ADHD & Anxiety: Understanding the Link

ADHD & Anxiety: What Is the Connection?

ADHD and anxiety are two separate and distinct mental health diagnoses. However, evidence suggests a strong link between the two, and adults with ADHD are more likely to have an anxiety disorder than the general population.¹ The reasons behind this link are numerous, as many symptoms of ADHD can feed anxiety and vice versa.

Below are possible connections between anxiety and ADHD:

Poor Self-Regulatory Skills

ADHD impacts self-regulation, which can cause issues with impulsivity, sustained attention, and concentration. Because of these challenges, individuals with ADHD may feel anxious and hyperfixated on their performance when working on projects, interacting with others, or following instructions. For example, some may worry they will not meet deadlines or expectations due to distractions or restlessness.

Perfectionism

ADHD and perfectionism commonly co-occur, as many individuals with ADHD hold themselves to unrealistic standards while attempting to adhere to a neurotypical world. ADHD masking is also a common technique they use to hide their symptoms to appear more “normal” and maintain their perfect facade. These fears of failure and negative self-talk can contribute to and exacerbate anxiety.

Emotional Dysregulation

Emotional dysregulation is a common feature of ADHD, leading to rapid mood swings, irritability, or emotional outbursts. Navigating intense emotions without proper coping skills can leave individuals feeling chronically “stuck” in fight or flight mode, meaning they may struggle with procrastination, avoidance behavior, or task aversion. Over time, deadlines and responsibilities can accumulate, thus exacerbating worry and anxiety as they struggle to regain stability.

Executive Dysfunction

ADHD impacts executive functions, such as task completion, organization skills, and decision-making. As with emotional dysregulation and self-regulatory skills, executive dysfunction can create problems in managing responsibilities and day-to-day life. Individuals with ADHD must work harder to complete tasks than their neurotypical counterparts, leaving them burnt out, anxious, and mentally exhausted.

Medications

ADHD medication and anxiety may be connected. For example, some stimulant medications can activate the nervous system and worsen anxiety symptoms. Of course, these reactions vary depending on the person, dosages, and type of medication. A doctor can work with individuals to determine an appropriate pharmaceutical option if they experience frequent and unmanageable anxiety.

Can ADHD Cause Anxiety?

Many may wonder if ADHD causes anxiety. While ADHD and anxiety do not directly cause one another, they share a bidirectional relationship. In short, each condition can feed and worsen the symptoms of the other.

Is Anxiety a Symptom of ADHD?

Anxiety is not a direct symptom of ADHD but is commonly reported by those diagnosed. Anxiety can come in many forms, affecting every aspect of life for individuals with ADHD. While these symptoms may not warrant an anxiety diagnosis, they can create additional challenges for people to navigate.

Can You Have Anxiety & ADHD?

As mentioned, ADHD and anxiety commonly co-occur, and people can experience both ADHD and a diagnosable anxiety disorder. A qualified mental health professional can offer a dual diagnosis if an individual meets the DSM criteria for both conditions.

Is It Anxiety or ADHD?

Specific telltale signs and symptoms make distinguishing ADHD from anxiety more straightforward.  ADHD symptoms often manifest as behaviors like poor focus, impulse control, or regulation skills. Anxiety typically presents as body sensations, such as chest pain, nervousness, or sweating.

Typical symptoms of ADHD include:

• Inattention
• Hyperactivity
• Impulsivity 
• Forgetfulness
• Inability to sit still

Typical symptoms of anxiety include:

• Chest pain
• Cold or sweaty hands or feet
• Restlessness
• Sleep-related concerns (too much or too little)
• Nausea
• Nervousness

Signs of Comorbid ADHD & Anxiety

People can easily misinterpret symptoms of ADHD as anxiety and vice versa. Other times, individuals may believe they have one or the other, only to receive a comorbid diagnosis. Managing ADHD with anxiety can be challenging, but recognizing the signs of both conditions can help you seek the best support and treatment.

Signs you may have both anxiety and ADHD include:

• Irritability
• Difficulties socializing
• Restlessness
• Being fearful of trying new things
• Overanalyzing and not taking action
• Social withdrawal

How to Treat ADHD & Anxiety in Adults

ADHD and anxiety treatment typically involve medication and therapy. Seeking professional support can provide much-needed guidance and advice on how to manage comorbid conditions. Navigating these challenges can be scary, but help is available as you start your self-healing journey.

Therapy for ADHD & Anxiety

Psychotherapy offers a safe space to share your feelings, experiences, and thoughts with an unbiased and neutral professional. Plus, therapy is not exclusive to those who feel overwhelmed by their symptoms. You can benefit from finding a neurodiversity-affirming therapist who also specializes in anxiety treatments, even if you feel in control of your symptoms.

Consider reaching out to loved ones or your doctor for a referral. An online therapist directory is another valuable resource where you can filter providers based on expertise, location, and more.

Therapy options for anxiety and ADHD may include:

• Cognitive behavioral therapy (CBT): CBT encourages individuals to reframe anxious thoughts and focus on adopting healthier behaviors and mindsets. This method can also help clients improve their self-esteem, productivity, and motivation.
• Dialectical behavior therapy (DBT): DBT focuses on teaching mindfulness and coping skills so clients can handle challenges as they occur.
• Group therapy: Group therapy can also be beneficial for those with ADHD and anxiety. Members with similar struggles share their experiences managing symptoms, allowing each person to gain new insight into their own challenges.

Medication for Anxiety & ADHD

Determining the best ADHD medication for adults with anxiety may not be easy, as everyone reacts differently to prescription drugs. Your doctor will work with you to identify problem symptoms that negatively impact your life. They will also ask you about your history of mental and physical illness, your family history, and previous prescriptions. This knowledge can help them narrow options and start you on the right path.

Medication management is often a trial-and-error process, so be patient as you and your prescriber experiment with various prescriptions. Finding and choosing a psychiatrist specializing in ADHD and anxiety is important–spend some time exploring local providers until you find one who suits your needs.

Medications for ADHD and anxiety may include:

• SSRIs*
• Stimulants**
• Non-stimulants
• SNRIs*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

**This medication has a black box warning, the most serious kind of warning from the FDA for a risk of medication misuse or abuse.

How to Cope With ADHD & Anxiety

While seeking professional help is critical, developing coping skills for combined symptoms of ADHD and anxiety can reduce stress and overwhelm. Focus on maintaining healthy habits like regular exercise and eating nutritious foods. Simple changes can improve your well-being over time–you just have to take the first step!

Below are six tips for coping with ADHD and anxiety:

1. Schedule Unstructured Time

Schedule time for unstructured activities and tap into your creativity. Find a space where you feel at peace and free of responsibilities or obligations. Prioritize taking this break, and do not make plans that overlap with this allotment.

During this time, allow yourself to do anything that brings you joy. These moments offer a respite from the bustle of daily life, allowing you to ground yourself in relaxation and calm before returning to your routine.

2. Exercise & Move Your Body

Moving your body releases endorphins that help boost your overall mood. For those with anxiety and ADHD, regular physical activity can distract from negative thoughts, increase productivity, and combat inattention. Exercise and mental health are closely related, so spend time engaging in activities you like, even for only a few minutes.

3. Organize Your Space

A clean and organized space can help you feel more at ease, relaxed, and less anxious. A cluttered environment brings many distractions, leading to overwhelm and stress. Keeping up with household chores and to-do lists can greatly improve your overall well-being at home. In other cases, organizing your desk or cubicle at work can be a positive change, too.

4. Reframe Your Thoughts

Negative thoughts confine us to a mental space of overwhelm and stress. Unhealthy self-beliefs and ideas leave us feeling depleted and only further exacerbate symptoms of anxiety and ADHD.

Take a step back to reframe your thoughts and replace them with positive alternatives. Explore your strengths and build healthy goals around them. Yes, living with ADHD and anxiety poses unique challenges, but you are not powerless in how you view the situation and yourself. Practice self-love and compassion as you work toward symptom management.

5. Create a Routine

Create a routine that makes the most of your natural rhythms. For instance, schedule mentally involved tasks in the morning if you feel the most sharp and focused after waking. Or, consider incorporating movement breaks throughout the afternoon if you feel distracted during specific time frames.

6. Seek Accommodations

Many schools and workplaces offer accommodations to help people manage anxiety and ADHD. Some may provide flexible deadlines, extended time for taking tests, or quiet spaces. Check with your student or employee resources department for more information.

How to Support a Loved One With ADHD & Anxiety

Remember, your loved one with ADHD faces many unique challenges throughout their lives. Everyone experiences ADHD and anxiety differently, so listen to how they ask for support and express their needs. Practice empathy and patience as you encourage their efforts to manage their symptoms more effectively.

Here are tips for supporting someone with anxiety and ADHD:

• Be patient with them: Managing a dual diagnosis of ADHD and anxiety can be exhausting. Stay patient with your loved one as they develop coping skills and explore treatment options.
• Consider family therapy: Family therapy can be beneficial for family members of an individual with ADHD. Sitting with a professional to discuss family dynamics and conflict can provide insight into approaching challenges associated with ADHD.
• Provide a structured environment: Knowing what to expect every day can help ease anxiety and provide structure for those with ADHD. If you have a child with ADHD, consider creating a physical outline of their day-to-day responsibilities, appointments, or due dates to help them stay on task and centered.
• Listen openly to their struggles: Everyone needs support, especially when dealing with distressful mental health symptoms. Lend a listening ear to your loved one as they share their struggles. Sometimes, just being present is the best support.
• Celebrate their success: Take time to celebrate milestones and small victories, especially for a child with ADHD. Encourage them to continue exploring self-improvement and acceptance.
• Support their desire to seek professional help: Continue to offer support as your loved one starts therapy or medication. Treatment can be scary, but you can help relieve some of the worries by providing reassurance.