Unraveling ADHD and Anxiety: A Deep Dive into Co-occurring Conditions

According to the National Institute of Mental Health (NIMH), up to 50% of individuals with ADHD experience anxiety. In this article, we will delve deep into the relationship between ADHD and anxiety, discussing their co-occurrence, symptoms, impact on daily life, diagnosis, treatment, and the latest research findings.

Anxiety is a mental health condition that involves:

• Feelings of fear, worry, and apprehension
• The American Psychological Association (APA) defines anxiety as the feeling of nervousness, worry, or unease about something with an uncertain outcome.

People experiencing anxiety may experience:

• Racing thoughts
• Feeling agitated or restless
• Trembling or sweating
• Panic attacks

Anxiety disorders are mental health conditions characterized by excessive fear, worry, or apprehension about events or objects. Some common anxiety disorder types include:

• Generalized Anxiety Disorder (GAD)
• Panic Disorder (PD)
• Social Anxiety Disorder (SAD)
• Post-Traumatic Stress Disorder (PTSD)

Research shows that the COVID-19 pandemic led to a significant surge in anxiety levels across populations. As for the pandemic's impact on ADHD symptoms, one study suggests that while it didn't necessarily increase core ADHD symptoms like inattention and hyperactivity, it did slightly elevate stress levels in adults with ADHD.

However, experts point out that the major disruptions and changes to daily routines during the pandemic severely exacerbated symptoms of both ADHD and anxiety disorders. The pandemic blurred the lines between work, school, and home life, making it incredibly challenging for those with ADHD and anxiety to maintain structure and boundaries.

I do agree that the combination of increased domestic demands, social isolation, and pervasive uncertainty exacerbated issues for those with anxiety and ADHD. "With this increased intensity, people with ADHD have had difficulty delegating, organizing, and processing information. This can push them even further behind and leave them even more overwhelmed."

The lack of structure and simultaneous juggling of disparate responsibilities like childcare, homeschooling, and remote work proved exceptionally tough for ADHD brains that thrive on consistency. Meanwhile, the ubiquitous stress and unpredictability of the pandemic worsened anxiety symptoms like excessive worry, irritability, and panic attacks.

Co-occurrence: The Connection Between ADHD and Anxiety

The co-occurrence of ADHD and anxiety is prevalent and can have a profound impact on individuals. The National Institute of Mental Health (NIMH) states that up to 60% of children with ADHD experience symptoms of anxiety, while up to 20% of adults with ADHD report having anxiety disorders. The presence of anxiety can exacerbate ADHD symptoms and make it more challenging to manage daily life.

Although both conditions share some commonalities, they have distinct characteristics. People with ADHD exhibit symptoms such as inattention, hyperactivity, impulsivity, or a combination thereof. On the other hand, individuals with anxiety display symptoms of fear, worry, apprehension, and nervousness. It's important to note that these symptoms can sometimes overlap. For example, someone with ADHD may experience increased anxiety when faced with tasks requiring prolonged focus or organization.

The presence of both conditions can have a profound impact on individuals' daily functioning. People with co-occurring ADHD and anxiety may struggle to prioritize their tasks, manage their time effectively, stay focused for extended periods, maintain organized workspaces, and cope with the stressors of their academic or professional lives.

Diagnosis: Identifying Co-occurring ADHD and Anxiety

To diagnose co-occurring ADHD and anxiety, healthcare professionals typically follow a standardized diagnostic process. They will begin by evaluating the individual's history of symptoms, conduct interviews with family members or significant others, administer standardized psychological assessments, and perform physical examinations. Healthcare providers may use various tools, such as the Diagnostic and Statistical Manual (DSM-5) for mental health disorders and the Conners Adult ADHD Rating Scales for ADHD both these test have been incorporated by our very own ADHD test assessment.

Several studies have investigated the relationship between ADHD and anxiety, as well as the potential underlying neural mechanisms:

Brain Imaging Studies

• A study published in the Journal of Affective Disorders (2018) used structural MRI to examine gray matter volume in adults with ADHD, anxiety disorders, or both conditions. They found that those with comorbid ADHD and anxiety had reduced gray matter density in the anterior cingulate cortex and insula - brain regions involved in attention, emotional regulation, and interoceptive processing.
• A functional MRI study (Biological Psychiatry, 2017) looked at neural activation patterns during an attention task in adolescents with ADHD, anxiety, or both. Those with comorbid conditions showed altered activation in the amygdala, ventrolateral prefrontal cortex, and parietal regions - areas related to emotional processing, cognitive control, and attention.

Stress and Anxiety

• Research published in the Journal of Abnormal Child Psychology (2015) explored how different types of stressors (e.g. family, peer, academic) may exacerbate anxiety symptoms in children and adolescents with ADHD compared to those with just ADHD or just anxiety.
• A longitudinal study (Journal of Consulting and Clinical Psychology, 2019) followed adults with ADHD over 5 years and found that those with comorbid anxiety experienced more negative life events and perceived stress, which worsened their ADHD and anxiety symptoms over time.

Genetics and Neurobiology

• Twin studies (Journal of Child Psychology and Psychiatry, 2012) have suggested that ADHD and anxiety disorders may share some genetic and neurobiological underpinnings related to dysregulation in dopamine and norepinephrine neurotransmitter systems.
• Research (Molecular Psychiatry, 2021) has identified genes involved in synaptic plasticity and neural development that may contribute to susceptibility for both ADHD and anxiety when dysregulated.

Treatment: Managing Co-occurring ADHD and Anxiety

Pharmacological Interventions: Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and beta blockers can be effective in managing symptoms of both ADHD and anxiety disorders.

Psychological Interventions: Cognitive-behavioral therapy (CBT), mindfulness practices, and psychotherapy are beneficial in addressing the underlying emotional and cognitive aspects of both conditions.

Lifestyle Modifications: Regular exercise, a balanced diet, adequate sleep, and stress management techniques like deep breathing, progressive muscle relaxation, and guided imagery can significantly improve overall wellbeing in individuals coping with co-occurring ADHD and anxiety disorders.

Mechanisms and Coping Strategies

For example, researchers have investigated the potential underlying neural mechanisms that may contribute to their relationship. One study found that individuals with both conditions had reduced gray matter density in specific brain regions related to attention and emotion processing. Another study explored the role of stressors in exacerbating anxiety symptoms for people with ADHD.

While different conditions, ADHD and anxiety have high comorbidity rates and can create a cyclical pattern of distractibility worsening anxiety, which in turn makes focusing even harder. Experts recommend several coping strategies:

For ADHD - Maintaining routine as much as possible, using planners/apps, breaking big tasks into smaller steps, getting regular exercise, and creating a designated workspace. Medication can also provide symptom relief.
For Anxiety - Relaxation techniques like deep breathing, mindfulness, journaling, limiting news consumption, staying socially connected, and seeking professional therapy or counseling if needed.

Frequently Asked Questions About ADHD and Anxiety

How common is it to have both ADHD and anxiety?

Very common. Research consistently shows that between 40 and 60 percent of adults with ADHD have at least one co-occurring anxiety disorder. In clinical populations, the rate is even higher. The two conditions share some symptoms — difficulty concentrating, restlessness, sleep disturbance — which can make differential diagnosis challenging. A comprehensive assessment by a qualified clinician is essential to disentangle them.

Does ADHD cause anxiety, or are they separate conditions?

They are separate conditions with distinct neurobiological profiles, but ADHD frequently leads to secondary anxiety. The chronic experience of forgetting things, underperforming, letting people down, and feeling out of control — all consequences of untreated ADHD — accumulates into genuine anxiety over time. This is sometimes called "ADHD-generated anxiety" and tends to improve when ADHD is effectively treated. Primary anxiety disorders (such as generalised anxiety disorder or social anxiety) have a different aetiology and require their own intervention.

Can ADHD medication make anxiety worse?

Stimulant medications can exacerbate anxiety symptoms in some individuals, particularly at higher doses or in those with pre-existing anxiety disorders. This is one reason why anxiety must be assessed thoroughly before and during medication management. In other cases, stimulants reduce ADHD-driven anxiety by improving executive function and reducing the chaos that feeds it. Treatment decisions must be made on an individual basis with careful monitoring.

What therapy works best for someone with both ADHD and anxiety?

Cognitive Behavioural Therapy (CBT) adapted for ADHD has the strongest evidence base. Standard CBT protocols often need modification for ADHD — sessions may need to be more structured, with more emphasis on practical skills and less on abstract cognitive techniques. Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches also show promise. For many people, a combination of medication and psychological therapy produces the best outcomes.

How do I know if my worry is ADHD-related or a separate anxiety disorder?

ADHD-related anxiety tends to be situational — triggered by specific demands, deadlines, or the anticipation of failure — and reduces significantly when the external pressure is removed. Generalised Anxiety Disorder, by contrast, involves persistent, pervasive worry that is difficult to control across many domains of life, even when things are going well. A clinician will assess the timing, triggers, content, and persistence of anxiety to make this distinction. Self-reporting tools are a useful starting point, but they do not replace professional assessment.

Is it possible to treat ADHD and anxiety at the same time?

Yes, and this is typically the goal. When both conditions are present, treating one often improves the other — particularly when ADHD treatment reduces the downstream anxiety caused by its consequences. Atomoxetine (Strattera) is a non-stimulant ADHD medication that has shown efficacy for both ADHD and anxiety and may be preferred in cases of significant comorbid anxiety. A skilled ADHD psychiatrist or psychologist will develop a plan that addresses both conditions simultaneously.

References

• Kessler, R.C. et al. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.
• Schatz, D.B. & Rostain, A.L. (2006). ADHD with comorbid anxiety: A review of the current literature. Journal of Attention Disorders, 10(2), 141–149.
• Sobanski, E. et al. (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 19(2), 167–177.
• Safren, S.A. et al. (2010). Cognitive behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 48(9), 831–839.
• National Institute for Health and Care Excellence (2019). Attention deficit hyperactivity disorder: diagnosis and management (NG87). nice.org.uk/guidance/ng87

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Written and clinically reviewed by Adeel Sarwar, Consultant Psychologist (DClinPsy, HCPC Registered, MBPsS). Adeel has over 15 years of experience in neurodevelopmental assessment across NHS and independent settings, specialising in ADHD and autism across the lifespan. He is a member of the British Psychological Society and is committed to evidence-based, compassionate care.

If anxiety or attention difficulties are affecting your daily life, our free validated ADHD self-assessment can help you reflect on your symptoms and decide whether a professional evaluation is the right next step.