2026 ECNP Congress

PS04-4075

Preliminary findings: The impact of executive dysfunction on anxiety severity in patients with attention-deficit/hyperactivity disorder across gender

Martin Katzman — E. Toumeh, A. Greifenberger, K. Fotinos, A. Jeyakumar, F. Husain, T. Sternat, I. Epstein · START Clinic for Mood and Anxiety Disorders, Research, Toronto, Canada

2026 ECNP Congress

Background

Approximately 34% of people with attention-deficit/hyperactivity disorder (ADHD) have a diagnosed comorbid anxiety disorder [1,2]. With respect to gender, females with ADHD are often misdiagnosed and under-treated, while consistently reporting increased symptoms of anxiety and executive dysfunction compared to males with ADHD [3,4]. There are higher rates of misdiagnosis, resulting in treatment resistance and inadequate treatment outcomes among females with ADHD [5].Aim:This study aims to identify unique gender differences in ADHD symptomatology and diagnostic presentations, with respect to the impact of executive dysfunction on anxiety severity. Overall, by examining the interconnected underlying mechanisms at play, we hope to emphasize the potential role of transdiagnostic factors, such as executive dysfunction, in ADHD and anxiety severity, which may better explain the level of misdiagnosis and delayed onset of treatment within the female ADHD population.

Methods

This retrospective analysis included data from 27 adult psychiatric outpatients diagnosed with ADHD (17 female, 10 male), who have been referred to the S.T.A.R.T. Clinic for Mood and Anxiety Disorders, a tertiary care psychiatric clinic in Toronto, Canada. Participants completed self-report questionnaires, including the Barkley Deficits in Executive Functioning Scale (BDEFS) to determine executive dysfunction and the Generalized Anxiety Disorder 7-Item Scale (GAD-7) to determine the severity of generalized anxiety disorder (GAD), in addition to completing the MINI-International Neuropsychiatric Interview (MINI) to assess for presence of psychiatric disorders, primarily ADHD and GAD.

Results

Results from an independent t-test demonstrated that females (M = 14.61, SD = 4.36) reported significantly higher levels of GAD severity (t(49) = 2.75, p = .008) compared to males (M = 10.05, SD = 7.49). However, levels of executive dysfunction did not significantly differ across gender (t(25) = 1.194, p = 0.244). Furthermore, executive dysfunction significantly predicted 36.5% of the variance in GAD severity scores in females (R2adj = .365, F(1,15) = 10.202, p = .006). Contrasting the effect found in males, wherein executive dysfunction (t(1,8) = 1.485, p = 0.176) was found not to be a significant predictor of GAD severity, with the overall model being insignificance (R2adj = .118, F(1,8) = 2.207, p = 0.176), accounting for 11.8% of the variance.

Conclusions

These findings suggest that executive dysfunction in ADHD manifests differently across gender, wherein executive dysfunction may contribute to increased anxiety severity in female subjects, but not in males. This aligns with the common differential symptoms of inattentive and internalizing behaviours among females with ADHD, as opposed to typical externalizing behaviours more often associated with males. Furthermore, the high prevalence of anxiety symptoms in females may be masking the primary and timely diagnosis of ADHD, leading to increased delays or misdiagnosis and subsequent undertreatment. This highlights the importance of comprehensive screening for ADHD in patients presenting with generalized anxiety. Additionally, these findings emphasize the potential value of augmenting ADHD treatments for female patients presenting with symptoms of GAD who fail to respond to treatment.

References

  1. Schatz, D.B., Rostain, A.L., 2006. ADHD with comorbid anxiety: A review of the current literature. J Atten Disord. 10 (2), 141-149.
  2. Hesson, J., Fowler, K., 2018. Prevalence and correlates of self-reported ADD/ADHD in a large national sample of Canadian adults. J Atten Disord. 22 (2), 191–200.
  3. Biederman, J., Faraone, S.V., Spencer, T., Wilens, T., Mick, E., Lapey, K.A., 1994. Gender differences in a sample of adults with attention deficit hyperactivity disorder. Psychiatry Res. 53 (1), 13-29.
  4. Solberg, B.S., Halmøy, A., Engeland, A., Igland, J., Haavik, J., Klungsøyr, K., 2018. Gender differences in psychiatric comorbidity: A population‐based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatr Scand. 137 (3), 176-186.
  5. Young, S., Adamo, N., Ásgeirsdóttir, B.B., Branney, P., Beckett, M., Colley, W., … Woodhouse, E., 2020. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry 20 (1), 1-27.