(PS1-C70) Co-occurring ADHD and Anxiety in Youth: Links with Social Difficulties in a Large, Icelandic Sample

Youth with ADHD commonly experience impairment in social functioning (Pelham et al., 2005). ADHD often co-occurs with anxiety disorders, and the presence of both may lead to greater social impairment (Jarrett & Ollendick, 2008). Prior research on youth with ADHD and anxiety has revealed mixed evidence for greater social impairment (Becker et al., 2014; Greenberg & De Los Reyes, 2022; Hoza et al., 2005; Kraustis et Mikami et al., 2011). To our knowledge, the significant co-occurrence of ADHD and anxiety and its impact on social impairment has been limited to research based in the United States, so additional research is needed to examine ADHD, anxiety, and social impairment across cultures.
 

The current study is a part of a larger data collection, including 2,672 children (aged 6-10 years) referred to the Center for Child Development and Behavior (CCDB) in Iceland. The children, their parent(s), and teachers completed a comprehensive assessment battery. Presence of ADHD and/or anxiety was determined by the CCDB’s staff via clinical interview and multi-informant assessments. Social impairment was assessed with the Autism Spectrum Screening Questionnaire (ASSQ; Ehlers et al., 1999; Prosserud et al., 2008). The ASSQ is comprised of three factors, with Factor 1 (Social Difficulties) featuring items related to social difficulties (e.g., wishes to be sociable but fails to make relationships with peers). For the current study, four groups were defined: ADHD (n = 2,311), Anxiety (n = 855), ADHD + Anxiety (n = 600), and Control (HC; no significant elevations in ADHD/anxiety) (n = 2,177).
 

A series of ANCOVAs were conducted to examine social difficulty differences across groups based on multiple informants, while controlling for autism spectrum disorder. The overall ANCOVAs for father, F(3,556) =8.08, mother, F(3, 2708) = 52.07 and teacher, F(3, 2665) = 19.06 were significant (ps < .05). Correcting for multiple comparisons, fathers reported significantly greater social difficulties for ADHD + Anxiety (M=7.71) and ADHD (M=6.59) groups compared to HC (M= 5.10) but not Anxiety (M=4.74). ADHD + Anxiety did not differ from ADHD (p=.11). Teachers reported significantly greater social difficulties for the ADHD + Anxiety (M=7.52) and ADHD (M=7.58) groups compared to HC (M= 6.15) but not Anxiety (M=5.93). ADHD + Anxiety did not differ from ADHD (p=.84). Mothers reported significantly greater social difficulties for ADHD + Anxiety (M=7.57), ADHD (M=6.83), and Anxiety (M=5.94) relative to HC (M=4.69). ADHD + Anxiety had significantly greater social difficulties than the Anxiety and ADHD groups (ps < .05).
 

Overall, these results provide mixed evidence that co-occurring ADHD and anxiety are associated with greater social difficulties in youth. Teachers did not report significant differences between the ADHD + Anxiety and ADHD groups, but mothers reported greater social difficulties for ADHD + Anxiety relative to ADHD. It may be that mothers are better attuned to the social difficulties in their children relative to teachers and fathers, but additional research is needed to support that assertion. Clinicians working with youth with ADHD and co-occurring anxiety should assess social functioning and consider social difficulties as an important intervention target.