Effect of trait anxiety on cognitive test performance in adolescents with and without attention-deficit/hyperactivity disorder.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) and anxiety are frequently comorbid disorders associated with different types of abnormal performance on neuropsychological tests. Although some studies have shown that comorbid anxiety alters ADHD test performance, results inconsistently show both improvements and worsening of different abilities, with failures to replicate across different anxiety disorders. Alternatively, trait anxiety may reflect a more stable influence on ADHD test performance than various diagnosable anxiety disorders.


METHODS
To better understand the possible enhancing or deleterious effects of anxiety on ADHD cognitive impairments, this study examined the effect of individual differences in trait anxiety measured by the Multidimensional Anxiety Scale for Children (MASC) on a battery of computerized, rapid-performance tests measuring attention and impulsivity-related performance in 98 Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Combined-Subtype ADHD adolescents and 123 healthy controls. It was hypothesized that trait anxiety would attenuate response inhibition and attention deficits in ADHD.


RESULTS
ADHD-diagnosed adolescents with higher trait anxiety performed better on indices of sustained attention, reaction time, and motor variability, and had altered overall test-performance strategy, while response inhibition was affected in both ADHD and non-ADHD.


CONCLUSIONS
This study provides the first evidence that pathological levels of anxiety are not needed to see differences in ADHD neuropsychological test performance. Instead, mildly elevated trait anxiety confers a protective influence by reducing the degree of impairment seen in ADHD. These findings suggest that better performing ADHD adolescents might have optimized levels of cortical arousal, and raise new questions about how best to identify the neurobiological substrates responsible for the beneficial effects.
a Olin Neuropsychiatry Research Center, Institute of Living is the Institution , Hartford , CT , USA.|b Department of Psychiatry , Brown Alpert Medical School , Providence , RI , USA.
Barbara M
BM
Ruf
a Olin Neuropsychiatry Research Center, Institute of Living is the Institution , Hartford , CT , USA.|c Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA.
Katie L
KL
Bessette
a Olin Neuropsychiatry Research Center, Institute of Living is the Institution , Hartford , CT , USA.|d Department of Psychiatry , Yale University School of Medicine , Hartford , CT , USA.
Godfrey D
GD
Pearlson
a Olin Neuropsychiatry Research Center, Institute of Living is the Institution , Hartford , CT , USA.|d Department of Psychiatry , Yale University School of Medicine , Hartford , CT , USA.|e The Institute of Living , Hartford , CT , USA.
Michael C
MC
Stevens
D000293:Adolescent; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000502:physiology; D008297:Male; D009483:Neuropsychological Tests; D011930:Reaction Time / Q000502:physiology
Adolescents; Attention; Attention-deficit hyperactivity disorder; Executive function; Humans; Inhibition; Trait anxiety