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Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?

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Abstract

Growing evidence suggests that childhood ADHD is associated with larger impairments in working memory relative to inhibition. However, most studies have not considered the role of co-occurring anxiety on these estimates – a potentially significant confound given prior evidence that anxiety may increase working memory difficulties but decrease inhibition difficulties for these children. The current study extends prior work to examine the extent to which co-occurring anxiety may be systematically affecting recent estimates of the magnitude of working memory/inhibitory control deficits in ADHD. The carefully-phenotyped sample included 197 children with ADHD and 142 children without ADHD between the ages of 8 and 13 years (N = 339; Mage = 10.31, SD = 1.39; 144 female participants). Results demonstrated that ADHD diagnosis predicted small impairments in inhibitory control (d = 0.31) and large impairments in working memory (d = 0.99). However, child trait anxiety assessed dimensionally across multiple informants (child, parent, teacher) did not uniquely predict either executive function, nor did it moderate estimates of ADHD-related working memory/inhibition deficits. When evaluating anxiety categorically and controlling for ADHD, anxiety diagnosis predicted slightly better working memory (d = 0.19) but not inhibitory control for clinically evaluated children generally. Findings from the current study indicate that trait anxiety, measured dimensionally or categorically, does not differentially affect estimates of executive dysfunction in pediatric ADHD. Further, results suggest that trait anxiety is generally not associated with executive dysfunction above and beyond the impact of co-occurring ADHD. Future research is needed to further assess the role of anxiety in ADHD behavioral symptomatology, neurocognitive functioning, and mechanisms underlying these relations.

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Notes

  1. As recommended in the K-SADS, oppositional-defiant disorder (ODD) was diagnosed only with evidence of multi-informant/multi-setting symptoms. ODD prevalence in the ADHD group was 34.9% based on meeting parent-reported symptom counts.

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Authors and Affiliations

  1. Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA

    Carolyn L. Marsh, Sherelle L. Harmon, Sooyun Cho, Fatou Gaye, Lauren DeGeorge, Katie E. Black & Michael J. Kofler

  2. Rutgers University, Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA

    Elizabeth S. M. Chan

  3. Johns Hopkins All Children’s Hospital, Center for Behavioral Health, St. Petersburg, FL, USA

    Lauren N. Irwin Harper

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This work was supported by NIH grant R01 MH115048 (PI: Kofler). The sponsor had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Conflict of Interest

The principal investigator (Michael Kofler) holds a patent for neurocognitive interventions that target central executive working memory and inhibitory control. These interventions were not used in the current study. Michael Kofler discloses travel reimbursement from the American Professional Society for ADHD and Related Disorders (APSARD) and consulting payments from Sky Therapeutics and Boys Town National Research Hospital in the past 2 years (no prior disclosures). None of the other investigators have potential conflicts to report.

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Marsh, C.L., Harmon, S.L., Cho, S. et al. Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?. Res Child Adolesc Psychopathol (2023). https://doi.org/10.1007/s10802-023-01152-y

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  • DOI: https://doi.org/10.1007/s10802-023-01152-y

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