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Comorbidity of ADHD with Anxiety Disorders and Obsessive Compulsive Disorder

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Moodiness in ADHD

Abstract

Anxiety disorders and to a lesser extent obsessive compulsive disorders (OCD) are common in children and adolescents with attention deficit hyperactivity disorders (ADHD), and add significant impairment. While pediatric anxiety disorders and OCD are labeled “internalizing” disorders, they often present with “externalizing” symptoms such as irritability, agitation, or even aggression in young people. Proper diagnosis of these disorders must consider overlapping symptoms shared with ADHD and other disorders, clinical observations, and symptoms reported over time. Genetic, environmental, temperamental, and cognitive correlates are all potential risk factors or moderators of comorbid anxiety or OCD. Evidence-based cognitive behavioral therapy (CBT) is often recommended first for anxiety disorders or OCD, but has not been as well studied when these disorders occur comorbidly with ADHD. Randomized controlled trials have also supported the first-line use of selective serotonin reuptake inhibitors (SSRIs) for anxiety or OCD, or stimulants for ADHD. Yet, there is limited and conflicting evidence about the response of the internalizing disorders or the ADHD when the other disorder is targeted with its first-line pharmacotherapy. Atomoxetine is another viable first-line option when ADHD co-occurs with an anxiety disorder, as it potentially could treat both disorders. Combining psychotherapy and pharmacotherapy may be the best treatment approach for ADHD and comorbid anxiety or OCD, but more clinical trials are needed in these comorbid patients.

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Spaniardi, A.M., Saenger, R.C., Walkup, J.T., Borcherding, B. (2018). Comorbidity of ADHD with Anxiety Disorders and Obsessive Compulsive Disorder. In: Daviss, W. (eds) Moodiness in ADHD. Springer, Cham. https://doi.org/10.1007/978-3-319-64251-2_4

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