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Early Development of Comorbidity Between Symptoms of ADHD and Anxiety

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Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that shares a high comorbidity with anxiety disorders. However, the early development of comorbid ADHD and anxiety symptoms is not well-understood. In this study, the bidirectional relation between ADHD and anxiety symptoms was examined by testing two models of the development of ADHD and anxiety comorbidity: an anxiety effects model, which posits that anxiety symptoms contribute to the development of ADHD symptoms, and an ADHD effects model, which posits that ADHD symptoms contribute to the development of anxiety symptoms. Within the ADHD effects model, parenting practices were tested as mediators of this relation. Participants included children who were 3 years old at baseline (n = 258) and their caregivers who reported on their children’s ADHD and anxiety symptoms annually for 3 years. The bidirectional relation of parent-reported anxiety and ADHD symptoms was tested using a series of cross-lagged models. Results indicated that ADHD symptoms predicted later anxiety symptoms, but anxiety symptoms did not predict later ADHD symptoms. Parenting practices did not mediate the relation between ADHD and anxiety symptoms within the ADHD effects model. These findings suggest that ADHD-anxiety comorbidity may develop in part because early symptoms of ADHD contribute to the development of anxiety symptoms; future research should be conducted to elucidate the mechanisms of this relation.

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Data Availability

The data that support the findings of this study are available from the corresponding author, EH, upon reasonable request.


  1. We did not test parenting as a mediator of anxiety effects because theoretical explanations of anxiety effects do not point to parenting as a likely mechanism.

  2. Note that DSM-IV ADHD symptoms are identical to DSM-5 ADHD symptoms, except that additional examples are provided in DSM-5 to aid clinicians in identifying symptoms.

  3. Both the DISC and BASC can be used to measure ADHD and anxiety symptoms. However, although diagnostic interviews are considered a gold standard for assessing ADHD, they do not readily yield a symptom count for anxiety symptoms. Therefore, two different assessment methods were chosen; this methodology has the added advantage of reducing the effects of shared method variance.

  4. There was too little variation in harsh/overreactive parenting during the observational task, so self-report of overreactivity was used. There was not a self-report measure of warmth available at all time points.


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This work was supported by a grant from NIMH to the 5th author (MH60132).

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Correspondence to Elizabeth A. Harvey.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gair, S.L., Brown, H.R., Kang, S. et al. Early Development of Comorbidity Between Symptoms of ADHD and Anxiety. Res Child Adolesc Psychopathol 49, 311–323 (2021).

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