It is very common for people with attention deficit hyperactivity disorder (ADHD) to also have an anxiety disorder. Some research estimates that up to 50% of people with ADHD also have an anxiety disorder. The most common anxiety disorders seen in people with ADHD are generalized anxiety disorder (GAD), social anxiety disorder, specific phobias, and separation anxiety disorder.
What is ADHD?
ADHD is a neurodevelopmental disorder characterized by ongoing problems with inattention, hyperactivity, and impulsivity. The symptoms of ADHD typically emerge in childhood and can continue into adulthood. The three main subtypes of ADHD are:
- Predominantly inattentive – difficulty staying focused, easily distracted, forgetful
- Hyperactive/impulsive – fidgety behavior, excessive talking, difficulty sitting still
- Combined – symptoms of both inattentive and hyperactive/impulsive
While the exact causes of ADHD are not fully understood, it is known that genetics and differences in brain development and chemistry play a role. Treatments for ADHD include medications, therapy, education, training for parents, and lifestyle changes. When appropriately treated, people with ADHD can manage their symptoms and function well.
What is anxiety?
Anxiety refers to excessive fear or worry that disrupts daily life. Anxiety disorders differ from normal anxiety or stress in that they are excessive, persistent, and interfere with normal functioning. Some common types of anxiety disorders include:
- Generalized anxiety disorder – chronic, exaggerated worry about everyday issues
- Social anxiety – extreme fear and avoidance of social situations
- Specific phobias – irrational fear related to specific objects or situations
- Panic disorder – sudden attacks of terror/panic
- Separation anxiety – excessive fear about being away from home or loved ones
Like ADHD, anxiety disorders have a neurobiological basis and can run in families. Environmental factors such as trauma or stress can also play a role. Anxiety disorders are typically treated with psychotherapy, medications, or both.
Overlap between ADHD and anxiety
ADHD and anxiety disorders frequently co-occur. Some key points about the overlap between the two conditions:
- Up to 50% of people with ADHD also have an anxiety disorder
- The most common anxiety disorders seen in people with ADHD are GAD, social anxiety, specific phobias, and separation anxiety
- People with both ADHD and anxiety tend to have more severe symptoms of both disorders
- The combo of ADHD and anxiety disorders appears to run in families
- It’s not completely clear why the two conditions overlap so much, but shared genetic and neurobiological factors likely play a role
Some researchers conceptualize ADHD and anxiety as two dimensions of one overarching disorder. However, the majority of experts view them as separate but frequently overlapping conditions.
Reasons for the overlap
There are several theories as to why ADHD and anxiety overlap so much:
Genetics
Twin and family studies show ADHD and anxiety disorders both run in families. Research has identified some shared genetic variants that predispose people to both conditions. There are likely overlapping inherited vulnerabilities for developing ADHD, anxiety, or both.
Brain differences
People with ADHD and anxiety disorders show some similar differences in brain structure and function, particularly in the prefrontal cortex. They also share some neurotransmitter irregularities, like low serotonin levels. These nervous system differences may underlie the emergence of both ADHD and anxiety symptoms.
Challenges from ADHD symptoms
The difficulties caused by ADHD symptoms may predispose people to developing anxiety. For example, problems with inattention and disorganization can lead to chronic stress, underachievement, and criticism from others. Hyperactivity and impulsivity can cause relationship problems and accidents. This type of chronic stress and poor coping may make anxiety more likely to emerge.
Anxious personality
Some research indicates that the personality trait of anxiousness is more common in people with ADHD. An inherited tendency to be anxious may lead to both anxiety disorders and a higher risk of ADHD in some families.
Overlapping environmental factors
Exposure to childhood adversity and trauma is linked to both ADHD and anxiety disorders. Difficult early life circumstances like abuse, neglect, family dysfunction may contribute to the development of both conditions in vulnerable individuals.
How ADHD medications affect anxiety
Stimulant medications like Adderall, Ritalin, and Vyvanse are commonly prescribed to treat ADHD symptoms. For many people with both ADHD and anxiety, these medications can:
- Improve focus and concentration
- Increase ability to think before acting
- Reduce overall restlessness and fidgeting
By improving ADHD symptoms, medications can help reduce stress levels. In some cases, treating the ADHD resolves the anxiety.
However, stimulants also have the potential to exacerbate or induce anxiety in some people with ADHD at certain dosages. Possible anxiety-related side effects include:
- Nervousness
- Insomnia
- Agitation
- Rapid heart rate
- Sweating
If stimulant medications are causing anxiety symptoms, adjusting the dosage or type of medication may help. Adding an anti-anxiety medication or therapy may also be beneficial. Frequent monitoring by a doctor is important to find the optimal ADHD treatment regimen.
Treatments for co-occurring ADHD and anxiety
When ADHD and anxiety disorders co-occur, experts recommend a combination treatment approach including:
Medications
- Stimulants to target ADHD symptoms
- Antidepressants or anti-anxiety meds to reduce anxiety
Medications can be helpful in managing both conditions. However, medication alone is usually insufficient.
Psychotherapy
Types of therapy that can help with ADHD and anxiety:
- Cognitive behavioral therapy (CBT) – Helps identify and change negative thought patterns
- Acceptance and commitment therapy (ACT) – Uses mindfulness and acceptance to promote psychological flexibility
- Dialectical behavior therapy (DBT) – Teaches distress tolerance and emotion regulation skills
Learning coping strategies through therapy is crucial for better managing anxiety symptoms.
ADHD coaching
Coaches work with individuals to improve organization, time management, and planning. For people with ADHD and anxiety, coaches provide support for implementing tools and strategies to minimize anxiety-provoking symptoms.
Psychoeducation
Education about ADHD and anxiety disorders helps individuals understand the nature of their conditions. Knowing more about the causes, symptoms, and treatment options tends to improve coping.
Lifestyle changes
Steps like eating healthy, exercising, minimizing stress, and getting enough sleep can also help manage both ADHD and anxiety. Maintaining balance through self-care activities is important.
Tips for coping with both ADHD and anxiety
Having both ADHD and anxiety can feel overwhelming. Here are some tips that may help with managing life’s demands:
- Take medications as prescribed and report any side effects
- Attend therapy and coaching consistently
- Learn your own anxiety triggers and patterns
- Use to-do lists, reminders, calendars to stay organized
- Avoid overbooking your schedule
- Exercise daily to reduce stress
- Build relaxation practices into each day like deep breathing, meditation, yoga
- Get adequate sleep nightly
- Reduce caffeine intake
- Take short breaks during challenging tasks
- Identify and limit beliefs that exacerbate anxiety
- Share your challenges with supportive loved ones
- Forgive yourself for mistakes
- Celebrate small successes
Learning to balance self-compassion with self-discipline helps in managing ADHD and anxiety. Be patient and persistent in finding the right strategies for your needs.
Challenges of having both ADHD and anxiety
While ADHD and anxiety disorders can occur separately, having both conditions concurrently can present some unique challenges:
- More severe and complex symptoms
- Overlapping symptoms can be hard to distinguish
- Increased risk of depression
- Higher rate of substance abuse
- Difficulty adhering to treatment plans
- Daily emotional volatility
- High self-criticism
- Trouble managing stress
- Social and occupational impairment
The combined impact of ADHD and anxiety makes day-to-day life more difficult. Simple tasks can seem impossible. Emotional dysregulation is common. Finding the right professional help is critical.
Should anxiety be treated before ADHD?
There is some debate around whether to treat the anxiety or ADHD symptoms first when both conditions are present. Some considerations:
- When anxiety is severe, treating it first can help ADHD treatment be more effective
- Treating the ADHD first can resolve anxiety symptoms for some people
- Determining which symptoms are most impairing and targeting those guides the treatment sequence
- Both disorders may require concurrent treatment for optimal improvement
There are no definitive rules on treating ADHD vs. anxiety first. Unique factors in each individual’s case must be evaluated. Often a combined approach is best. The key is being patient and persistent to find each person’s optimal treatment over time.
How to tell if it’s ADHD, anxiety, or both
Because ADHD and anxiety share some similar symptoms, distinguishing between them can be tricky. Some clues that it may be both conditions:
- You’ve had ongoing anxiety and problems with focus/hyperactivity since childhood
- Symptoms fluctuate but never fully resolve
- Attention improves with stimulants, but anxiety remains elevated
- Anxiety worsens when ADHD symptoms flare up
- Managing environment/lifestyle reduces anxiety but inattention persists
- Cognitive behavioral therapy helps anxiety but not focus or disorganization issues
Professionals look for evidence of impaired functioning from childhood plus current symptom criteria for ADHD and an anxiety disorder to make the diagnoses. Getting an accurate evaluation is the first step.
Should you treat ADHD along with anxiety?
If you have been diagnosed with or suspect you have both ADHD and an anxiety disorder, getting treatment for both conditions is recommended. Here’s why treating both concurrently is important:
- Each disorder can exacerbate the other if left untreated
- Overlapping symptoms may be hard to resolve if only one condition is targeted
- Optimizing treatment requires a coordinated approach
- Using therapy and/or medications for just anxiety often will not improve ADHD symptoms
- Treating only the ADHD does not equip the individual with anxiety management skills
- Integrated treatment that addresses both ADHD and anxiety is associated with better outcomes
A personalized, multidimensional plan combining medications, therapy, lifestyle changes, and coaching is ideal for the comorbid presentation of ADHD and anxiety. Input from both a psychiatrist and a psychologist helps ensure all facets are adequately treated.
Conclusion
In summary, ADHD and anxiety disorders frequently co-occur because of overlapping inherited vulnerabilities and environmental risk factors. The combination of both conditions makes life more challenging. Getting an accurate diagnostic assessment is the first step toward combined treatment. Integrated management using medications, therapy, coaching, and lifestyle changes can significantly improve ADHD and anxiety symptoms. Addressing both conditions concurrently leads to better functioning despite the inherent challenges of this comorbidity. Consistency and self-compassion are key in the ongoing process.