Comorbidity between ADHD and anxiety disorders across the lifespan

Abstract

Abstract Objectives: Attention deficit/hyperactivity disorder (ADHD) and anxiety disorders are among the most common psychiatric disorders with a 25% comorbidity rate with each other. In this study, we overview the comorbidity between ADHD and anxiety disorders in a longitudinal perspective across the lifespan and we discuss possible therapeutic strategies. Methods: A literature search was performed using PubMed to identify clinical studies assessing comorbidity between ADHD and anxiety disorders from childhood to adulthood. Results: Anxiety disorders may substantially change the presentation, the prognosis, and the treatment of ADHD itself. In childhood, the presence of generalised anxiety disorder, could prevent the typical inhibitory dysfunction present in ADHD, in adolescence may increase the deficit of working memory, and in adulthood may enhance the presence of sleep problems. Individuals with comorbid ADHD and anxiety disorders would benefit from adjunctive psychosocial or adjunctive pharmacotherapy interventions to cognitive behavioural treatment. Conclusions: The management of individuals with comorbid ADHD and anxiety disorders could be challenging for clinicians, and assessing the developmental course is crucial in order to shed light on individualised treatment. Keypoints The comorbidity between ADHD and anxiety disorders changes the clinical presentation, the prognosis and treatment of patients with ADHD across lifespan. ADHD and anxiety disorders shared common neurobiological dysfunctions but have also different neurobiological abnormalities suggesting that they are different diagnoses. These patients are less likely to benefit from cognitive behavioural treatment strategies alone and often need adjunctive pharmacological treatments. Studies that evaluated the response to MPH reported conflicting results. These patients could respond less well and get more unpleasant arousal side-effects, but these findings need to be confirmed. For his unique mechanism of action, low dose aripiprazole treatment in adolescents and adults with this comorbid condition could be an intriguing avenue of exploration.