Js. March et al., Anxiety as a predictor and outcome variable in the Multimodal Treatment Study of Children with ADHD (MTA), J ABN C PSY, 28(6), 2000, pp. 527-541
Initial moderator analyses in the Multimodal Treatment Study of Children wi
th ADHD (MTA) suggested that child anxiety ascertained by parent report on
the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) different
ially moderated the outcome of treatment. Left unanswered were questions re
garding the nature of DISC Anxiety, the impact of comorbid conduct problems
on the moderating effect of DISC Anxiety, and the clinical significance of
DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of
MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simpl
e phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid op
positional-defiant or conduct disorder whereas one-third did not, yielding
an odds ratio of approximately two for DISC Anxiety, given conduct problems
. In this context, exploratory analyses of baseline data suggest that DISC
Anxiety may reflect parental attributions regarding child negative affectiv
ity and associated behavior problems (unlike fearfulness), particularly in
the area of social interactions, another core component of anxiety that is
more typically associated with phobic symptoms. Analyses using hierarchical
linear modeling (HLM) indicate that the moderating effect of DISC Anxiety
continues to favor the inclusion of psychosocial treatment for anxious ADHD
children irrespective of the presence or absence of comorbid conduct probl
ems. This effect, which is clinically meaningful, is confined primarily to
parent-reported outcomes involving disruptive behavior, internalizing sympt
oms, and inattention: and is generally stronger for combined than unimodal
treatment. Contravening earlier studies, no adverse effect of anxiety on me
dication response for core ADHD or other outcomes in anxious or nonanxious
ADHD children was demonstrated. When treating ADHD, it is important to sear
ch for comorbid anxiety and negative affectivity and to adjust treatment st
rategies accordingly.