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Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD? CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Anxiety disorders are common comorbidities in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are also at a high risk of bullying behavior. However, little is known about the roles of anxiety symptomatology in the relationship between ADHD and bullying behavior.
Objective
This cross-sectional, clinic-based study aims to investigate the associations between anxiety symptomatology and bullying involvement in youth with ADHD.
Method
One hundred and eighty children and adolescents with ADHD aged 10–18 years participated in the study. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was self-rated, and the participants were interviewed with the Revised Olweus Bully/Victim Questionnaire to categorize bullying involvement. Data were analyzed through percentage, nonparametric statistics, chi-squared statistics, and logistic regression analysis.
Results
Sixty-nine percent of youth with ADHD reported involvement in bullying, of which 33.3%, 8.9%, and 27.2% were classified as victims, bullies, and bully-victims, respectively. The means and 95% confidence intervals of the total SCARED scores showed a significant difference among bullying behavior groups. The highest SCARED scores could be noticed in the victim and bully-victim groups, with the lowest scores observed in the bully group. Youth with ADHD who had comorbid anxiety were 3.51 times more likely to be bullied than those who did not have anxiety.
Conclusions
A differential effect of anxiety symptomatology on bullying behavior in youth with ADHD was evident. These results highlight the utility of including anxiety in the conceptualization of bullying problems in youth with ADHD to plan successful anti-bullying interventions.
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Vermilion J, Pedraza C, Augustine EF, Adams HR, Vierhile A, Lewin AB, Collins AT, McDermott MP, O'Connor T, Kurlan R, van Wijngaarden E, Murphy TK, Mink JW. Anxiety Symptoms Differ in Youth With and Without Tic Disorders. Child Psychiatry Hum Dev 2021; 52:301-310. [PMID: 32519083 DOI: 10.1007/s10578-020-01012-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared anxiety symptoms in youth with and without tic disorders by comparing scores on the Multidimensional Anxiety Scale for Children (MASC) in youth with tic disorders to those in a concurrent community control group and in a group of treatment-seeking anxious youth from the Child/Adolescent Anxiety Multimodal Study (CAMS). Data from 176 youth with tic disorders, 93 control subjects, and 488 CAMS participants were included. Compared to youth with tic disorders, controls had lower total MASC scores (p < 0.0001) and CAMS participants had similar total MASC scores (p = 0.13). Separation Anxiety (p = 0.0003) and Physical Symptom (p < 0.0001) subscale scores were higher in youth with tic disorders than in CAMS participants. We conclude that the anxiety symptom profile differs in youth with and without tic disorders, which may have important implications for targeting treatment of anxiety in youth with tic disorders.
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Affiliation(s)
- Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA. .,Division of Child Neurology, Department of Neurology, Box 631, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | | | - Erika F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Alyssa T Collins
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Roger Kurlan
- Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Bishop C, Mulraney M, Rinehart N, Sciberras E. An examination of the association between anxiety and social functioning in youth with ADHD: A systematic review. Psychiatry Res 2019; 273:402-421. [PMID: 30684786 DOI: 10.1016/j.psychres.2019.01.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/18/2022]
Abstract
Although up to 50% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) meet criteria for an anxiety disorder, it is unclear how comorbid anxiety influences social functioning for this population. Understanding the factors associated with social functioning in ADHD is important given the limited efficacy of existing social skills interventions for this population. This systematic review aimed to determine the association between anxiety and social functioning (social problems, peer status, and social skills/ competence) in children and adolescents with ADHD. A standardised search protocol was used, identifying 4807 articles for screening with 31 included in the final review. Anxiety symptom severity was associated with lower levels of social skills and higher levels of social problems in young people with ADHD. However, few differences emerged when defining anxiety based on diagnostic measures. Although the results varied considerably amongst studies, a number of key variables emerged that influenced the associations between anxiety and social functioning including the type of reporter and sample characteristics such as age, sex, ADHD subtype and other mental health comorbidities. These findings have implications for social functioning interventions in ADHD given the role of anxiety symptoms in predicting poorer social functioning.
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Affiliation(s)
- Caitlin Bishop
- Deakin University Geelong, Deakin Child Study Centre, School of Psychology, Faculty of Health, Victoria, Australia; Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Melissa Mulraney
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nicole Rinehart
- Deakin University Geelong, Deakin Child Study Centre, School of Psychology, Faculty of Health, Victoria, Australia
| | - Emma Sciberras
- Deakin University Geelong, Deakin Child Study Centre, School of Psychology, Faculty of Health, Victoria, Australia; Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Poh W, Payne JM, Gulenc A, Efron D. Chronic tic disorders in children with ADHD. Arch Dis Child 2018; 103:847-852. [PMID: 29317441 DOI: 10.1136/archdischild-2017-314139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine in a community-based cohort: (1) the prevalence of chronic tic disorder (CTD) in children with attention-deficit/hyperactivity disorder (ADHD) compared with non-ADHD controls at ages 7 and 10; and (2) the additional psychiatric and functional burden of CTD in children with ADHD. METHODS Children aged 6-8 years with ADHD (n=179) and controls (n=212) were recruited through 43 Victorian schools using parent and teacher screening surveys (Conners 3 ADHD Index), followed by case confirmation (Diagnostic Interview Schedule for Children-IV (DISC-IV)). CTD was identified using the DISC-IV categories chronic motor tic disorder, chronic vocal tic disorder or Tourette syndrome at baseline and 36-month follow-up. Internalising and externalising disorders, social functioning, academic performance and quality of life were also measured. Tests of proportions and independent t-tests were used to compare the ADHD+CTD group with sex-matched ADHD alone children. RESULTS Compared with controls, children with ADHD were 4.1 (95% CI 1.1 to 14.1) times more likely to have CTD at age 7, and 5.9 (95% CI 1.6 to 17.9) times more likely at age 10. Children with ADHD+CTD experienced higher rates of internalising disorders and peer problems, and poorer quality of life than those with ADHD alone. CONCLUSIONS CTD prevalence is higher in children with ADHD compared with controls, and confers substantial additional psychiatric and functional burden. Clinicians need to consider CTD in both the initial assessment and ongoing management of children with ADHD, and address both the symptoms and the associated impairments.
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Affiliation(s)
- William Poh
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan M Payne
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alisha Gulenc
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daryl Efron
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
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Abstract
OBJECTIVE Children with Tourette syndrome (TS) are at risk for a variety of co-occurring conditions and learning and school problems. The purpose of this study was to determine the impact of TS and co-occurring conditions on school measures. METHODS Parent-reported data from the 2007-2008 and 2011-2012 National Survey of Children's Health were combined (n = 129,353 children aged 6-17 yrs). Parent report of health care provider diagnosis of TS; co-occurring mental, emotional, and behavioral conditions; learning and language conditions; and school measures were assessed. School measures included type of school, individual education plan (IEP), number of school days missed, school problems, doing well in school, doing homework, and repeating a grade. Children with TS were compared with those who never had TS on school measures accounting for co-occurring conditions. RESULTS After adjusting for demographics, compared with children without TS, children currently with TS were more likely to have an IEP, have a parent contacted about school problems, and not complete homework. After further adjusting for co-occurring conditions, only IEP status remained statistically significant. Compared with children with mild TS, children with moderate or severe TS were more likely to have an IEP, repeat a grade, encounter school problems, and not care about doing well in school. CONCLUSION Tourette syndrome severity and co-occurring conditions are associated with school challenges and educational service needs. Awareness among health care providers, teachers and parents of the potential challenges related to both TS and co-occurring conditions would help to best support the child's education.
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Voltas N, Hernández-Martínez C, Arija V, Canals J. The natural course of anxiety symptoms in early adolescence: factors related to persistence. ANXIETY STRESS AND COPING 2017; 30:671-686. [PMID: 28678525 DOI: 10.1080/10615806.2017.1347642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases. DESIGN Prospective cohort study. METHODS Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases. RESULTS Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence. CONCLUSIONS The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.
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Affiliation(s)
- Núria Voltas
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
| | - Carmen Hernández-Martínez
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
| | - Victoria Arija
- b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili.,c Nutrition and Public Health Unit , University Rovira i Virgili , Reus , Spain
| | - Josefa Canals
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
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Decreased Anterior Cingulate Cortex γ-Aminobutyric Acid in Youth With Tourette's Disorder. Pediatr Neurol 2016; 65:64-70. [PMID: 27743746 DOI: 10.1016/j.pediatrneurol.2016.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/15/2016] [Accepted: 08/21/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND γ-Aminobutyric acid has been implicated in the pathophysiology of Tourette's disorder. The present study primarily sought to examine in vivo γ-aminobutyric acid levels in the anterior cingulate cortex in psychotropic medication-free adolescents and young adults. Secondarily, we sought to determine associations between γ-aminobutyric acid in the anterior cingulate cortex and measures of tic severity, tic-related impairment, and anxiety and depression symptoms. METHODS γ-Aminobutyric acid levels were measured using proton magnetic resonance spectroscopy. Analysis of covariance compared γ-aminobutyric acid levels in 15 youth with Tourette's disorder (mean age = 15.0, S.D. = 2.7) and 36 healthy comparison subjects (mean age = 15.9, S.D. = 2.1). Within the Tourette disorder group, we examined correlations between γ-aminobutyric acid levels and tic severity and tic-related impairment, as well as anxiety and depression severity. RESULTS Anterior cingulate cortex γ-aminobutyric acid levels were lower in participants with Tourette's disorder compared with control subjects. Within the Tourette disorder group, γ-aminobutyric acid levels did not correlate with any clinical measures. CONCLUSIONS Our findings support a role for γ-aminobutyric acid in Tourette's disorder. Larger prospective studies will further elucidate this role.
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Johnson R. Towards an Evidence-Based Clinical Forensic Diagnostic Assessment Framework for Juvenile Fire Setting and Bomb Making: DSM-5 Quadrant. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2015. [DOI: 10.1080/15228932.2015.1022479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fourneret P, Desombre H, Broussolle E. [From tic disorders to Tourette syndrome: current data, comorbidities, and therapeutic approach in children]. Arch Pediatr 2014; 21:646-51. [PMID: 24815597 DOI: 10.1016/j.arcped.2014.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/02/2014] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
Abstract
Motor tics are frequently observed in children during development. Usually transient and benign, they can become chronic over time, join various morbid disorders (vocal tics, attention deficit and hyperactivity disorder, and obsessive-compulsive disorders) and move toward genuine Tourette syndrome. In this case, it will be necessary to prevent impacts - mainly in terms of quality of life and emotional and relational problems - using a global therapeutic strategy combining psychoeducational approaches with appropriate medication.
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Affiliation(s)
- P Fourneret
- Service de psychopathologie du développement, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France; Institut des sciences cognitives, CNRS UMR 5304, 67, boulevard Pinel, 69675 Bron cedex, France; Faculté de médecine Lyon-Est, université Claude-Bernard - Lyon 1, 69003 Lyon, France.
| | - H Desombre
- Service de psychopathologie du développement, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - E Broussolle
- Service de neurologie C, centre de compétence Gilles-de-la-Tourette, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 69677 Bron cedex, France; Centre de neurosciences cognitives, CNRS UMR 5229, 69675 Bron cedex, France; Faculté de médecine Lyon-Sud - Charles-Mérieux, université Claude-Bernard - Lyon 1, 69921 Oullins, France
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Masi G, Gagliano A, Siracusano R, Berloffa S, Calarese T, Ilardo G, Pfanner C, Magazù A, Cedro C. Aripiprazole in children with Tourette's disorder and co-morbid attention-deficit/hyperactivity disorder: a 12-week, open-label, preliminary study. J Child Adolesc Psychopharmacol 2012; 22:120-5. [PMID: 22375853 DOI: 10.1089/cap.2011.0081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tourette's disorder (TD) in children and adolescents is frequently co-morbid with attention-deficit/hyperactivity disorder (ADHD). Dopamine-blockers are the first line treatment for TD, whereas dopamine-agonists, such as stimulants, are the gold-standard in the treatment of ADHD. These contrasting effects supported concerns about the risk that stimulants for treating ADHD may trigger or worsen co-morbid tics. Aripiprazole, a partial dopamine agonist, acts as an antagonist at dopamine D2 receptors in hyperdopaminergic conditions and displays agonist properties under hypodopaminergic conditions. The present study describes the use of aripiprazole (10.0 ± 4.8 mg/day) in a consecutive group of 28 patients with a primary diagnosis of TD and co-morbid ADHD, combined subtype. The Yale Global Tic Severity Scale (YGTSS) and the ADHD-Rating Scale (ADHD-RS-IV) were used as primary outcome measures and both significantly improved (p<0.001) after the treatment. Global measures of severity (Clinical Global Impressions-Severity) and of functional impairment (Children's Global Assessment Scale) also significantly improved during the treatment (p<0.001). At the YGTSS there was a reduction of 42.5%, in motor tics, of 47.9% in phonic tics (44.7% for the combined scores), and of 32.3% in tic impairment. Nineteen patients (67.9%) had a reduction of at least 50% of the YGTSS score (motor+phonic tics). The improvement at the ADHD-RS-IV score was 22.5%, 12 patients (42.8%) presented an improvement of 30%, but only 2 (7.1%) an improvement greater than 50%. Using a logistic regression model, a reduction of at least 30% in ADHD-RS-IV score was more likely to occur in the obsessive-compulsive disorder co-morbid group. Aripiprazole was well tolerated and none of the patients discontinued medication because of side effects. In summary, aripiprazole resulted in an effective treatment for TD, but it was only moderately effective on co-occurring ADHD symptomatology. Our preliminary data suggest that aripiprazole may represent a possible therapeutic option, among other possible monotherapies addressing both tics and ADHD.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
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Gadow KD, Nolan EE. Methylphenidate and comorbid anxiety disorder in children with both chronic multiple tic disorder and ADHD. J Atten Disord 2011; 15:246-56. [PMID: 20378921 DOI: 10.1177/1087054709356405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). METHOD Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial with rating scales and laboratory measures. RESULTS The +ANX group obtained more severe parent, teacher, and child ratings of anxiety and more severe parent ratings of depression, tics, oppositional defiant disorder (ODD), and peer aggression than the -ANX group. Treatment with short-term MPH-IR was associated with improvement in ADHD, ODD, and peer aggression in the +ANX group. When controlling for ODD severity, there were no apparent group differences in therapeutic response to MPH-IR in children ±ANX. There was little evidence that MPH-IR contributed to improvement in anxiety or depression symptoms in the +ANX group. There was some indication that children with comorbid anxiety may differentially experience greater increase in systolic blood pressure (0.5 mg/kg of MPH-IR > placebo). CONCLUSION Findings suggest that the co-occurrence of diagnosed CMTD+ADHD+ANX represents a particularly troublesome clinical phenotype, at least in the home setting. Comorbid anxiety disorder was not associated with a less favorable response to MPH-IR in children with ADHD+CMTD, but replication with larger samples is warranted before firm conclusions can be drawn about potential group differences.
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Wood JJ, Gadow KD. Exploring the nature and function of anxiety in youth with autism spectrum disorders. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1468-2850.2010.01220.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Developmental comorbidity in attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2010; 2:267-89. [PMID: 21432612 DOI: 10.1007/s12402-010-0040-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/12/2010] [Indexed: 12/14/2022]
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Guttmann-Steinmetz S, Gadow KD, DeVincent CJ, Crowell J. Anxiety symptoms in boys with autism spectrum disorder, attention-deficit hyperactivity disorder, or chronic multiple tic disorder and community controls. J Autism Dev Disord 2010; 40:1006-16. [PMID: 20143146 DOI: 10.1007/s10803-010-0950-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale. All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.
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