Sequential pharmacotherapy for children with comorbid attention-deficit/ hyperactivity and anxiety disorders

Howard Abikoff, James McGough, Benedetto Vitiello, James McCracken, Mark Davies, John Walkup, Mark Riddle, Melvin Oatis, Laurence Greenhill, Anne Skrobala, John March, Pat Gammon, James Robinson, Robert Lazell, Donald J. McMahon, Louise Ritz

Research output: Contribution to journalArticlepeer-review


Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulant + fluvoxamine (STIM/FLV) or stimulant + placebo (STIM/PL). Primary efficacy measures were the Swanson, Nolan, Atkins, and Pelham IV Parent and Teacher Rating Scale ADHD score and the Pediatric Anxiety Rating Scale total score. ADHD, ANX, and overall Clinical Global Impressions- Improvement scores were also obtained. Results: Of the 32 medication-naïve children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Scale or Clinical Global impressions-improvement- defined responder rate. Medications in both arms were well tolerated. Conclusions: Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.

Original languageEnglish (US)
Pages (from-to)418-427
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number5
StatePublished - May 2005


  • Anxiety
  • Attention-deficit/hyperactivity
  • Combination pharmacotherapy
  • Comorbidity

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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