordan HJ, Huey L, Saykin AJ. Contribution of organizational strategy to verbal learning and memory in adults with attention-deficit/hyperactivity disorder. Neuropsychology. 2004;18:78–84. https://doi.org/10.1037/0894-4105.18.1.78.

    Article  PubMed  Google Scholar 

  60. Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9(525–40):vii.

    Google Scholar 

  61. Manassis K, Tannock R, Young A, Francis-John S. Cognition in anxious children with attention deficit hyperactivity disorder: a comparison with clinical and normal children. Behav Brain Funct. 2007;3:4. https://doi.org/10.1186/1744-9081-3-4.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Pliszka SR. Comorbidity of attention-deficit hyperactivity disorder and overanxious disorder. J Am Acad Child Adolesc Psychiatry. 1992;31:197–203. https://doi.org/10.1097/00004583-199203000-00003.

    Article  CAS  PubMed  Google Scholar 

  63. Kooij JJS, Huss M, Asherson P, Akehurst R, Beusterien K, French A, et al. Distinguishing comorbidity and successful management of adult ADHD. J Atten Disord. 2012;16:3S-19S. https://doi.org/10.1177/1087054711435361.

    Article  PubMed  Google Scholar 

  64. Krone B, Newcorn JH. Comorbidity of ADHD and anxiety disorders: diagnosis and treatment across the lifespan. In: Adler LA, Spencer TJ, Wilens TE, editors. Attention-deficit hyperactivity disorder in adults and children. Cambridge: Cambridge University Press; 2015. p. 98–110. https://doi.org/10.1017/CBO9781139035491.010.

  65. • Grogan K, Gormley CI, Rooney B, Whelan R, Kiiski H, Naughton M, et al. Differential diagnosis and comorbidity of ADHD and anxiety in adults. Br J Clin Psychol. 2018;57:99–115. https://doi.org/10.1111/bjc.12156. This is a study examining the relationship between adult ADHD and anxiety comorbidity.

  66. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  67. Lilienfeld SO. Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions. J Abnorm Child Psychol. 2003;31:285–91. https://doi.org/10.1023/a:1023229529866.

    Article  PubMed  Google Scholar 

  68. Youngstrom EA, Findling RL, Calabrese JR. Who are the comorbid adolescents? Agreement between psychiatric diagnosis, youth, parent, and teacher report. J Abnorm Child Psychol. 2003;31:231–45. https://doi.org/10.1023/a:1023244512119.

    Article  PubMed  Google Scholar 

  69. Epstein JN, Willoughby M, Valencia EY, Tonev ST, Abikoff HB, Arnold LE, et al. The role of children’s ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior. J Consult Clin Psychol. 2005;73:424–34. https://doi.org/10.1037/0022-006X.73.3.424.

    Article  PubMed  Google Scholar 

  70. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36:159–65. https://doi.org/10.1017/S003329170500471X.

    Article  PubMed  Google Scholar 

  71. DuPaul GJ, Barkley RA, McMurray MB. Response of children with ADHD to methylphenidate: interaction with internalizing symptoms. J Am Acad Child Adolesc Psychiatry. 1994;33:894–903. https://doi.org/10.1097/00004583-199407000-00016.

    Article  CAS  PubMed  Google Scholar 

  72. Buitelaar JK, Van der Gaag RJ, Swaab-Barneveld H, Kuiper M. Prediction of clinical response to methylphenidate in children with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1995;34:1025–32. https://doi.org/10.1097/00004583-199508000-00012.

    Article  CAS  PubMed  Google Scholar 

  73. Ter-Stepanian M, Grizenko N, Zappitelli M, Joober R. Clinical response to methylphenidate in children diagnosed with attention-deficit hyperactivity disorder and comorbid psychiatric disorders. Can J Psychiatry. 2010;55:305–12. https://doi.org/10.1177/070674371005500506.

    Article  PubMed  Google Scholar 

  74. Diamond IR, Tannock R, Schachar RJ. Response to methylphenidate in children with ADHD and comorbid anxiety. J Am Acad Child Adolesc Psychiatry. 1999;38:402–9. https://doi.org/10.1097/00004583-199904000-00012.

    Article  CAS  PubMed  Google Scholar 

  75. Garcia SP, Guimarães J, Zampieri JF, Martinez AL, Polanczyk G, Rohde LA. Response to methylphenidate in children and adolescents with ADHD: does comorbid anxiety disorders matters? J Neural Transm. 2009;116:631–6. https://doi.org/10.1007/s00702-009-0211-3.

    Article  CAS  PubMed  Google Scholar 

  76. Blouin B, Maddeaux C, Stanley Firestone J, van Stralen J. Predicting response of ADHD symptoms to methylphenidate treatment based on comorbid anxiety. J Atten Disord. 2010;13:414–9. https://doi.org/10.1177/1087054708326269.

    Article  PubMed  Google Scholar 

  77. Coughlin CG, Cohen SC, Mulqueen JM, Ferracioli-Oda E, Stuckelman ZD, Bloch MH. Meta-analysis: reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2015;25:611–7. https://doi.org/10.1089/cap.2015.0075.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities. Neuropsychiatr Dis Treat. 2017;13:357–71. https://doi.org/10.2147/NDT.S115707.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Bloch Y, Aviram S, Segev A, Nitzan U, Levkovitz Y, Braw Y, et al. Methylphenidate reduces state anxiety during a continuous performance test that distinguishes adult ADHD patients from controls. J Atten Disord. 2017;21:46–51. https://doi.org/10.1177/1087054712474949.

    Article  PubMed  Google Scholar 

  80. Young JL, Sarkis E, Qiao M, Wietecha L. Once-daily treatment with atomoxetine in adults with attention-deficit/hyperactivity disorder: a 24-week, randomized, double-blind, placebo-controlled trial. Clin Neuropharmacol. 2011;34:51–60. https://doi.org/10.1097/WNF.0b013e31820c00eb.

    Article  CAS  PubMed  Google Scholar 

  81. Durell TM, Adler LA, Williams DW, Deldar A, McGough JJ, Glaser PE, et al. Atomoxetine treatment of attention-deficit/hyperactivity disorder in young adults with assessment of functional outcomes: a randomized, double-blind, placebo-controlled clinical trial. J Clin Psychopharmacol. 2013;33:45–54. https://doi.org/10.1097/JCP.0b013e31827d8a23.

    Article  CAS  PubMed  Google Scholar 

  82. Abikoff H, McGough J, Vitiello B, McCracken J, Davies M, Walkup J, et al. Sequential pharmacotherapy for children with comorbid attention-deficit/hyperactivity and anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2005;44:418–27. https://doi.org/10.1097/01.chi.0000155320.52322.37.

  83. Kratochvil CJ, Newcorn JH, Arnold LE, Duesenberg D, Emslie GJ, Quintana H, et al. Atomoxetine alone or combined with fluoxetine for treating ADHD with comorbid depressive or anxiety symptoms. J Am Acad Child Adolesc Psychiatry. 2005;44:915–24. https://doi.org/10.1097/01.chi.0000169012.81536.38.

    Article  PubMed  Google Scholar 

  84. Gabriel A. The mixed amphetamine salt extended release (Adderall XR, Max-XR) as an adjunctive to SSRIS or SNRIS in the treatment of adult ADHD patients with comorbid partially responsive generalized anxiety: an open-label study. Atten Defic Hyperact Disord. 2010;2:87–92. https://doi.org/10.1007/s12402-010-0025-z.

    Article  PubMed  Google Scholar 

  85. Wilens TE, Spencer TJ, Biederman J, Girard K, Doyle R, Prince J, et al. A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. Am J Psychiatry. 2001;158:282–8. https://doi.org/10.1176/appi.ajp.158.2.282.

    Article  CAS  PubMed  Google Scholar 

  86. •• Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001. This is an important reference on diagnosis and treatment of adult patients with ADHD with anxiety.

  87. Houghton S, Alsalmi N, Tan C, Taylor M, Durkin K. Treating comorbid anxiety in adolescents with ADHD using a cognitive behavior therapy program approach. J Atten Disord. 2017;21:1094–104. https://doi.org/10.1177/1087054712473182.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmet Koyuncu.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Anxiety Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koyuncu, A., Ayan, T., Ince Guliyev, E. et al. ADHD and Anxiety Disorder Comorbidity in Children and Adults: Diagnostic and Therapeutic Challenges. Curr Psychiatry Rep 24, 129–140 (2022). https://doi.org/10.1007/s11920-022-01324-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-022-01324-5

Keywords

Navigation