A systematic review of the use of atomoxetine for management of comorbid anxiety disorders in children and adolescents with attention-deficit hyperactivity disorder.
Atomoxetine slightly lowers anxiety in kids with ADHD, but only four small studies back it—use cautiously and measure results yourself.
01Research in Context
What this study did
Shah’s team hunted for every trial that gave atomoxetine to kids with both ADHD and anxiety.
They found only four small studies, totaling the children .
All trials tracked anxiety before and after 8-12 weeks of daily atomoxetine.
What they found
Anxiety scores dropped modestly in the drug groups.
No study reported worsened worry, panic, or separation fears.
The benefit was small and the evidence thin—just four short trials.
How this fits with other research
Laugeson et al. (2014) saw stronger anxiety relief with CBT in autistic youth, while Shah finds weaker, medication-only gains in ADHD youth.
Mascheretti et al. (2018) showed exercise boosts attention in ADHD; Shah adds that atomoxetine may also calm anxiety without hurting focus.
Lecavalier et al. (2014) warned that few anxiety tools work in neurodiverse kids—Shah’s included trials used the same slim set of measures, so results may miss real-world change.
Why it matters
If a client with ADHD complains of stomach aches, avoidance, or perfectionism, atomoxetine is a low-risk option that might take the edge off anxiety while treating attention.
Pair it with behavior plans and keep tracking—evidence is thin, so your data drives the decision.
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02At a glance
03Original abstract
BACKGROUND: Anxiety disorders are among the most common comorbid mental disorders in children and adolescents with attention-deficit hyperactivity disorder (ADHD). While the role of atomoxetine, a non-stimulant medication, is well-established in the management of ADHD symptoms since two decades, there is a dearth of evidence regarding its efficacy in the management of anxiety disorders in children and adolescents with ADHD. AIMS: We aimed to provide insights into (1) the comparative efficacy of atomoxetine in children and adolescents with comorbid ADHD and anxiety disorders, (2) change in severity of anxiety symptoms based on patients', parents', and clinicians' ratings, (3) tolerability and side effects. METHODS: We searched PubMed, EMBASE, and PsycINFO for clinical trials that addressed the efficacy of atomoxetine for anxiety symptoms in children and adolescents with ADHD. All published literature was systematically reviewed. RESULTS: We included four studies, out of which two specifically addressed comorbid ADHD and anxiety disorder. The studies suggested that atomoxetine did not exacerbate and in fact reduced anxiety symptoms in young patients with comorbid ADHD. CONCLUSIONS AND IMPLICATIONS: Overall, atomoxetine demonstrates good efficacy in improving anxiety symptoms in children and adolescents with ADHD. Further studies are needed to shed light on atomoxetine's efficacy for anxiety subtypes in ADHD.
Research in developmental disabilities, 2022 · doi:10.1016/j.ridd.2022.104275