Adult ADHD and anxiety: Neuropsychological and STAI responses to methylphenidate treatment

Suzanne Rozgonyi Eaton (2001)

Adult attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous psychiatric disorder which initially manifests in childhood and often persists into adulthood. It is often complicated by a comorbid psychiatric disorder resulting in "complex ADHD." A thorough understanding of the presentation, assessment, and treatment of many varieties of complex ADHD has yet to be established. This study investigates the impact of comorbid anxiety on the neuropsychological performance of adults with ADHD, and evaluates their response to a trial of methylphenidate. Subjects were 35 adults who were diagnosed with ADHD and 15 controls who did not differ in terms of age, sex, handedness, reading recognition score, or years of education. ADHD subjects received a comprehensive neuropsychological evaluation of cognitive, motor, and affective functioning before and after a trial of methylphenidate. The control subjects received the same evaluation at a yoked time interval. The ADHD subjects exhibited a distinct neuropsychological profile. In addition, increased anxiety was correlated with decreased performance in Verbal Memory, Visual Distraction, Processing Speed, and Global neuropsychological functioning. At follow-up evaluation, anxiety accounted for some of the change in neuropsychological performance. Change in state anxiety (A-state) as measured by the Stait-Trait Anxiety Inventory (Spielberger, 1977) was correlated with change in Verbal Memory, Visual Distraction, and Global performance. Following medication, the ADHD group exhibited a significant decrease in A-state, although a small number showed an increase in A-state. These results indicate that treatment with methylphenidate improves the neuropsychological performance of adults with simple ADHD as well as adults with ADHD complicated by comorbid anxiety. Treatment with methylphenidate relieves symptoms of anxiety in many adults with ADHD and comorbid anxiety, most likely as a result of improved attentional deficits. Methylphenidate should therefore remain a primary treatment option for adults with ADHD even in the presence of comorbid anxiety.