ADHD & Anxiety: Two Common Coexisting Disorders
Attention deficit hyperactivity disorder (ADHD) is a condition characterized by an ongoing pattern of inattention, hyperactivity, impulsivity, and/or issues with executive functioning. Symptoms of ADHD often include a persistent and pervasive inability to focus, disorganization, and restlessness.
Over two-thirds of people with ADHD have at least one additional coexisting condition1 such as anxiety disorders, which impact about 30% of people with ADHD. Unlike “everyday anxiety,” anxiety disorders are characterized by constant and unsubstantiated worry that causes significant distress and interferes with daily life. Cognitive components of anxiety are often accompanied by physical components such as a racing heart, sweating, or nausea.
According to the Anxiety & Depression Association of America (ADAA), a coexisting condition like anxiety may overshadow ADHD, causing ADHD to go undiagnosed for years due to the focus on the other disorder. Moreover, if anxiety is not diagnosed and treated, it can negatively affect the immune system, mood, and thought processes and make ADHD symptoms worse and recovery more difficult.
Roberto Olivardia
“Having ADHD can be stressful and anxiety-provoking,” said Roberto Olivardia, PhD, a clinical psychologist at McLean Hospital, lecturer at Harvard Medical School, and ADAA member. “It can lead to executive dysfunctions in the ability to organize one’s space and thoughts, manage time, make decisions, and regulate emotions. When those executive dysfunctions are not in accordance with what one wants to happen, tremendous anxiety and stress can result.”
“People with ADHD are drawn to stimulation and have a hard time being in the present moment unless they are highly stimulated,” he continued. “Unfortunately, not all stimulation is positive or pleasurable. Anxiety is a good example of something that is highly stimulating but not positive or pleasurable as it prevents people from being grounded and mindful. Anxiety is therefore particularly distracting for people with ADHD who have issues with attention regulation.”
ADHD in Children, Teens and Adults
ADHD begins in childhood and can continue to teen years and adulthood. Children with ADHD have a low frustration tolerance, which makes them prone to frequent tantrums and outbursts when things don’t go their way2. Boys with ADHD typically exhibit hyperactivity and impulsivity, while girls tend to be more inattentive, often daydreaming or appearing lost in thought. Girls with ADHD are also more likely to experience major depression, anxiety, and eating disorders than girls without ADHD3.
Adolescents with ADHD usually show less hyperactivity and may appear restless or fidgety. Symptoms of inattention and impulsivity typically continue and may cause academic, organizational, or relationship challenges. Teens with ADHD are more likely to engage in impulsive, risky behaviors, such as substance use and unsafe sexual activity4.
About 90% of children with ADHD become adults with ADHD, although it will present differently and fluctuate depending on the situation5. Although hyperactivity often diminishes by adulthood, inattentiveness and impulsivity may persist and may occur across multiple situations and interfere with daily life, including jobs and relationships. According to ADAA, about half of adults with ADHD also suffer from an anxiety disorder.
Dr. Olivardia referenced the impact of having both ADHD and anxiety, including:
- Becoming oriented toward avoiding anxiety and/or toward instant stimulation
- Learned helplessness
- Low self-esteem
- Decreased confidence in oneself to take risks
- Feelings of ineffectiveness
- Feeling “done to” by the world
- Isolation
- Suicidal ideation
Treatment for ADHD and Anxiety
ADAA notes that while there is no cure for ADHD, there are various treatments to help manage ADHD symptoms. Those may include medication and behavioral, psychological, educational, and coaching interventions. Less than 20 percent of adults with ADHD have been diagnosed or treated, and only about one-quarter of those adults seek help, according to one study6.
For those with ADHD and coexisting anxiety, ADAA recommends seeking out a behavioral health professional to assess specific areas of impairment – such as issues with attention, impulsivity, sleep, work, school, or family life – and focus on the disorder associated with the highest degree of impairment.
“It can be difficult to differentiate between anxiety and ADHD and know which one is driving the bus,” Dr. Olivardia said. “Those with anxiety tend to focus on avoiding threats and overstimulation. Those with ADHD tend to focus on avoiding boredom and understimulation.”
“ADHD and anxiety are both very treatable conditions,” he added. “It is essential for clinicians to assess for coexisting conditions because if one isn’t being diagnosed and treated, it can undermine the treatment of the other disorder.”
Anxiety and ADHD may be treated separately or simultaneously, but ADHD should aways be treated, according to ADAA, which offers an online therapist directory to help connect people with a licensed mental health professional in their area.
Dr. Olivardia acknowledged that it can be difficult to find a therapist specializing in ADHD – one who understands the diagnostic nuances involved.
“Unlike some other conditions like learning disabilities, neuropsychological testing is not the gold standard,” he said, pointing to high rates of false negatives. “People often accuse ADHD of being vastly overdiagnosed, but in reality, it is vastly underdiagnosed.”
Awareness of coexisting ADHD and anxiety or other behavioral health conditions is improving, said Dr. Olivardia, in part thanks to the efforts of ADAA. In addition to its treatment provider database, ADAA offers free online peer-to-peer support groups, live and on-demand webinars, inspiring personal stories, and a variety of learning tools developed by ADAA’s expert professional members.
“It is easier than ever for people to find help for their ADHD and anxiety,” concluded Dr. Olivardia, who last year hosted an ADAA webinar on ADHD and anxiety. “For most people, the two conditions don’t exist in a vacuum, and ADAA is committed to helping people get the diagnosis and treatment they need.”
Editor’s Note: If you care for a child with ADHD and need help affording copayments for medication, therapies, devices, or transportation to medical appointments, HealthWell Foundation may be able to assist through its Pediatric Assistance Fund®. For more information and to apply for a grant visit https://www.healthwellfoundation.org/fund/pediatric-assistance-fund/.
References:
- About ADHD: Coexisting Conditions, Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)
- ADHD and Behavior Problems, Child Mind Institute
- How Girls with ADHD Are Different, Child Mind Institute
- Attention-Deficit/Hyperactivity Disorder: What You Need to Know, National Institute of Mental Health
- Study: Only 1 in 10 Children with ADHD Will Outgrow Symptoms, Attitude Magazine
- First Treatment Contact for ADHD: Predictors of and Gender Differences in Treatment Seeking https://psychiatryonline.org/doi/ref/10.1176/appi.ps.201300298
**If you or someone you know needs immediate help, please call 988 or visit https://988lifeline.org for the Suicide and Crisis Lifeline.***
