Behavioural Activation and Inhibition Profiles in Adolescents with Comorbid ADHD and Social Anxiety

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prominent developmental disorder affecting youth today, frequently in combination with social anxiety disorder. This comorbidity has been associated with increased severity and irregular presentation of symptoms compared to individuals with only one disorder. Despite the prominence of the comorbidity, the underlying mechanisms at work remain unclear. One theory which may be relevant to understanding this association posits that two neurological systems, the behavioural inhibition system (BIS) and behavioural activation system (BAS) play a role in anxiety and impulsivity related behaviours, respectively. ADHD and social anxiety each have their own distinct BIS/BAS activation patterns but there is less clarity on how the systems function when both conditions are present. The current study investigated whether social anxiety symptoms would be associated with different patterns of BIS and BAS activation among adolescents...Show moreAttention-deficit/hyperactivity disorder (ADHD) is one of the most prominent developmental disorder affecting youth today, frequently in combination with social anxiety disorder. This comorbidity has been associated with increased severity and irregular presentation of symptoms compared to individuals with only one disorder. Despite the prominence of the comorbidity, the underlying mechanisms at work remain unclear. One theory which may be relevant to understanding this association posits that two neurological systems, the behavioural inhibition system (BIS) and behavioural activation system (BAS) play a role in anxiety and impulsivity related behaviours, respectively. ADHD and social anxiety each have their own distinct BIS/BAS activation patterns but there is less clarity on how the systems function when both conditions are present. The current study investigated whether social anxiety symptoms would be associated with different patterns of BIS and BAS activation among adolescents with ADHD compared to the usual patterns when only ADHD is present. It was also investigated whether these associations would differ for the two subtypes of ADHD; inattentive and hyperactive. A cross-sectional design was used with a sample of 96 adolescents, gathered from a larger study on ADHD. Social anxiety symptoms, ADHD diagnosis, and BIS and BAS activity were measured. Two regression analyses and a moderation analysis were conducted to examine the effects of social anxiety on BIS/BAS levels as well as the effect on individual ADHD subtypes. Results showed that higher levels of social anxiety were significantly associated with increased BIS activation but no significant relationship was found with BAS activation. Social anxiety did not moderate the relationship between BAS levels and ADHD subtype but independent of this, the hyperactive subtype showed higher overall levels of BAS activity compared to the inattentive subtype. Effect sizes were small to moderate and 95% confidence intervals supported the observed effects. These findings suggest that social anxiety symptoms influence behavioural inhibition patterns in adolescents with ADHD and that behavioural activation might be more strongly associated with impulsivity. These results support the relevance of these systems in understanding the ADHD-social anxiety comorbidity and highlight which systems might be more relevant to which behaviours.Show less

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Behavioural Activation and Inhibition Profiles in Adolescents with Comorbid ADHD and Social Anxiety