Comorbidity of ADHD with Anxiety and Mood Disorders

Prevalence and Comorbidity Patterns

In children with ADHD, approximately 14% have comorbid anxiety disorders and 9% have comorbid depressive disorders, with comorbidity rates increasing with age 1, 2
Comorbidities between ADHD and anxiety/mood disorders significantly increase family and social dysfunction compared to those with ADHD alone 1

Children with both ADHD and anxiety/mood disorders show greater impairment in social functioning and academic achievement 1, 3

The relationship between ADHD and anxiety/depression may be bidirectional, with ADHD symptoms exacerbating anxiety and depression, and vice versa 3, 4

For comorbid ADHD and major depressive disorder, treating depression first may be necessary if it is the primary disorder or has severe symptoms 3, 4
For comorbid anxiety disorders, treating the anxiety disorder until clear symptom reduction is observed before treating ADHD may be more effective than treating ADHD first, although a combined treatment approach may also be appropriate 4

The American Academy of Pediatrics recommends screening for comorbid conditions, including anxiety and mood disorders, in all patients evaluated for ADHD 5, 6
Clinicians should be aware that oppositional behavior in children with ADHD may sometimes be used to manage anxiety in the face of overwhelming demands 1, 7
ADHD should be managed as a chronic condition requiring ongoing monitoring for the emergence of comorbid conditions throughout the lifespan 5