When ADHD And Anxiety Occur Together - Psych Central

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Psych CentralSubscribeADHDWhen ADHD and Anxiety Occur Together

Medically reviewed by N. Simay Gökbayrak, PhD — Written by Robyn Russell — Updated on July 7, 2021

The connection
Does ADHD worsen anxiety?
Telling them apart
Treatment
COVID-19
Coping strategies
So, now what?

ADHD and anxiety are unique conditions with distinct symptoms. And yet, it’s common for the two to exist at the same time.

It’s not uncommon for people with attention deficit hyperactivity disorder (ADHD) to also have symptoms of anxiety. In fact, nearly half of adults who have ADHD also have an anxiety disorder.

The conditions have some similar symptoms, which might make it difficult to tell them apart. This also might complicate diagnoses and treatment plans.

There’s a strong link between ADHD and anxiety, but with the right management plan, you can create a strategy to cope with one or both of them.

What’s the connection between ADHD and anxiety?

Some of the hallmark symptoms of ADHD — such as trouble focusing and restlessness — can interfere with daily life and prevent you from accomplishing tasks or meeting obligations.

“Having ADHD makes daily life stressful,” says William “Billy” Roberts, a licensed and independent social worker in the state of Ohio. Roberts manages a private practice that focuses exclusively on ADHD.

“Because ADHD is a condition of executive functioning, individuals with ADHD experience chronic forgetfulness and organization [problems].” He explains. “This leaves the mind of someone with ADHD in a constant search: Where did I leave this? Or, when was that appointment?”

From this, pressure can mount and anxiety can develop.

Here are a few other reasons why ADHD and anxiety can occur together:

Medication. ADHD is often treated with medications that can have a stimulating effect, such as Ritalin. This may contribute to or cause symptoms of anxiety. For example, one of the common side effects of Adderall — a medication frequently prescribed to treat ADHD — is anxiety.
Genetics. Research indicates that genes may explain the link between ADHD and anxiety, as well as between ADHD and depression.
Trauma. Approximately 12% to 37% of adults with ADHD will have post-traumatic stress disorder (PTSD) at some point in their lives.

Some other risk factors of ADHD include environmental factors and premature birth. These can also be risk factors for anxiety.

Does my ADHD make my anxiety worse?

Knowing that there’s a strong link between ADHD and anxiety, you may be asking, Does my ADHD make my anxiety worse, or does my anxiety make my ADHD worse?

In a word: Possibly. Difficulty concentrating, fidgeting, feeling overwhelmed — all common features of ADHD — may feel intensified when you’re also experiencing anxiety.

It’s also common for one condition to exacerbate the other.

“ADHD can make matters, such as critical decisions and difficult conversations, even harder,” says Charna Cassell, licensed family and marriage therapist, trauma therapist, and the founder of the Center for Passionate Living in California. “When something feels challenging or overwhelming, it may lead to increased anxiety.”

Cassell also points out that perfectionism is one characteristic of anxiety that’s often overlooked. “So if one’s ADHD is preventing them from meeting their standards,” she says, “they may experience even more anxiety.”

For people with ADHD and anxiety, Robinson notes that the possibility of symptoms of anxiety being more severe is highly likely. He says, “ADHD is also a condition of emotional regulation, as the executive, functioning part of the brain is responsible for emotional regulation.”

This might make the symptoms of anxiety more intense and harder to shake off.

How can you tell your anxiety and ADHD apart?

The symptoms of ADHD and anxiety can often overlap. Some of the symptoms they share include:

difficulty concentrating
trouble completing work and meeting deadlines
restlessness
distraction
insomnia

Given their similarities, it can be tough to differentiate between the two. But it’s important to keep the following in mind:

Anxiety is namely characterized by nervousness, fear, and worry.
ADHD is mainly defined by inattention, impulsivity, and hyperactivity.

You might also be able to tell your ADHD and anxiety apart by thinking back to when your symptoms started.

ADHD generally starts in childhood. While the National Institute of Mental Health points out that ADHD can continue through your teenage years and into adulthood, anxiety usually emerges in adolescence and adulthood.

“An important question to ask when trying to figure out the root of the symptoms is: Is the anxiety causing difficulty focusing, or is the inability to focus causing anxiety?” says Dr. Sasha Hamdani, MD, board-certified psychiatrist and ADHD clinical specialist in Leawood, Kansas.

Consider working with a mental health professional or ADHD specialist to help you “untie” the two.

How to treat ADHD and anxiety

A healthcare or mental health professional, if one is available to you, can help you develop a management plan that will help you cope with both conditions. If in-person services are not an option for you, consider telehealth support over the phone or online.

“The first step is appropriate diagnosis and management,” Dr. Hamdani says. “It’s important to see a trained professional to delineate if this is ADHD, anxiety, or an underlying medical condition mimicking these conditions.”

One thing to take into consideration is which of the two — ADHD or anxiety — affects you more, or has a greater impact on your daily functioning. This may inform your management plan.

A thorough evaluation might also be needed to rule out the possibility, or co-occurrence, of trauma.

“What some diagnose as ADHD actually has a basis in trauma,” Cassell says. “ADHD can include hypervigilance, and tracking the environment and the people in it.”

What’s more, Cassell says, “in a hypervigilant state, there’s going to be more anxiety.”

Medication may be prescribed as part of your treatment plan. However, therapy might be preferable due to the potential for side effects from medications.

One such type of therapy, for example, might be condition-specific psycho-education for both you and your family.

If the co-occurrence of anxiety and ADHD sounds familiar to you, you may be wondering if your anxiety will impact your ADHD treatment.

This may be the case if the medications you’re taking to treat your ADHD symptoms are worsening your symptoms of anxiety.

However, do know that the side effects of medications for ADHD tend to recede over time.

ADHD and anxiety and the COVID-19 pandemic

Research shows that the pandemic led to a surge in anxiety. As far as the COVID-19 pandemic’s affect on ADHD symptoms, one study suggests that while the pandemic didn’t necessarily increase ADHD symptoms, it did slightly increase stress levels in adults with ADHD.

Experts, however, point out that the changes to our day-to-day routines during the pandemic exacerbated symptoms of both conditions.

“The pandemic has heightened both anxiety and ADHD symptoms, as adults and children with both conditions have had to navigate blurred work, school, and home boundaries,” Roberts says.

Dr. Hamdani agrees that the combination of increased demands at home, social isolation, and general uncertainty have been challenging for people with anxiety and ADHD.

“With this increased intensity, people with ADHD have had difficulty delegating, organizing, and processing,” Dr. Hamdani says. “This can push them even further behind and leave them even more overwhelmed.”

But there are different strategies for coping with symptoms of both ADHD and anxiety.

Strategies to cope with ADHD and anxiety

Treatment for ADHD and anxiety typically includes medication, therapy, or a combination of both. But there are also lifestyle changes that can help you manage both conditions.

“People with both ADHD and anxiety can cope by learning to manage both conditions,” Roberts says. “Learning skills to decrease the occurrence of forgetfulness is helpful for people with ADHD.”

Roberts also stresses the importance of learning skills — such as meditation — to help manage anxiety. “Daily meditation can help people better identify their feelings and determine which are based on facts vs exaggerated fears.”

Other self-care strategies you might want to consider include:

yoga
mindfulness practices
deep breathing strategies
nutritional changes
adequate sleep
exercise

So, now what?

ADHD and anxiety are distinct conditions, each with their own set of features. But at the same time, they can go hand in hand.

The good news is that both are highly manageable.

Consider talking with a mental health professional, if available to you, to tell the conditions apart, as well as to create a management plan that works for you and your lifestyle.

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Adamou M, et al. (2020). Psychological effects of the COVID-19 imposed lockdown on adults with attention deficit hyperactivity disorder: cross-sectional survey study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744136/
Any anxiety disorder. (n.d.). https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
Attention deficit hyperactivity disorder. (n.d.). https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd
Attention deficit hyperactivity disorder: The Basics. (n.d.). https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/
Aylett E, et al. (2018). Exercise in the treatment of clinical anxiety in general practice—A systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048763/
Byakodi R. (2021). Personal interview.
Cassell C. (2021). Personal interview.
Czeisler M, et al. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
Data and statistics about ADHD. (n.d.). https://www.cdc.gov/ncbddd/adhd/data.html
Faraone S, et al. (2019). Genetics of attention deficit hyperactivity disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477889/
Geffen J, et al. (2018). Treatment of adult ADHD: a clinical perspective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761907/
Generalized anxiety disorder: When worry gets out of control (n.d.). https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/
Hamdani S. (2021). Personal interview.
Harrington KM, et al. (2012). Attention deficit hyperactivity disorder comorbidity in a sample of veterans with post-traumatic stress disorder.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519447/
Katzman M, et al. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567978/
Roberts B. (2021). Personal interview.

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Medically reviewed by N. Simay Gökbayrak, PhD — Written by Robyn Russell — Updated on July 7, 2021

ADHD: Types, Symptoms, and Treatment Options
Medications Used in the Treatment of Attention-Deficit / Hyperactivity Disorder
What Are Anxiety Disorders?
What Causes Anxiety?
Tips for Living with ADHD

When ADHD And Anxiety Occur Together - Psych Central

What’s the connection between ADHD and anxiety?

Does my ADHD make my anxiety worse?

How can you tell your anxiety and ADHD apart?

How to treat ADHD and anxiety

ADHD and anxiety and the COVID-19 pandemic

Strategies to cope with ADHD and anxiety

So, now what?

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