What is the link between anxiety and ADHD?

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Attention deficit hyperactivity disorder (ADHD) usually begins during childhood, and can continue to adulthood in some people. This developmental disorder is typically associated with symptoms such as:

• a short attention span
• fidgeting
• hyperactivity
• impulsivity
• restlessness

According to the Anxiety and Depression Association of America, approximately 50 percent of American adults with ADHD also have an anxiety disorder. The National Resource Centre on ADHD estimate that up to 30 percent of children with the condition experience anxiety.

Currently, it is unclear why anxiety and ADHD appear together so frequently. Factors such as genetics, premature birth, and environmental toxins are thought to play a part in ADHD, so it is possible that they also influence anxiety disorders; more research is needed.

What is an anxiety disorder?

A person with an anxiety disorder is likely to experience long-lasting feelings of nervousness, fear, and worry. Although occasional anxiety is normal, those with anxiety disorders experience anxiety most, or all, of the time.

They may have difficulty identifying and controlling their specific fears and worries. These feelings tend to be out of proportion to the situation, and can interfere with people’s daily lives and relationships with others.

There are many types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder.

The connection

Although anxiety and ADHD may occur together, ADHD is not an anxiety disorder.

Sometimes, anxiety can occur independently of ADHD. Other times, it can be as a result of living with ADHD.

A person who has ADHD and misses a work deadline or forgets to study for an important exam can become stressed and worried. Even the fear of forgetting to do such important tasks may cause them anxiety.

If these feelings and situations continue, which they do for many people with ADHD, they can lead to an anxiety disorder.

Furthermore, the medications used to treat ADHD, especially stimulant medications such as amphetamines, can cause symptoms of anxiety. Genetics may also play a role.

It can be difficult to differentiate between anxiety and ADHD as the two conditions can appear similar. Some signs and symptoms that are common to both conditions include:

• difficulty socializing
• fidgeting
• inattentiveness
• working slowly or failing to complete work on time

According to Understood, additional signs of anxiety in children with ADHD can include:

• being irritable or argumentative
• causing trouble in class
• playing video games or watching TV most of the time
• telling lies about schoolwork or other responsibilities that haven’t been completed
• withdrawing from people

How to tell the difference

Although there are many things in common, there are some differences between the two conditions. Anxiety is primarily a disorder of nervousness, worry, and fear, while ADHD is characterized by a lack of attention and focus. People with anxiety can also display compulsive or perfectionist behaviors, which aren’t typically seen in those with ADHD.

Someone with an anxiety disorder will find it difficult to concentrate during certain situations that cause them to feel anxious. However, someone with ADHD will find it difficult to concentrate most or all of the time.

Although friends and family may recognize the symptoms of anxiety, ADHD, or both, a health professional should carry out a full evaluation before a diagnosis is made.

When anxiety and ADHD occur together, they can make daily activities more difficult. A person with ADHD who also has anxiety may find concentrating on tasks even more challenging. Therefore, it is very important to get proper treatment to ensure a better quality of life.

Anxiety can also complicate ADHD treatment because it tends to make people afraid to try new things. And, to deal with ADHD, new strategies might need to be employed to keep on top of the condition.

Treatment plans will vary based on the individual and the situation. Some people may benefit from having both conditions treated simultaneously.

Other times, treating just one of the conditions might be the priority. This may be appropriate if ADHD is the cause of the anxiety, as treating the ADHD can reduce the anxiety.

There are many different treatment options available to those with both ADHD and anxiety.

Medication

Prescription medications are most commonly used in treating ADHD. However, if stimulant medications are causing symptoms of anxiety, other non-stimulant medications may be prescribed. Anti-anxiety medications might also be considered.

If taking several medications is not recommended, or if the person does not wish to take them, a doctor may prescribe medication for one of the disorders and treat the other with therapeutic or lifestyle interventions.

Therapy and relaxation techniques

The anxiety related to ADHD may be better managed with:

• Cognitive behavioral therapy (CBT): this short-term intervention helps people to change their thinking patterns in order to positively influence their behavior. CBT is widely used for anxiety disorders, and has been shown to be effective in the treatment of GAD and many other conditions.
• Relaxation techniques: practicing techniques, such as meditation, progressive muscle relaxation, visualization, and deep-breathing exercises can help treat stress and anxiety by slowing the heart rate, reducing muscle tension, and boosting concentration and mood.

Lifestyle changes

In addition to taking medication, considering therapy, and practicing relaxation techniques, several lifestyle factors can help those with anxiety related to ADHD.

Sleep: tiredness can worsen feelings of anxiety. At least one study has indicated that anxiety in children with ADHD is linked with sleep disturbances.

People should aim to go to sleep and wake up at the same time each day.

Those who struggle to fall asleep or stay asleep should discuss the issue with their doctor.

Exercise: regular exercise can reduce anxiety in a number of ways, including through the release of brain chemicals that boost mood.

Schedule tasks: keeping a list of tasks and activities that need to be completed, and setting realistic timeframes for each, can ensure goals are remembered and achieved. This can help reduce anxiety levels.

Nutrition: eating healthful and balanced meals and staying hydrated can help manage anxiety. Reducing the intake of caffeine and alcohol may also be useful, as both of these interfere with sleeping patterns.

Tips for caregivers

Caregivers should:

• Try to give the doctor as much information as possible on the symptoms experienced by the person in their care, even those that do not seem related to ADHD or anxiety. This will help the doctor to make an accurate diagnosis and create an effective treatment plan.
• Be patient. Anxiety can cause people to become afraid to try new things, including new treatments for ADHD or the anxiety itself. Feeling anxious can also add to the lack of focus and forgetfulness experienced by those with ADHD.
• Be supportive. Being critical or negative will only add to the stress and worry experienced by those with ADHD and anxiety.
• Control parental anxiety. Children learn to respond to situations based on their parents’ reactions. Parents of children with ADHD who remain calm and positive will influence their children to do the same in stressful situations.
• Consider parenting skills training. Parents can learn new ways of understanding and responding to children with ADHD.
• Consider family therapy. This may be useful for parents and siblings who need additional support in dealing with the challenges of living with someone with ADHD.