Treatment of comorbid attention-deficit/hyperactivity disorder and anxiety in children: processes of change.

Approximately 30%-40% of children with attention-deficit/hyperactivity disorder (ADHD) meet criteria for a comorbid anxiety disorder in clinical samples (Tannock, 2009), but little is known about treatment response for this subgroup. The current study evaluated processes of change in a psychosocial treatment designed for children with ADHD and anxiety (Jarrett & Ollendick, 2012). Processes included the slope of symptom change during treatment, the temporal relations between ADHD and anxiety symptoms during treatment, and changes in neurocognitive functioning, parent-child relationships, and family functioning. Treatment involved a combination of parent management training for ADHD and family based cognitive-behavioral therapy for anxiety. Sessions lasted approximately 90 min, and the treatment consisted of 10 weekly sessions. Eight children ages 8-12 with ADHD, combined type (ADHD-C), and at least 1 of 3 anxiety disorders (separation anxiety disorder, generalized anxiety disorder, social phobia) were selected for the study. The study utilized a single-case design with weekly measures of ADHD and anxiety symptoms along with pretreatment, midtreatment, and 1-week posttreatment assessments. Slopes of symptom change and temporal relationships among symptom domains were examined using simulation modeling analysis (Borckardt et al., 2008), while other analyses involved standard comparisons across time points. Results generally supported declining slopes for ADHD and anxiety and greater concurrent change between anxiety and hyperactivity/impulsivity than anxiety and inattention. Few changes were found for neurocognitive functioning, but some changes were found for parent-child relationships and family functioning. Future studies are needed to better understand the treatment of ADHD and comorbid anxiety.