Clinical anxiety does not appear to moderate aggression directly in patients with attention-deficit hyperactivity disorder (ADHD), according to study results published in Psychiatry Research.

Investigators abstracted participant data from the ongoing Zurich Project on the Social Development from Childhood to Adulthood (n=1359). In 2004, the Zurich Project began surveying children entering primary school in Zurich regularly, with the latest data collection occurring in 2017 when participants were 17 years of age. The Zurich cohort is 50% boys and includes participants with parents from Switzerland (38.4%), Italy (8.8%), Serbia-Montenegro (8.7%), Germany (6%), and Portugal (5%). Researchers constructed cross-lagged panel models to observe any correlation between teacher- and self-reported measures of anxiety, ADHD symptoms, reactive aggression, and proactive aggression.

According to teacher reports, ADHD symptoms in children were “highly” stable over the study course, and anxiety and reactive aggression were “moderately” stable. Self-reports, by contrast, showed that each of these measures remained “highly” stable across follow-up timepoints. Cross-lagged panel models built from teacher reports indicated a statistically significant positive effect of anxiety on proactive aggression (β = -0.10), although anxiety did not appear to interact with ADHD symptoms. The panel model generated from youth self-reports instead suggested that anxiety had a negative effect on proactive aggression. No significant cross-lagged effects of ADHD symptoms on proactive aggression were observed in the student-report model. Gender-stratified results were highly similar across measures.

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Study data suggests that although anxiety may be protective against both proactive and reactive aggression, it does not moderate the strength of ADHD symptom-aggression interaction. Researchers did note that self-reported data are liable to underestimate the severity of ADHD symptoms, and therefore, study information must be extrapolated with care. These results do not support existing hypotheses on the role of anxiety as either an exacerbating or protective factor for ADHD-related aggression.


Murray AL, Booth T, Obsuth I, Zirk-Sadowski J, Eisner M, Ribeaud D. Testing the exacerbation and attenuation hypotheses of the role of anxiety in the relation between ADHD and reactive/proactive aggression: a 10-year longitudinal study. Psychiatry Res. 2018;269:585-592.