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Research Update: Treatment of ADHD and Anxiety
The co-occurrence of ADHD and anxiety disorder in children is common. It is estimated that from 20 percent to 40 percent of children with ADHD also have anxiety disorder. Some short-term studies have shown that there are more side effects and a less robust response to treatment with psychostimulants when ADHD was accompanied by anxiety than when treating ADHD alone.  However, longer-term studies (including the MTA study) suggest that children with ADHD with and without anxiety show comparable improvements in ADHD symptoms with stimulants with some concomitant improvement in anxiety symptoms as well.

A recent study by Abicoff et al., (2005), published in the Journal of the American Academy of Child and Adolescent Psychiatry, investigated the efficacy of sequential pharmacotherapy for ADHD/anxious children. Children, ages six to seventeen years, with ADHD and anxiety were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to eight weeks of double-blind stimulant plus fluvoxamine (Luvox) or stimulant plus placebo. There were three outcome measures: the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score (SNAP IV), the Pediatric Anxiety Rating Scale total score, and overall Clinical Global Impressions-Improvement scores. Of the thirty-two medication naïve children openly treated with methylphenidate, eighty-one percent improved as to ADHD symptoms. Twenty-five children entered the randomized trial. There was no differences between the children who received stimulant plus fluvoxamine and stimulant plus placebo. The authors concluded that children with ADHD and anxiety have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding fluvoxamine to stimulants for anxiety remains unproven.  Consistent with findings in the MTA study, a small b ut significant minority of children exhibited clinically meaningful reductions in anxiety with stimulant therapy alone. Current consensus recommendations on treatment of ADHD and anxiety suggest stimulant titration followed by SSRI therapy (Pliszka et al, 2000).

Abicoff, H., McGouogh, J., Vitiellow, B., et al. (2005). Sequential pharmacotherapy for children with comorbid attention-deficit/hyperactivity and anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 44 (5) 418-427.

MTA Cooperative Group (1999b). Moderators and mediators of treatment response for chldren with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56: 1088-1096.

Pliszka, R.R., Greehill, L.L., Crismon, ML, et al. (2000). The Texas children’s medication algorithm project: Report of the Texas consensus conference panel on medication treatment of childhood attention-deficit/hyperactivity Ddisorder. Part I. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 903-919.

August's Featured myADHD.com's Tools
Parents of children and adolescents with ADHD can benefit from using this month's treatment tools. These tools focus on family communication and problem solving. As we all know, parents and children can often focus too heavily on negative issues and may blame and threaten rather than listen and understand each family member's point of view. This month's treatment tools can help families improve communication styles and can result in more effective problem solving.