(PS4-11) The Interactive Effects of ADHD Comorbidity on Treatment Outcomes in a Child Partial Hospitalization Program

Abstract Text: Children with ADHD frequently present with co-occurring anxiety and depressive disorders (Biederman et al., 1991). Given that symptoms of ADHD can compromise a child’s ability to engage in treatment processes (Storch et al., 2008), it is critical to understand if they receive the same benefit from treatment as children without the diagnosis. In the outpatient setting, children with co-morbid ADHD and anxiety experience less reduction in anxiety when participating in CBT (Halldorsdottir et al., 2014). However, there is a dearth of research focused on the interactive effects of ADHD comorbidity on treatment outcomes in multidisciplinary higher levels of care. Here, we target this gap in knowledge through the examination of anxiety, depression and irritability outcomes of children with and without ADHD in a child partial hospitalization program (PHP). Participants were 63 youth aged 7-12 enrolled in a PHP who received daily individual therapy, medication management, group therapies and milieu based behavioral interventions. Data was collected via a survey administered to parents at the child’s time of admission and every 2 weeks thereafter. Our analysis focused on the initial and final datapoints for each child, and examined participants’ scores on the SCARED, MFQ, and ARI. Of this sample of youth, 59% had diagnosed ADHD. At admission, those with ADHD had average anxiety ratings around the clinical cut off of 25 (M=25.30, SD=14.81), elevated depression scores but below the clinical cut off of 27 (M=22.44, SD=10.53), and mid-range irritability scores (M = 6.94, SD = 3.56). At final timepoint, anxiety was 23.02, SD=15.53; depression was 17.93, SD=10.94; and irritability was 6.58, SD=3.21. Repeated measures ANOVA revealed that anxiety (F(1, 51)=7.385, p=.009) and depression (F(1, 46)=16.815, p< .001) decreased during treatment and that there were no significant interactions with ADHD diagnosis. However, for irritability, there was a significant interaction of ADHD diagnosis and time (F(1, 45)=5.425, p=.024) such that children with ADHD did not experience improvements whereas those without it did. Children enrolled in this PHP experienced improvements in anxiety and depression scores whether or not they had an ADHD diagnosis. It is likely that engagement in medication management and behavioral interventions mitigated the ADHD symptoms enough to allow for meaningful engagement in individual and group therapies that target anxiety and depression. However, irritability was shown to be less responsive to treatment for children with ADHD. One possibility is that irritability in ADHD reflects a more stable trait whereas irritability associated with depression is more variable (Riglin et al., 2019). Additional possibilities will be discussed.