Understanding ADHD and Anxiety: Relationship, Symptoms, and Tips for Living with Both

ADHD (Attention-Deficit/Hyperactivity Disorder) and anxiety often coexist and can have a complex relationship. While ADHD and anxiety are separate conditions, research has shown a higher prevalence of anxiety disorders among individuals with ADHD compared to the general population.

The Relationship and Comorbidity of ADHD and Anxiety

ADHD and anxiety disorders frequently occur together. It is estimated that approximately 30-40% of individuals with ADHD also have an anxiety disorder.

Anxiety disorders are widespread and include social anxiety, specific phobias, obsessive compulsive disorder (OCD), panic disorder, separation anxiety, and generalized anxiety. Regardless of the specific type, all anxiety disorders are characterized by excessive and persistent feelings of fear and worry. Anxiety can also be accompanied by symptoms of restlessness, fatigue, irritability, muscle tension, and difficulty concentrating.

The higher comorbidity between anxiety and ADHD can be attributed to several factors. Genetics contributes to both ADHD and anxiety so there may be overlapping genetic vulnerabilities and abnormalities in neurotransmitter systems such as dopamine and norepinephrine, that contribute to the development of both conditions.

Increased Stress in ADHD and Anxiety

Perhaps a more straightforward contributor is chronic stress. Living with ADHD is incredibly stressful and studies show that those with ADHD experience higher levels of stress than those who without this diagnosis. For those with inattentive type ADHD (previously called ADD), image suddenly finding yourself in a classroom, work meeting, or conversation and you don’t know what has been said in the last few minutes.

Or imagine frequently forgetting things and constantly being chastised by others about not being “motivated” enough. For the hyperactive/impulsive presentation of ADHD, imagine how stressful it is to navigate social relationships with family, teachers, colleagues, etc., when you keep losing track of time, saying things you shouldn’t have, or doing things impulsively that you regret later. I have often seen individuals with ADHD develop anxiety almost as a way of coping with forgetfulness, impulsivity, or social mistakes. Increased stress may further exacerbate anxiety symptoms and create a cycle where anxiety worsens ADHD symptoms, and vice versa.

Shared Symptoms

ADHD and anxiety can share some common symptoms, such as restlessness, difficulty concentrating, and irritability. These overlapping symptoms can make it challenging to differentiate between the two conditions without a trained expert and formal testing. It may lead to a misdiagnosis or an incomplete understanding of an individual’s difficulties.

Diagnostic bias occurs when symptoms of one condition overshadow or mask the symptoms of the other. For example, individuals with primarily inattentive-type ADHD may be more prone to internalizing symptoms, such as anxiety, rather than exhibiting hyperactive or impulsive behaviors. As a result, anxiety symptoms may be more noticeable or diagnosed, while ADHD symptoms go undetected or undiagnosed.

Impact on Daily Functioning

Both ADHD and anxiety can significantly impact daily functioning. ADHD symptoms, such as impulsivity and inattention, can lead to academic or occupational difficulties, while anxiety symptoms, such as excessive worry and fear, can interfere with social interactions and performance.

ADHD symptoms, including impulsivity and inattention, can create challenges in academic settings or work environments. Difficulties with staying focused, following instructions, organizing tasks, and completing assignments on time can lead to underachievement, poor grades, or work-related problems. These challenges can contribute to feelings of frustration, low self-esteem, and reduced motivation. Additionally, the presence of anxiety can further impede performance by causing excessive worry about academic or work-related tasks, potentially leading to procrastination or avoidance.

Both ADHD and anxiety can impact social interactions, albeit in different ways. ADHD symptoms such as impulsivity, hyperactivity, and difficulty with social cues can make it challenging to establish and maintain positive relationships. Impulsive behaviors or a tendency to interrupt others’ conversations may strain social connections. On the other hand, anxiety symptoms like excessive worry, self-consciousness, or social phobia can lead to avoidance of social situations or difficulties initiating or sustaining conversations. These challenges can result in social isolation, feelings of loneliness, and a reduced quality of relationships.

The presence of anxiety can interfere with performance in various domains, including academic, occupational, and personal pursuits. Anxiety can lead to excessive self-doubt, fear of failure, and heightened sensitivity to evaluation or criticism. These factors can impair decision-making, impede risk-taking, and hinder goal pursuit. In the context of ADHD, anxiety can exacerbate the already existing difficulties with attention and impulsivity, making it even more challenging to meet expectations and reach personal or professional goals.

The combined impact of ADHD and anxiety on daily functioning can take a toll on emotional well-being. Individuals may experience heightened stress, frustration, or a sense of being overwhelmed. The constant struggle to manage symptoms, meet responsibilities, and cope with anxiety-related worries can contribute to feelings of exhaustion and emotional dysregulation. Persistent feelings of anxiety can lead to irritability, restlessness, and a reduced ability to relax or enjoy activities, further impacting overall mood and happiness.

Treatment Challenges

The coexistence of ADHD and anxiety can present challenges in treatment. Stimulant medications commonly used for ADHD treatment may sometimes exacerbate anxiety symptoms. In such cases, alternative medications or a combination of treatments, such as therapy and behavioral interventions, might be considered.

This comorbidity can complicate the symptoms and treatment of both conditions. When a parent reaches out to me for executive functioning coaching or treatment for anxiety, I always want to know what other conditions they have. When a child has both ADHD and anxiety, treatment is often slower. Parents should know what to expect when they set out for treatment so that they do not become overly impatient or discouraged by slow progress.

Tips for Living with ADHD and Anxiety

Living with ADHD and anxiety can present unique challenges, but there are strategies and tips that can help individuals manage their symptoms and improve their well-being. Here are some tips for living with ADHD and anxiety:

  1. Seek Professional Help: Consulting with mental health professionals who specialize in ADHD and anxiety can provide valuable guidance and support. They can help with accurate diagnosis, treatment planning, and therapy options tailored to address the specific needs associated with both conditions.
  2. Educate Yourself: Learn more about ADHD and anxiety to better understand their symptoms and how they can impact your life. Knowledge empowers you to make informed decisions, advocate for yourself, and seek appropriate resources and support.
  3. Develop Structure and Routines: Establishing structure and routines can be helpful in managing ADHD symptoms. Create a daily schedule that includes regular routines for tasks, such as work, study, meals, and sleep. Utilize tools like planners, reminders, or smartphone apps to stay organized and on track.
  4. Break Tasks into Manageable Steps: Breaking tasks or projects into smaller, more manageable steps can make them less overwhelming. Focus on one step at a time, setting realistic goals and rewarding yourself for completing each milestone. This approach can help reduce anxiety and increase productivity.
  5. Use Organization Strategies: Develop systems for organizing your physical and digital spaces. Utilize labels, folders, color-coding, or digital tools to keep your belongings, files, and information organized. A clutter-free environment can help reduce distractions and promote focus. It may be helpful to work with an executive functioning coach to get some things set up initially.
  6. Practice Mindfulness and Relaxation Techniques: Engaging in mindfulness exercises, such as deep breathing, meditation, or progressive muscle relaxation, can help alleviate anxiety symptoms. These techniques promote relaxation, reduce stress, and increase self-awareness, allowing you to manage ADHD and anxiety more effectively.
  7. Prioritize Self-Care: Taking care of your physical and emotional well-being is crucial. Get regular exercise, eat a balanced diet, prioritize sleep, and engage in activities you enjoy. Self-care activities, such as hobbies, socializing, or spending time in nature, can help reduce stress and enhance overall well-being.
  8. Utilize Support Systems: Seek support from understanding family members, friends, or support groups. Sharing your experiences and challenges with others who may be going through similar situations can provide validation, empathy, and practical advice. Consider joining ADHD or anxiety support groups, either in person or online.
  9. Practice Effective Coping Strategies: Develop healthy coping mechanisms for managing stress and anxiety. This may include journaling, practicing relaxation techniques, engaging in physical activities, or engaging in hobbies that provide a sense of calm and enjoyment. Experiment with different strategies to find what works best for you.
  10. Consider Therapy: Therapy, such as cognitive-behavioral therapy (CBT), can be beneficial in managing both ADHD and anxiety. CBT can help identify negative thought patterns, develop effective coping strategies, and address the underlying beliefs or behaviors contributing to anxiety and ADHD symptoms.

Remember, finding the right strategies and techniques may require some trial and error. Be patient with yourself, celebrate your progress, and don’t hesitate to seek professional support when needed. With proper management and support, it is possible to live a fulfilling and successful life with ADHD and anxiety.

It’s important to note that while ADHD and anxiety often occur together, not everyone with ADHD will have anxiety, and vice versa. The precise relationship between the two conditions can vary from person to person. If you suspect you or someone you know has ADHD or anxiety, it’s recommended to consult with a healthcare professional for a proper evaluation and guidance regarding diagnosis and treatment options.