Social Processes Underlying Co-Occurring ADHD and Anxiety Across the Lifespan

ABSTRACT/PROJECT SUMMARY Anxiety is one of the most common and debilitating comorbidities with ADHD, affecting 57% of youth and 84% of adults, with particularly high rates in girls and women. Despite its widespread prevalence, this co-occurrence is often overlooked and poorly understood, contributing to worse mental health outcomes and greater economic costs than either condition alone. Social processes (i.e., social cognitions and relationships) appear to contribute to the emergence of anxiety in youth with ADHD, but extant work has most often relied on mother-reports in community samples, lacking a multi-informant perspective and consideration of how ADHD and anxiety co-occur across development or in clinical populations. These gaps hinder our ability to provide effective, timely interventions, leaving those at highest risk—especially girls and women—without the necessary support. There is also a notable lack of research on girls and women with ADHD and potential sex differences, despite growing identification of ADHD in girls and women, many of whom are identified with anxiety prior to diagnosis of ADHD. Aligned with Goal 2 of the NIH Strategic Plan (Examine Mental Illness Trajectories Across the Lifespan), this project will address these gaps using three existing datasets with large samples of girls and women. Aim 1 will use ongoing clinical cohort data from a specialized lifespan ADHD clinic to identify developmentally relevant social processes in the co-occurrence of ADHD and anxiety in children and adults, utilizing one of the most well- characterized and ecologically valid samples of girls and women with ADHD to date. Aim 2 will use data from two completed studies and one ongoing study to examine electroencephalography (EEG) measures of social processing as markers of ADHD and anxiety, as well as sex differences, in adolescents—a critical period for anxiety onset and heightened social sensitivity, particularly in girls. Findings will provide developmentally and sex-specific insights into altered social processing as a mechanism for co-occurring ADHD and anxiety, along with neural biomarkers during a critical risk period. With mentorship from experts in lifespan ADHD and sex differences (Babinski), EEG methods for assessing anxiety risk (Pérez-Edgar), measurement-based ADHD care in clinical settings (Waschbusch), and translational analytics/bioinformatics in clinical data (Tuan), this project is designed with an integrated training plan to provide the applicant with real-world clinical research experience, focusing on advanced data analytics to how altered social processing contributes to co-occurring ADHD and anxiety across the lifespan, alongside innovative EEG methods to identify neural markers of these processes. The exceptional mentorship team, coupled with the resources and infrastructure at Penn State College of Medicine, offers the optimal environment to support the applicant’s training goals, foster professional development, and promote growth as an independent ADHD researcher focused on identifying developmentally and sex-specific comorbidity risks in ecologically valid populations across development.