title: Anxiety as a predictor and outcome variable in the multimodal treatment study of children with ADHD (MTA).
abstract: Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.
authors: Department of Psychiatry, DUMC, Durham, NC 27710, USA. jsmarch@acpub.duke.edu
authors: J S
authors: JS
authors: March
authors: J M
authors: JM
authors: Swanson
authors: L E
authors: LE
authors: Arnold
authors: B
authors: B
authors: Hoza
authors: C K
authors: CK
authors: Conners
authors: S P
authors: SP
authors: Hinshaw
authors: L
authors: L
authors: Hechtman
authors: H C
authors: HC
authors: Kraemer
authors: L L
authors: LL
authors: Greenhill
authors: H B
authors: HB
authors: Abikoff
authors: L G
authors: LG
authors: Elliott
authors: P S
authors: PS
authors: Jensen
authors: J H
authors: JH
authors: Newcorn
authors: B
authors: B
authors: Vitiello
authors: J
authors: J
authors: Severe
authors: K C
authors: KC
authors: Wells
authors: W E
authors: WE
authors: Pelham
mesh_terms: D001007:Anxiety / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D019955:Conduct Disorder / Q000523:psychology; D015986:Confounding Factors, Epidemiologic; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009341:Negativism; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012960:Socioenvironmental Therapy; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants