There is a relationship between ADHD and anxiety, so it is unsurprising that many people struggle to tell the difference. According to research, it is estimated that up to 50% of ADHD sufferers will also experience anxiety at some point during their life. Since they also have some common symptoms, this can cause confusion when you’re looking for a diagnosis.
ADHD often has secondary anxiety, where the anxiety is associated with the person’s ADHD difficulties. This is different from a generalized anxiety disorder, since the anxiety stems from difficulty functioning with the ADHD symptoms. Whether you suspect you have ADHD or are struggling with anxiety, it is important to understand the differences, so that you can advocate for yourself.
An Introduction to ADHD
ADHD is a neurodevelopmental disorder, which means that the onset is often during early childhood when we are in our developmental period. There is a strong genetic component to the condition, so if a parent or sibling has ADHD, you have a greater likelihood.
ADHD is characterized by hyperactivity, impulsivity and inattention, due to the impact on specific areas of the brain including the areas that regulation focus, emotions and attention. There are three ADHD classifications: ADHD Primarily Inattentive, ADHD Primarily Hyperactive-Impulsive and Combined.
To diagnose ADHD, the presence of impulsivity, hyperactivity and inattention must interfere with daily functioning in a minimum of two contexts. For example, work and home or school and home.
Common Symptoms of ADHD
Difficulty Focusing on Tasks
People with ADHD may daydream constantly, zoning in and out of focus. Staying focused on a routine, boring or repetitive task can be very challenging, which may impact completing tasks on a deadline.
Forgetfulness
Forgetting instructions, losing track of belongings, misplacing items or struggling to remember important dates can also be a sign of ADHD. Adults with ADHD may tend to miss meetings or deadlines as part of their ADHD.
Organizational Issues
ADHD can cause difficulties with organizing and prioritizing tasks. The ADHD brain typically values novelty rather than importance. So, having a long to-do list can overwhelm someone with ADHD quickly, driving them to the point of feeling almost unable to take action or make any decisions until they can regain their composure.
Fidgeting and Restlessness
Those with ADHD may find themselves constantly shifting in their seat, tapping hands or feet, moving around or generally fidgeting. They can often find it hard to sit still and may resort to stimming or unconsciously repeating certain movements or sounds to calm themselves.
Conversation Difficulties
Someone with ADHD may have difficulties focusing on following a conversation, particularly if the topic is not of interest to them. They may speak too rapidly or too much, interrupt the other person or simply go off on a tangent when speaking. They can also appear distracted and like they are not listening when the other person is speaking.
Impulsivity
Impulsive actions can present in a variety of ways. Someone with ADHD may purchase an item, say something, perform an action or make a decision without considering the consequences thoroughly.
Difficulties Regulating Emotions
Some with ADHD may have difficulties regulating their emotions. They may struggle with irritability, frequently start conflicts, be quick to lose their temper or have unpredictable mood swings.
An Introduction to Generalized Anxiety
When considering anxiety, it is important to appreciate that feeling anxious is a normal emotional response to uncomfortable, difficult situations. However, when the anxiety or fear reactions become irrational, excessive or simply out of proportion to the situation or problem, it is considered a more generalized anxiety condition.
The character of generalized anxiety is excessive, uncontrollable and pervasive worry. The worries must be excessive and occur more days than not for a minimum of six months and be about several activities or events. The duration, frequency and intensity of the anxiety should be out of proportion to the actual impact or likelihood of the anticipated event or activity.
What distinguishes generalized anxiety from everyday worries and anxious feelings is the excessive nature and how this interferes with school, work or daily living. People with generalized anxiety often have significant difficulties completing daily activities and the responsibilities of life, leading to problems with work, school, relationships and more.
Symptoms of Generalized Anxiety
Excessive Worry, Fear or Stress
Those with anxiety feel constantly tense due to a feeling of impending panic, danger or doom. This can lead to nausea, dizziness, rapid breathing, trembling, sweating, an increased heart rate and the feeling of chest tightness.
Trouble Focusing
People with an anxiety disorder can often find that they struggle with concentrating. They may feel distracted by fearful thoughts and worries, or find their minds going blank when they are trying to complete a task.
Sleep Difficulties
Anxiety can make it feel far more challenging to fall asleep or stay asleep during the night. You may have difficulties falling asleep or find yourself bolting awake before your alarm and unable to get back to sleep. This can lead to feeling overtired, which can also impact concentration and mood.
Irritability
Someone struggling with anxiety may be easier to upset, meaning that they are more likely to get emotional or lash out at family members and friends.
Avoidance
When a bout of anxiety or excessive fear strikes, it is common for those with anxiety to have the behavioral response of avoidance. For example, someone with social anxiety may simply avoid events or social situations due to a fear of being embarrassed or judged in front of other people.
The Overlap Between ADHD and Anxiety
As you may have noticed, there are some symptoms that are typical with both ADHD and anxiety. This can cause difficulties in self identifying whether you or your loved one is struggling with ADHD, anxiety or both.
Some Overlapping Experiences
Inattentiveness
Difficulty regulating attention is one of the key features of ADHD, but excessive worry can also make it difficult to focus. When the brain is hyper-focused on fear signals, it is less primed to attend to other cues and signals. This means that being inattentive is one of the most common overlap symptoms.
Sleep Difficulties
Anxiety issues can interfere with sleep and sleep issues are also common among those with ADHD. Sleep problems, particularly nightmares and insomnia are higher among those with anxiety, but approximately 25 to 50% of people with ADHD also struggle with circadian rhythm sleep, insomnia, sleep disordered breathing, and restless leg syndrome.
Intrusive Thoughts
Intrusive thoughts can be a common experience for many anxiety disorders, but this can also be a common symptom for ADHD sufferers. Intrusive thoughts can be anything from an unpleasant idea to an image that is upsetting or distressing and can be difficult to eliminate or manage. In some circumstances, this unwelcome, involuntary thought can become an obsession.
Digestive Problems
Whether as a result of the stress of anxiety or ADHD symptoms, digestive issues are a common symptom for both conditions.
Fight or Flight Dominance
Fight or flight is a sympathetic nervous system response and when this is dominant, it means spending more time in the activated part of the nervous system with a harder time transitioning into the “rest and digest” mode. Anxiety sufferers often exist primarily in the sympathetic mode, struggling to move into the parasympathetic mode.
Low GABA Levels
This follows on from the previous point, but both ADHD and anxiety are associated with a low level of GABA. GABA is a primary inhibitory neurotransmitter in the central nervous system, playing an important role in choosing appropriate behavioral responses and processing sensory information.
When there is imbalance in the GABA Glutamate cycle, it can lead to hyperactivation of the central nervous system.
Irritability, Agitation and Restlessness
These symptoms are common in both conditions, relating to the central nervous system activation and GABA levels.
Difficulty Concentrating
Both ADHD and anxiety involve difficulties concentrating, but the origins of this symptom is different. While in someone with anxiety, the overwhelming anxious thoughts can create the difficulty in concentrating, for the ADHDer, struggling to concentrate can continue even when they are feeling a relative state of peace or calm.
Spotting the Difference Between Anxiety and ADHD
Since there are a number of commonalities, spotting the difference between ADHD and anxiety can be tricky. There are some baseline questions that can help to distinguish between the two.
- Are you generally a worrier? Do you typically have worries that will not go away regardless of what you do? Do these worries make it harder for you to do the things you want?
- Are you shy or socially awkward?
- Do things make you feel scared or worried when you think about them?
- Are you anxious about work or school? Do you feel homesick when you’re outside of the house?
- Is there a history of anxiety in your family?
If the answers to any of these questions are yes, then you need to speak to a clinician for an official diagnosis. One of the first things that the clinician will determine is whether the anxiety symptoms relate to primary or secondary anxiety. Remember that ADHD can cause worry and anxious thoughts about the ability to get things done and if the stress is explicitly tied to these functioning difficulties, it is likely to be secondary anxiety associated with ADHD.
On the other hand, the anxiety symptoms may be co-occurring with ADHD. In this scenario, the worry and anxiety is more global than ADHD concerns. Those with an anxiety disorder and ADHD tend to experience more general, broader anxiety. This anxiety is not explicitly connected to the ADHD and tends to be more pervasive in nature. They are also more likely to have physical manifestations of anxiety such as sleep difficulties and restlessness. Unfortunately, these can mimic ADHD symptoms, so the clinician needs to explore the triggers for the worry to understand the mental, internal experience of the anxious thoughts.
The clinician will also need to determine the proportion of worry to the stressor or risk. In a generalized anxiety disorder, the proportion of anxiety to the actual risk is disproportionate, while in an ADHD context, the sufferer tends to have anxiety and stress associated with their functioning difficulties, so the worry is likely to be proportional.
The clinician will also explore the cause of any inattention. To fully understand the difference between anxiety and ADHD, the clinician must appreciate the experience of the patient to determine if focus and attention difficulties are due to all consuming worry or if the difficulty concentrating is present even without stressful thoughts, which would indicate ADHD.
People with anxiety tend to struggle with attention and focus, but it is due to preoccupation with worry filled thoughts, while ADHD brains struggle due to the propensity for being easily distracted.
During your consultation, the clinician will obtain a thorough clinical history and speak to you in detail about your symptoms and issues. This will help to determine the underlying cause of symptoms and diagnose ADHD, an anxiety disorder or both.
ADHD and Anxiety Treatments
Once you have a diagnosis, your healthcare professional will guide you through the treatment options. While there are some common symptoms, the medications used to treat these conditions are different. If you are experiencing both conditions, treatment can be a little tricker, since some ADHD medications have the potential to exacerbate anxiety symptoms.
In adults and children, the most effective ADHD treatment regimen is a combination of therapy and medication.
Cognitive Behavioral Therapy
This is a talk therapy that can help to identify unhealthy beliefs, behaviors, mindsets and ways of thinking and reframe them into healthier habits and thinking patterns. CBT can also help you to tackle disorganization and poor time management.
Family Counseling
This type of therapy can be useful to empower you and your loved ones in exploring conflicts, finding strategies to resolve and prevent them. This can help build thriving relationships.
ADHD Coaching
The coach will collaborate with you to help devise personalized strategies to overcome everyday struggles to stay focused and increase motivation.
Stimulant Medications
This type of medication is typically an effective choice for ADHD as stimulant medications help to regulate brain activity. However, they do require close monitoring. In some cases, stimulant medications may not work for you or could lead to problematic side effects. In this scenario, your healthcare professional may recommend a non-stimulant medication.
There are two main anxiety disorder treatment methods; medication and therapy. Cognitive behavioral therapy can also be effective for anxiety sufferers, teaching essential skills to help you to change your ways of thinking to effectively manage your symptoms.
There are also various types of medications that can treat anxiety. SSRIs or selective serotonin reuptake inhibitors and SNRIs or selective serotonin norepinephrine reuptake inhibitors are the preferred treatment for this disorder, as the benefits typically outweigh the risks for most patients.
Of course, each individual is unique and your treatment plan will be tailored to your specific symptoms and requirements. Your healthcare professional will assess your medical and clinical history, to determine a treatment plan. However, since everyone reacts differently to medications, this can require a little trial and error, particularly if you have both ADHD and anxiety.
| Treatment Type | ADHD Treatments | Anxiety Treatments |
|---|---|---|
| Medications | Stimulants (Adderall, Ritalin, Vyvanse) | SSRIs (Zoloft, Prozac), SNRIs (Effexor, Cymbalta) |
| Non-stimulants (Strattera, Intuniv) | Benzodiazepines (Xanax, Ativan, Valium) | |
| Therapy | Cognitive Behavioral Therapy (CBT) | Cognitive Behavioral Therapy (CBT) |
| Behavioral therapy | Exposure therapy | |
| Executive function coaching | Acceptance and Commitment Therapy (ACT) | |
| Lifestyle Changes | Regular exercise, structured routines | Regular exercise, mindfulness, relaxation |
| High-protein diet, avoiding sugar | Avoiding caffeine, deep breathing techniques | |
| Alternative Treatments | Omega-3 supplements, neurofeedback | Herbal remedies (chamomile, lavender) |
| Mindfulness meditation, yoga | Yoga, meditation, acupuncture |
Is It ADHD, Anxiety, or Both?
Getting proper treatment starts with an official diagnosis of whether you have ADHD or anxiety, so it is important to seek proper medical advice if you are struggling with symptoms of either condition.
Anxiety can cause a number of symptoms, such as panic attacks or feelings of dread, while ADHD can cause hyperactivity and impulse control issues. Bear in mind that the symptoms for both conditions can overlap and it is possible to have both anxiety and ADHD. Even if you have a pre-existing diagnosis for either condition, it is important to have your symptoms assessed. A proper diagnosis and treatment plan can help you to manage your symptoms and deal with your daily struggles that may be standing between you and your goals.
If you have noticed concerning symptoms but are unsure whether they are caused by anxiety or ADHD, there are some tests that can help you to decide which type of professional support and evaluation you should consider. This can provide a starting point if you’re unsure where to begin.
If your ADHD is complicated with an anxiety disorder, you will need to speak to a specialist with experience in this area. This can help you to explore more tailored treatment plans, since some ADHD medications can exacerbate anxiety disorder symptoms.
Fortunately, there are therapies and medications that can help to treat either or both conditions. Speaking to your doctor can help you achieve an accurate diagnosis and access a treatment plan to ease your symptoms. So, while you may feel a little overwhelmed about seeking help, it is the first step to an effective treatment, which will help you to deal with your symptoms and empower you with the ability to tackle your day to day struggles.
