The effects of childhood inattention and anxiety on executive functioning: inhibition, updating, and shifting.

Although anxiety and attention-deficit/hyperactivity disorder (ADHD) symptoms are highly comorbid, research has generally examined the executive functioning (EF) deficits associated with each of these symptoms independently. The purpose of this study was to examine the unique and interactive effects of anxiety and ADHD symptoms (first respectively, then collectively) on multiple dimensions of EF (i.e., inhibition, updating, and shifting, respectively). A sample of 142 youth from the community (age range 8-17 years; M = 11.87 ± 2.94 years) completed the Delis-Kaplan Executive Function System and dimensional measures of anxiety, inattention, and hyperactivity/impulsivity. It was hypothesized that anxiety would moderate the effect of ADHD symptomatology on EF. Multiple regression models examined anxiety and ADHD symptom domains as predictors of EF. When examining ADHD symptom domains separately, anxiety moderated the relationship between inattention and both updating and shifting; the association between hyperactivity/impulsivity and updating was also moderated by anxiety. Within the full model including both ADHD symptom domains, results indicated that anxiety moderated the relationship between inattention and shifting. Analyses of ADHD symptoms in separate and combined models demonstrated a similar pattern: Increased inattention was associated with worse EF and when anxiety was a significant moderator, and increased ADHD symptoms were associated with worse EF only for those with high levels of anxiety. These results highlight the utility of including anxiety in studies examining the relationship between ADHD and EF. EF is related to multiple aspects of daily functioning (e.g., academic achievement), and EF deficits are often targeted in interventions for ADHD.