Reciprocal relations between dimensions of attention‐deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample

Abstract

BackgroundSymptoms of anxiety and attention‐deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD—inattention and hyperactivity‐impulsivity—are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown.MethodsTwo birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross‐lagged panel model, adjusting for all unobserved time‐invariant confounding effects.ResultsIn girls, increased inattention, but not hyperactivity‐impulsivity, predicted increased anxiety 2 years later across all time‐points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity‐impulsivity. In boys, increased hyperactivity‐impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity‐impulsivity.ConclusionsThe two ADHD dimensions were differentially related to anxiety, and the relations were sex‐specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity‐impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time‐points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity‐impulsivity may reduce anxiety risk in boys during late childhood (at ages 8–10).