ADHD and Anxiety: How to Tell the Difference

If you've ever felt restless, struggled to concentrate, or found your mind racing when you should be focused, you may have wondered: is this ADHD, anxiety, or both? You're not alone. Research shows that approximately 50% of adults with ADHD also meet criteria for at least one anxiety disorder — a rate far higher than the general population's 11%. Understanding where these two conditions overlap and where they diverge is essential for getting the right diagnosis and the right help.

Why ADHD and Anxiety Are So Often Confused

ADHD and anxiety share a surprising number of surface-level symptoms. Both can cause difficulty concentrating, restlessness, irritability, sleep problems, and a sense of being mentally overwhelmed. For clinicians and patients alike, this overlap can make it genuinely difficult to tell which condition is driving the difficulties — or whether both are present simultaneously.

The confusion runs deeper than a simple checklist. Standard self-report scales, including the widely used Adult ADHD Self-Report Scale (ASRS), have been shown to have limited ability to distinguish between ADHD and anxiety in adults. A 2024 study published in the Journal of Attention Disorders found that anxiety symptoms can inflate ASRS scores, potentially leading to ADHD misdiagnosis in people whose primary condition is an anxiety disorder.

Key Differences: How to Tell Them Apart

Despite the overlap, ADHD and anxiety are fundamentally different conditions with distinct underlying mechanisms. Here are the clinical markers that help distinguish them:

The Timing of Inattention

This is one of the most important differentiators. People with ADHD struggle to sustain attention even when calm and relaxed — their difficulty with focus is present across situations, regardless of emotional state. In contrast, anxiety-driven inattention tends to emerge specifically when worry or fear is activated. If you can concentrate well when you're feeling calm but lose focus when stressed or worried, anxiety is more likely the culprit.

The Nature of Worry

Both conditions involve worry, but the quality differs. In generalised anxiety disorder (GAD), worry is typically disproportionate to the actual situation — you might spend hours catastrophising about a minor email or a routine appointment. In ADHD, worry and stress tend to be proportional to real executive functioning difficulties: you're anxious because you genuinely did forget the deadline, lose the document, or arrive late again.

Childhood History

ADHD is a neurodevelopmental condition — its symptoms must have been present before age 12. If concentration difficulties, impulsivity, and disorganisation are lifelong patterns that began in childhood, ADHD is more likely. Anxiety disorders can develop at any age and are often triggered by life events, transitions, or accumulating stress.

Physical Symptoms

Anxiety frequently presents with prominent physical symptoms: muscle tension, a racing heart, nausea, sweating, and a persistent feeling of dread. While ADHD can involve physical restlessness (fidgeting, inability to sit still), it doesn't typically produce the same pattern of somatic tension and autonomic arousal that anxiety does.

When It's Both: ADHD and Anxiety Together

For many people, the answer isn't ADHD or anxiety — it's both. A 2025 review in Frontiers in Psychiatry confirmed that adults with comorbid ADHD and anxiety tend to experience more severe ADHD symptoms, a higher number of additional psychiatric conditions, and an earlier age of onset compared to those with ADHD alone.

This makes clinical sense. Living with undiagnosed or untreated ADHD — repeatedly underperforming at work, missing social cues, struggling with everyday organisation — creates fertile ground for anxiety to develop. Over time, the accumulated frustration and self-doubt can evolve into a full anxiety disorder that then compounds the original ADHD difficulties.

Key insight: A helpful clinical question is: "What remains when the anxiety decreases?" If attention and organisational difficulties persist even during calm, low-stress periods, ADHD is likely present alongside the anxiety.

Getting the Right Diagnosis

Because of the symptom overlap, accurate diagnosis requires more than a quick screening questionnaire. A thorough assessment should include:

• A detailed developmental history — exploring whether attention and behavioural difficulties were present in childhood, well before current stressors emerged
• Assessment across multiple settings — ADHD symptoms appear at home, at work, and in social situations; anxiety may be more situation-specific
• Standardised rating scales for both conditions — using ADHD-specific and anxiety-specific measures rather than relying on a single tool
• Collateral information — input from partners, family members, or old school reports can reveal patterns the individual may not recall
• Screening for other conditions — depression, sleep disorders, and trauma responses can also mimic ADHD and anxiety symptoms

If you're unsure whether your symptoms point to ADHD, anxiety, or both, a structured assessment is the best starting point. You can take our free ADHD assessment to get an initial indication of whether ADHD symptoms are present, and our anxiety disorder test can help you evaluate anxiety symptoms separately.

Treatment: Addressing Both Conditions

When ADHD and anxiety co-occur, treatment needs to address both — but the approach matters. International clinical guidelines recommend a multimodal strategy combining medication and psychological therapy.

Medication Considerations

Stimulant medications (such as methylphenidate and lisdexamfetamine) remain first-line treatment for ADHD. In many cases, effectively treating ADHD with stimulants also reduces anxiety, because the person is better able to manage their responsibilities and no longer lives in a constant state of catching up. However, stimulants can occasionally increase anxiety in some individuals, which is why careful monitoring and dose titration are essential.

For those whose anxiety doesn't improve with ADHD treatment alone, SSRIs or SNRIs may be added. Non-stimulant ADHD medications such as atomoxetine (which also has anxiolytic properties) can be a useful option when stimulants exacerbate anxiety.

Cognitive Behavioural Therapy (CBT)

CBT has strong evidence for treating both ADHD and anxiety. Adapted CBT for adults with ADHD typically focuses on building practical strategies for attention, planning, and impulse control alongside cognitive restructuring techniques that address the negative thought patterns common in anxiety. A 2024 study in Frontiers in Psychiatry found that adults with ADHD experienced meaningful improvements from CBT, particularly in managing the emotional and organisational challenges that fuel anxiety.

Lifestyle and Self-Management

Several evidence-based strategies can help manage both conditions simultaneously:

• Regular physical exercise — shown to improve both attention regulation and anxiety levels
• Structured routines — reducing the cognitive load that triggers both ADHD-related disorganisation and anxiety about forgotten tasks
• Mindfulness practices — research supports mindfulness-based interventions for reducing anxiety symptoms in adults with ADHD
• Sleep hygiene — both ADHD and anxiety are worsened by poor sleep, creating a vicious cycle that good sleep habits can help break

What to Do Next

If you recognise yourself in the descriptions above, the most important step is getting a proper evaluation. Many people spend years attributing their difficulties to "just anxiety" or "just being disorganised" when a dual diagnosis could unlock more effective treatment.

Start by understanding your symptom profile. Our online ADHD test takes just a few minutes and can help you identify whether ADHD symptoms are a factor. For a more comprehensive picture, explore our detailed assessment reports which provide personalised insights you can share with your clinician.

Whether it turns out to be ADHD, anxiety, or both, understanding what's driving your difficulties is the first step towards getting the support you deserve.

Dr Marc Mandell is a Licensed Professional Clinical Counsellor specialising in ADHD and related conditions. Learn more about our clinical team.