Co-occurring anxiety and disruptive behavior disorders: The roles of anxious symptoms, reactive aggression, and shared risk processes

Abstract

The current review uses a developmental perspective to examine processes that may underlie and partially account for the association between anxiety disorders and disruptive behavior disorders among children and adolescents. We propose that one way to understand development of comorbid anxiety and disruptive behavior disorders is to examine symptoms that are precursors for or part of these syndromes, such as anxious symptoms and reactive aggression. We use a framework that considers these issues first at the syndrome or disorder level (e.g., anxiety disorders, disruptive behavior disorders), then at the symptom level (e.g., anxious symptoms, reactive aggression), and finally at the risk factor level (e.g., factors associated with anxious symptoms and/or reactive aggression). We apply various frameworks that have been put forth for understanding comorbidity of psychological syndromes to the co-occurrence of anxiety and disruptive behavior disorders and to the co-occurrence of reactive aggression and anxious symptoms where possible. We then identify gaps in the literature with regard to anxiety and reactive aggression, as well as anxiety and disruptive behavior disorders more generally. Finally, we provide a conceptual model describing how the relation of anxiety and reactive aggression may develop into clinically identifiable, comorbid anxiety and disruptive behavior disorders.

Comorbidity of Anxiety and Conduct Problems in Children: Implications for Clinical Research and Practice

“…These domains include (1) clinical phenomenology, (2) demographic correlates, (3) psychosocial correlates, (4) family environment factors, (5) family genetic factors, (6) biological factors, (7) response to treatment, and (8) clinical outcomes. These factors and others (e.g., cognitive factors, neuropsychological factors) may be important in understanding the comorbidity between AD and ODD (for a recent review, see Bubier and Drabick 2009). For purposes of this review, we will focus on several inter-related substantive factors, which are as follows: clinical phenomenology, demographic factors, psychosocial factors, family environment, temporal relations, and pathology/treatment outcome.…”

Aggression Among Children with ADHD, Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

“…First, the exacerbation hypothesis suggests that youth high in both ADHD and anxiety may be especially likely to display severe aggression because of the compounding impairment in inhibitory control associated with each diagnosis (e.g., Bubier and Drabick 2009). Youth with cooccurring internalizing and externalizing problems typically display greater behavioral impairment than youth with only one form of pathology (Biederman et al 1991).…”

A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation

“…Though research consistently has shown high associations between ADHD and ODD/CD (e.g., [23,26]), internalizing disorders also commonly co-occur with ADHD (for reviews, see [28, [66][67][68]). It has been estimated that up to one-third of children with ADHD have comorbid anxiety disorders [30,56,69], with median odds-ratio estimates of 3.0 (95 % CI 2.1-4.3) [23].…”

“…The onset of anxiety disorders varies based on disorder, with separation anxiety disorder typically developing by the age of 7.5 years and occurring among younger children, generalized anxiety disorder occurring between ages 10 and 14, social anxiety disorder developing around age 11, and specific phobias developing across childhood and adolescence [2]. Given these different ages of onset, multiple explanations might account for the co-occurrence of ADHD and anxiety disorders: ADHD might predict later developing anxiety disorders (e.g., social anxiety or generalized anxiety disorders), or symptoms or correlates of ADHD may confer risk for anxiety disorders (e.g., inattention, academic or interpersonal difficulties may contribute to anxiety among youth with ADHD) [39,66].…”