ADHD & Social Anxiety: Connections & How to Cope

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that begins in childhood and persists throughout the lifespan. ADHD refers to a cluster of symptoms that largely entail hyperactivity (excessive movement that’s disproportionate to the setting), inattentiveness (the inability to maintain focus), or both. ADHD symptoms range in severity and intensity but generally impair functioning in relationships and at school or work.¹

Common symptoms of ADHD include:

• Restlessness
• Forgetfulness
• ADHD Impulsivity
• Poor concentration
• Frequently interrupting others
• Excessive talking
• Making careless mistakes
• Disorganization
• Avoiding or resisting tasks that require significant mental effort
• Inability to stay seated
• Frequently or always “on the go”
• Difficulty waiting for turns

What Is Social Anxiety?

Social anxiety disorder refers to significant fears of social settings. People with social anxiety worry about being judged by others, and many experience extreme self-consciousness when communicating. In turn, they may avoid social situations in general.

Common symptoms of social anxiety include:

• Avoidance of social situations
• Heightened fears of rejection
• Worries about humiliation or being judged
• Fear of others being aware of the anxiety
• Avoidance of situations that trigger anxiety
• Self-scrutiny after certain social interactions
• Assuming negative outcomes will occur after social interactions

ADHD & Social Anxiety: What Is the Connection?

ADHD and social anxiety share some characteristics and can appear rather similar. Both conditions can contribute to low self-esteem, problems sustaining attention, and restlessness. Among these symptoms, individuals can also struggle with maintaining relationships, sometimes leading to social isolation or withdrawal.

Connections between ADHD and social anxiety include:

1. Low Self-Esteem

Low self-esteem often stems from self-doubt and poor self-confidence. For those with ADHD, feelings of inadequacy may come from how they believe others perceive them. For example, distractibility can make completing tasks challenging. People with ADHD may feel self-conscious about how these symptoms present in social situations and impact those around them. In turn, their low self-esteem leads to social anxiety when interacting with others.

2. Difficulty Completing Tasks

Both ADHD and social anxiety can contribute to poor task management. Individuals with these conditions often fear the judgment of others, especially when completing important tasks or fulfilling responsibilities. These fears can contribute to chronic procrastination or task avoidance, as individuals seek to avoid social rejection or criticism based on their productivity.

3. Difficulties Socializing

Difficulties with socialization are a common and inherent symptom of social anxiety. While not necessarily associated with the condition, these challenges can also impact those with ADHD.

For instance, many individuals with ADHD have different mannerisms or communication styles than their neurotypical peers. Because of these differences, they may overthink how they should behave, speak, or engage with others based on societal norms. These expectations can further increase social anxiety as they try to navigate a neurotypical world.

4. Avoidance & Isolation

Avoidance behavior and isolation are common occurrences for those with ADHD and social anxiety. Withdrawing from others offers them space to cope with their intense fears of judgment and criticism. However, avoidance feeds social anxiety, leading to a harmful cycle of self-isolation.

5. Inattentiveness

Inattentiveness may be more prevalent in ADHD but can also affect those with social anxiety. Those with comorbid ADHD and social anxiety may appear distracted in social situations because of their constant internal dialogue about how they should respond, act, and behave. Unfortunately, this apparent disinterest can frustrate others as they feel ignored or overlooked.

6. Panic Attacks

Social anxiety can contribute to severe panic attacks in those with ADHD. When this happens, a person may appear overstimulated and experience what resembles a meltdown. The risk of a panic attack is highest just before or during a dreaded social event.

7. Restlessness

Individuals with ADHD or social anxiety may experience restlessness in social situations. They may exhibit physical discomfort mitigated by tapping fingers, shaking, sweating, or blushing. Sometimes, this apprehension also leads to blurting inappropriate things or interrupting others (which they tend to self-scrutinize later).

Can ADHD Cause Social Anxiety?

Determining if one mental health condition causes another is impossible. However, ADHD may exacerbate symptoms of social anxiety and vice versa. Furthermore, some people may think they have social anxiety disorder without realizing their symptoms are actually a part of an ADHD diagnosis.

Can You Have Both ADHD & Social Anxiety?

Yes, individuals can have ADHD and social anxiety at the same time. Research shows upwards of 60% of children with ADHD also meet the criteria for another mental health disorder, with 30% being an anxiety disorder. People may also recognize the symptoms of one condition without discerning the symptoms of another.^2.

Why Do ADHD & Social Anxiety Occur Together?

Many factors contribute to the development of comorbid social anxiety and ADHD. While genetics likely play a role, external factors can intensify or exacerbate any possible predispositions to either condition.³

Possible causes of comorbid social anxiety and ADHD include:

• Previous trauma: A person with a history of trauma is more likely to experience social anxiety due to trust issues and fears of people in general.
• Genetic factors: Having family members with a history of either condition may increase the risk of developing ADHD, social anxiety, or both.
• Environment: Environmental factors, including culture, geographical location, lived experiences, and family influence, can all impact mental health. Such factors may increase the likelihood of developing anxiety.
• Social roles: Social roles refer to the expected norms and behaviors an individual assumes for themselves. Some roles (i.e., being more submissive to friends or being an excellent student) may aggravate social anxiety symptoms.
• Bullying or peer rejection: Bullying and peer rejection can be traumatic, and such behavior is common for those with ADHD. These experiences can lead people to feel anxious or awkward in social situations, which can exacerbate social anxiety disorder symptoms.
• Naturally shy temperaments: Naturally introverted or shy people with ADHD may be more predisposed to social anxiety.

Complications of ADHD & Social Anxiety

The co-occurring nature of ADHD and social anxiety can range from mildly distressing to debilitating. In most cases, these conditions affect the ability to make and form meaningful relationships. ADHD can cause problems with attunement and reading social cues, and social anxiety causes problems associated with social confidence and relational spontaneity.

Below are possible complications of ADHD and social anxiety:

• Relationship problems: People with ADHD and social anxiety often struggle to create and maintain meaningful relationships. They may be hypervigilant around others and excessively worried about how people perceive them.
• Difficulty maintaining employment: Work can be stressful for people with ADHD and social anxiety. Some tasks like public speaking and collaborating with colleagues can feel extremely daunting.
• Low self-esteem: Because humans are inherently social creatures, difficulty with social skills can often negatively impact self-esteem.
• Substance use: Some people with ADHD and social anxiety turn to drugs or alcohol to self-medicate their discomfort or gain a sense of social courage around others.

How Are ADHD & Social Anxiety Diagnosed?

ADHD and social anxiety disorder are inherently distinct from one another and need individual diagnoses. While some symptoms overlap, a qualified mental health professional can discern which behaviors are rooted in ADHD or social anxiety. Assessments tend to be multifaceted and include anecdotal information from teachers, parents, partners, and individuals.

Can ADHD & Social Anxiety Be Misdiagnosed?

In some cases, ADHD can be mistaken for anxiety as symptoms of both conditions can mimic or resemble one another. Additionally, those engaging in ADHD masking either purposefully or inadvertently hide their symptoms from themselves and others, further complicating the diagnostic process.

Unfortunately, social anxiety misdiagnosed as ADHD (or vice versa) can lead to the wrong treatment plan or support. Patients can help mental health professionals by providing accurate information about their struggles and symptom histories.

ADHD & Social Anxiety Treatment Options

ADHD and social anxiety symptoms can benefit from therapy and medication. When considering treatment, explore your options to find what works best. What suits one person may not meet your support needs, so determining your goals and expectations can be helpful.

Therapy for ADHD & Social Anxiety

The benefits of therapy are numerous, especially when navigating life with comorbid conditions. Therapy can help you explore how symptoms impact your life to make positive, long-lasting changes. You can also seek family therapy if you need additional support at home. Finding a neurodiversity-affirming therapist is a great first step, as these professionals can help you feel safe, validated, and understood.⁴

Therapy options for social anxiety and ADHD include:

• Cognitive behavioral therapy (CBT): CBT for ADHD and social anxiety allows a person to identify unhealthy thought patterns and reframe them to decrease anxiety.
• Group therapy: Group therapy offers individuals space to feel validated and supported by others experiencing similar symptoms.
• Somatic therapy: Somatic therapy encourages clients to pay attention to how their emotions affect their bodies. This approach can help them recognize and cope with their anxiety in the moment.
• Dialectical behavioral therapy (DBT): DBT teaches individuals how their thoughts and emotions relate to an action and how to address these feelings as they arise.
• Acceptance and commitment therapy (ACT): ACT incorporates elements of mindfulness to help clients stay grounded when feeling overwhelmed.

Medication for Social Anxiety & ADHD

Anxiety and ADHD medications may be appropriate during treatment. The proper prescription can decrease unwanted symptoms, improve functioning, and help individuals better navigate their day-to-day. However, you should understand pharmaceutical therapies bring the risk of adverse effects and negative interactions with other substances. Your doctor will help you determine the best option for your treatment.

Medication for social anxiety and ADHD may include:

• SSRIs*: Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that increase serotonin levels, resulting in decreased anxiety.
• SNRIs*: Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of both serotonin and norepinephrine to decrease feelings of sadness and improve overall mood.
• Stimulants**: Stimulants increase dopamine levels in the brain, helping boost attention, motivation, and calm.
• Benzodiazepines***: Benzodiazepines can alleviate anxiety and stress levels by increasing the effects of the neurotransmitter GABA.
• Tricyclic antidepressants: Tricyclic antidepressants work similarly to SNRIs but may result in fewer side effects.

*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.

***This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

How to Cope With ADHD & Social Anxiety

While navigating ADHD and social anxiety may be challenging, healthy coping mechanisms can help when facing difficulties. Finding what works for you may take time, but these tools can support your efforts to manage symptoms and live a healthy life with ADHD and social anxiety.

Here are some tips for coping with ADHD and social anxiety:

• Practice mindfulness: Mindfulness for anxiety helps you remain grounded in the present moment instead of focusing on the future. Mindfulness can help ease negative thoughts as they arise.
• Try journaling: Journaling helps rid your mind of unhealthy and negative thoughts. Write down your feelings and worries instead of ruminating on them.
• Socialize when possible: While scary, getting out of your comfort zone can help you gain new experiences and opportunities for growth. Consider finding groups of like-minded individuals with whom you feel comfortable and supported.
• Incorporate regular exercise: Exercising releases endorphins to help improve your mood and calm your thoughts.
• Find a support system: Leaning on the support of others can help you feel relaxed and secure when overwhelmed.
• Reframe your thoughts: You can recognize negative thoughts as untrue when you reframe them.