title: Anxiety in children with attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  Although anxiety is common in children with attention-deficit/hyperactivity disorder (ADHD), it is unclear how anxiety influences the lives of these children. This study examined the association between anxiety comorbidities and functioning by comparing children with ADHD and no, 1, or ≥2 anxiety comorbidities. Differential associations were examined by current ADHD presentation (subtype).
  
  
  METHODS
  Children with diagnostically confirmed ADHD (N = 392; 5-13 years) were recruited via 21 pediatrician practices across Victoria, Australia. Anxiety was assessed by using the Anxiety Disorders Interview Schedule for Children-IV. Functional measures included parent-reported: quality of life (QoL; Pediatric Quality of Life Inventory 4.0), behavior and peer problems (Strengths and Difficulties Questionnaire), daily functioning (Daily Parent Rating of Evening and Morning Behavior), and school attendance. Teacher-reported behavior and peer problems (Strengths and Difficulties Questionnaire) were also examined. Linear and logistic regression controlled for ADHD severity, medication use, comorbidities, and demographic factors.
  
  
  RESULTS
  Children with ≥2 anxiety comorbidities (n = 143; 39%) had poorer QoL (effect size: -0.8) and more difficulties with behavior (effect size: 0.4) and daily functioning (effect size: 0.3) than children without anxiety (n = 132; 36%). Poorer functioning was not observed for children with 1 anxiety comorbidity (n = 95; 26%). Two or more anxiety comorbidities were associated with poorer functioning for children with both ADHD-Inattentive and ADHD-Combined presentation.
  
  
  CONCLUSIONS
  Children with ADHD demonstrate poorer QoL, daily functioning and behavior when ≥2 anxiety comorbidities are present. Future research should examine whether treating anxiety in children with ADHD improves functional outcomes.
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia; emma.sciberras@mcri.edu.au.
authors.forename: Emma
authors.initials: E
authors.lastname: Sciberras
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia;
authors.forename: Kate
authors.initials: K
authors.lastname: Lycett
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia;
authors.forename: Daryl
authors.initials: D
authors.lastname: Efron
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Mensah
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia;
authors.forename: Bibi
authors.initials: B
authors.lastname: Gerner
authors.affiliation: Community Child Health, Murdoch Childrens Research Institute, Parkville, Australia; The Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia;
authors.forename: Harriet
authors.initials: H
authors.lastname: Hiscock
mesh_terms: D000041:Absenteeism; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001521:Behavior Therapy / Q000379:methods; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006801:Humans; D016487:Parenting / Q000523:psychology; D010379:Peer Group; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012951:Socialization; D014739:Victoria
keywords: anxiety disorders; attention-deficit/hyperactivity disorder; child; comorbidity; impairment; internalizing disorders; quality of life