Does Anxiety Enhance or Hinder Attentional and Impulse Control in Youth With ADHD? An ERP Analysis

Abstract

The addition of anxiety to ADHD appears to alter early attentional processing, which may be an important aspect of this comorbidity.

Does Child Anxiety Exacerbate or Protect Against Parent–Child Relationship Difficulties in Children with Elevated ADHD Symptoms?

“…For example, the co-occurrence of ADHD for children with anxiety disorders is not associated with more anxiety symptoms relative to children with anxiety only (Jarrett et al, 2016 ; Overgaard et al, 2016 ). In contrast, research on the impact of co-occurring anxiety on ADHD symptom expression suggests that anxiety may serve as both a risk and protective factor (e.g., Bowen et al, 2008 ; Chan et al, 2021a ; Klymkiw et al, 2017 ; Menghini et al, 2018 ; Sørensen et al, 2011 ). For example, some literature indicates that anxiety symptoms exacerbate attention problems (e.g., Bowen et al, 2008 ) and inhibitory control impairments (e.g., Sørensen et al, 2011 ).…”

“…However, other studies have reported that co-occurring anxiety does not significantly affect performance on laboratory-based tests of attention (e.g., Jarrett et al, 2016 ; Maric et al, 2018 ; Newcorn et al, 2001 ) or inhibitory/impulse control (e.g., Jarrett et al, 2016 ; Newcorn et al, 2001 ; Vloet et al, 2010 ). Still other studies suggest that anxiety symptoms may reduce or mitigate these ADHD symptoms, such that co-occurring anxiety has been associated with better performance on laboratory-based tests of inhibitory/impulse control (Maric et al, 2018 ; Menghini et al, 2018 ; Pliszka, 1992 ) and sustained attention (Klymkiw et al, 2017 ; Vloet et al, 2010 ), and increases in teacher-perceived resilience (Chan et al, 2021a ) for children with ADHD. Taken together, the literature suggests that anxiety may influence ADHD-related symptom expression (e.g., Bowen et al, 2008 ; Klymkiw et al, 2017 ; Maric et al, 2018 ; Menghini et al, 2018 ; Pliszka, 1992 ; Sørensen et al, 2011 ; Vloet et al, 2010 ), but the direction of this effect remains unclear.…”

“…Still other studies suggest that anxiety symptoms may reduce or mitigate these ADHD symptoms, such that co-occurring anxiety has been associated with better performance on laboratory-based tests of inhibitory/impulse control (Maric et al, 2018 ; Menghini et al, 2018 ; Pliszka, 1992 ) and sustained attention (Klymkiw et al, 2017 ; Vloet et al, 2010 ), and increases in teacher-perceived resilience (Chan et al, 2021a ) for children with ADHD. Taken together, the literature suggests that anxiety may influence ADHD-related symptom expression (e.g., Bowen et al, 2008 ; Klymkiw et al, 2017 ; Maric et al, 2018 ; Menghini et al, 2018 ; Pliszka, 1992 ; Sørensen et al, 2011 ; Vloet et al, 2010 ), but the direction of this effect remains unclear. The current study examined the extent to which this hypothesized interaction extends to affect the parent–child relationship.…”

Does Co-Occurring Anxiety Modulate ADHD-Related Cognitive and Neurophysiological Impairments?

“…Although atypical profiles have also been documented at the brain level in ADHD in several electroencephalography (EEG) studies (Johnstone, Barry, & Clarke, 2013; Tye, McLoughlin, Kuntsi, & Asherson, 2011), little is known about the mechanisms of the potential protective or interfering roles of anxiety on these impairments. Using event-related potentials (ERPs), one small-scale study examined the similarities and differences on neurophysiological impairments between participants with ADHD only and those with comorbid ADHD and an anxiety disorder (Klymkiw et al, 2020). Youth with both ADHD and an anxiety disorder showed milder impairments in response inhibition (commission errors) and ERP activity of conflict monitoring (N2 following no-go stimuli), as well as in early EEG measures reflecting auditory selective attention (early frontal positivity during a selective auditory attention task), compared with those with ADHD only (Klymkiw et al, 2020).…”

“…Using event-related potentials (ERPs), one small-scale study examined the similarities and differences on neurophysiological impairments between participants with ADHD only and those with comorbid ADHD and an anxiety disorder (Klymkiw et al, 2020). Youth with both ADHD and an anxiety disorder showed milder impairments in response inhibition (commission errors) and ERP activity of conflict monitoring (N2 following no-go stimuli), as well as in early EEG measures reflecting auditory selective attention (early frontal positivity during a selective auditory attention task), compared with those with ADHD only (Klymkiw et al, 2020). Thus, by measuring the brain dysfunctions in ADHD with and without co-occurring anxiety symptoms, the use of EEG measures may shed light on which cognitive and brain processes are linked to the modulating effects of anxiety in ADHD.…”