Comorbid ADHD: Implications for Cognitive-Behavioral Therapy of Youth with a Specific Phobia

Objective: Although findings have been mixed, accumulating evidence suggests that co-occurring attention-deficit/hyperactivity disorder (ADHD) diagnoses and symptoms negatively predict cognitive-behavioral therapy (CBT) outcomes for anxious youth. The current study extends past research by examining the association of not only ADHD but also other features of ADHD with treatment outcomes of youth who received an intensive CBT for a specific phobia. Method: 135 youth (ages 6-15; 52.2% female; 88.2% white) were randomized to either an individual or parent-augmented intensive CBT targeting a specific phobia. Latent growth curve models were used to explore the association of ADHD symptoms, effortful control, sluggish cognitive tempo, maternal depression and the two treatment conditions (i.e., individual versus parent-augmented) with pre-treatment severity of the specific phobia and the trajectory of change in the severity of the specific phobia from pre-treatment to the 6-month follow up after the intervention. Results: As expected, higher levels of ADHD symptoms were associated with lower levels of effortful control and increased maternal depression at pre-treatment. Contrary to expectations, ADHD symptoms and its associated difficulties were not significantly associated with treatment outcomes. Conclusion: Overall, the findings lend support to the generalizability of intensive CBT for a specific phobia to youth with comorbid ADHD and associated difficulties. Implications and limitations of the study are discussed.