Untangling the Relationship Between Anxiety and ADHD

Navigating the complexities of mental health can often feel like walking through a dense fog—especially when it comes to understanding ADHD and anxiety. While these two conditions can share overlapping symptoms, there are differences in their presentation, the underlying causes of the symptoms, and the effective treatments. We’re going to explore the key differences between ADHD and anxiety and, hopefully, help you distinguish when to view a symptom as anxiety versus when an underlying ADHD symptom is causing anxiety.

How common is it to see both ADHD and anxiety as a co-diagnosis?

In childhood, we see a diagnosis of anxiety in about 25-50% of children with ADHD. This number increases to 45-50% as we move into adulthood. 

These numbers make sense to us. Individuals with ADHD often have valid reasons to feel anxious. Frequently, people with ADHD can struggle with not engaging in tasks, places, and relationships as they would want to, which can lead to losing confidence in their ability to feel efficient, punctual, and competent. You know you’ve put forth your best effort; nevertheless, things don’t always unfold as expected. 

Patients sometimes describe that at any given moment, they feel like there is a ticking time bomb about to detonate, with an ADHD symptom ready to “explode” in their lives. 

When are anxiety and ADHD related?

For patients with ADHD, anxiety can be because of ADHD rather than its own diagnosis. When we speak to patients with ADHD, they can usually differentiate between “non-logical” worries and “logical” worries. You may be feeling anxious, but it is somewhat likely that the thing you are worried about has happened before or is likely to happen? If yes, then those anxious thoughts are more likely being driven by the ADHD symptom itself (e.g., time blindness, inattention).

When is anxiety, actually anxiety?

In contrast, the diagnosis of Generalized Anxiety Disorder, by definition, involves thoughts or worries that are not explainable. People with an anxiety disorder have excessive unwarranted worries for which there is very little justification. Symptoms of anxiety often include physical sensations of panic (nausea/vomiting, shortness of breath or an increased heart rate) and they are about things we have no control over (what if there is an earthquake? What if my partner is 5 minutes late from work because they’ve been in a catastrophic car accident). 

Can I have both ADHD and anxiety?

You can also have more than one diagnosis, and you can have both ADHD and Generalized Anxiety Disorder. It can be very revealing to recognize when your symptoms are more anxiety-related or ADHD related as the approach to managing those thoughts is really different, as are the medications. With ADHD, our executive function is impacted, and you know what makes that worse? Being anxious. So, there is also a role here for these diagnoses to impact each other. 

Many of our patients have an “aha” moment when we describe these different kinds of anxious thoughts. They will tell us that they’ve never felt like they were “anxious,” but when they describe their thoughts to someone else (who does not have ADHD), they are interpreted as anxious thoughts. 

Here is the good news: When anxiety shows up in response to ADHD, it can actually be helpful or motivating. If you feel anxious about being late, you may set several alarms and arrive a few minutes early to ensure you’re not late. As always, it’s just finding a balance of when the anxiety goes from beign productive to crippling. If the anxiety is becoming crippling that is likely a clue we’ve moved more into the anxiety realm as it’s own diagnosis. 

Key Differences Between ADHD and Anxiety

1. Nature of Symptoms

While both ADHD and anxiety can lead to difficulties with attention, the root of these challenges differs. In ADHD, inattention stems from issues related to executive functioning—like organizing tasks and maintaining focus. Distractions tend to be external to us. In contrast, anxiety-based inattention is often driven by excessive worry or fear that disrupts concentration; in other words, internal thoughts are distracting us.

2. Presence of Hyperactivity

Hyperactivity is a core symptom of ADHD. Individuals with ADHD may struggle to sit still, often fidgeting or talking excessively. People with anxiety may experience restlessness, but it is usually tied to nervous energy or anticipatory anxiety rather than a consistently hyperactive disposition.

3. Emotional Response

Anxiety is primarily an emotional experience, often marked by fear or apprehension. Those with ADHD may experience emotional dysregulation as an on/off switch but are less likely to feel the persistent fear and worry characteristic of anxiety disorders. In anxiety disorders, you can imagine a dimmer switch dialed all the way up, all the time. 

4. Triggers

Anxiety often has identifiable triggers—such as social situations or specific stressors—that elicit fear or worry. In contrast, ADHD symptoms are consistent across various settings and do not rely on specific triggers; they are more pervasive in nature.

Why Accurate Diagnosis Matters

Understanding the distinction between ADHD and anxiety is crucial for proper diagnosis and treatment. Overlapping symptoms might lead to misdiagnosis, which can affect the course of treatment and exacerbate the individual’s struggles. For example, treating anxiety with medication intended for ADHD, or vice versa, may not provide the relief one hopes for. You can read more about the assessment process for ADHD here. (link to our assessment page with the ASRS screening tool). 

Conclusion

Differentiating between ADHD and anxiety is key to ensuring you receive the support you truly need. While the symptoms may overlap in some cases, understanding their unique characteristics can lead to more effective management strategies. If you’re uncertain where to start, consider contacting your healthcare provider to discuss your symptoms and next steps.

If you want to learn more about ADHD strategies and how ADHD interacts with conditions like anxiety or shows up at work, school, home and your relationships, join us for our 8-week live virtual course “Level Up Your ADHD Game”. You can check it out here. (Link to landing page for course)

Resources:

ADHD and Anxiety: Highlights from my AMA with Dr. Sharon Saline 

Link: https://www.youtube.com/watch?v=wkq60psl320

Anxiety and ADHD - How Are They Related?

Link: https://www.youtube.com/watch?v=-Ab7dK34Ch0