Assessing the Association Between Anxiety and ADHD Symptoms: A Risk Analysis Among Primary School Students In Jakarta

Abstract

Aims: Anxiety frequently co-occurs with Attention-Deficit/Hyperactivity Disorder (ADHD) and may exacerbate core ADHD symptoms such as inattention, hyperactivity, and impulsivity. This study aimed to evaluate the association and risk of anxiety with ADHD symptoms among primary school students. Study Design: An analytical observational study with a quantitative cross-sectional design to assess the association between anxiety and ADHD symptoms. Place and Duration of Study: This study was conducted at a public elementary school in Jakarta from November 10 to 28, 2025. Methodology: A total of 120 students aged 10–12 years participated in this study, selected using consecutive non-random sampling. Sociodemographic data were collected using a structured questionnaire. ADHD symptoms were assessed using the Indonesian Hyperactive Child Behavior Rating Scale (SPPHAI). Anxiety levels were measured using the Revised Children’s Manifest Anxiety Scale (RCMAS). Odds ratio (OR) was used to determine risk. The association between anxiety and ADHD symptoms was analyzed using the chi-square test, with a P-value <0.05 considered statistically significant. Results: Most participants were female (59.2%), aged 11 years old (51.7%), and in fifth grade (53.3%). Parental characteristics were relatively homogeneous, with most parents being adults and having a secondary level of education. Low-risk ADHD was observed in (74.2%) of participants, while (67.5%) showed typical anxiety levels. A significant association was found between high anxiety and ADHD symptoms (p = 0.028; OR = 2.539; 95% CI = 1.090–5.916). Conclusion: This research found a significant association between anxiety and ADHD symptoms; students with higher anxiety levels were more likely to exhibit ADHD symptoms. These results underscore the need for early detection and mental health education, involving families, schools, and healthcare professionals, to address anxiety's potential impact on ADHD in children, though further validation of these predictors is necessary.