Peer Functioning and Anxiety Risk in Children With Elevated Attention-Deficit/Hyperactivity Disorder Symptoms

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for developing secondary anxiety symptoms. While interpersonal functioning has been implicated in this comorbidity, the specific peer-related factors contributing to anxiety in youth with ADHD remain unclear. This study examined the roles of social problems, ADHD-related cognitive biases associated with peer difficulties (i.e., negative social information processing [SIP] and rejection sensitivity), and functional impairment in the relation between ADHD and anxiety symptoms. Parents ( N = 120; 95% mothers) of 8- to 12-year-old children with elevated ADHD symptoms (58.3% [ n = 70] with ADHD diagnoses) completed questionnaires, while a subset of their children ( n = 69, M age = 9.70 years, SD = 1.38; 62.3% boys) completed questionnaires and a virtual SIP task. Results indicated that social problems, anger rejection sensitivity, and functional impairment each moderated the relation between ADHD and anxiety symptoms. These findings highlight the potential role of specific peer difficulties in the development of anxiety among children with ADHD and underscore the importance of regular anxiety screening for those experiencing social challenges and functional impairment.