This is one of those chicken-or-egg questions. My younger daughter M just underwent neuropsychological testing. She was diagnosed with executive function disorder. The neuropsychologist is recommending to M's psychiatrist that M start on a stimulant. M's psychiatrist is reluctant to trial a stimulant until M's mood is more stable. By way of background, M has always been an anxious child. She had separation anxiety as an infant and toddler and selective mutism as a preschooler. At age 7, she developed a choking phobia that led to extreme weight loss, hospitalization and feeding via an NG tube for a month. Through medication and intensive behavioral therapy, she recovered and now eats almost normally. M has been on Zyprexa since just before her hospitalization. Prozac was then added to address residual anxiety, but she became giddy and disinhibited. Her medical team wanted M to trial a second SSRI, but we declined given that her siblings had experienced manic reactions to just about every other SSRI out there. She has done better on Remeron, but we're still seeing "emotional reactivity" -- low frustration tolerance that results in meltdowns. This spring M's teachers reported lots of distractibility, slow work production and trouble initiating multi-step projects. That's why we decided to go ahead with neuropsychologist testing at this point. The neuropsychologist is convinced that M's executive function disorder is responsible for her anxiety. He has also reported that she is "dysregulated" (which makes me think M needs a mood stabilizer instead of a stimulant). M's psychiatrist believes her primary diagnosis is anxiety, and executive function disorder is a result of that anxiety. Any insight on how to sort all of this out?