Living with ADHD can be challenging enough, but what if you have anxiety too? An estimated 20 to 30 per cent of those with ADHD also live with anxiety, while other studies suggest as many as 50 per cent.
“I’m seeing an increase in children and adults with both problems, probably because there’s more awareness that both conditions can exist together,” says Daniela McCann, director of the Australian Association of Psychologists.
“But some symptoms of ADHD and anxiety can be similar, and ADHD can be mistaken for anxiety – that’s why an expert diagnosis from a psychologist or psychiatrist is so important. Symptoms of anxiety can also exacerbate ADHD. When the brain is in anxious mode you can be more distracted and disorganised.”
The increase in women now being diagnosed with ADHD in their 40s may be because their symptoms, like inattention or lack of motivation, were thought to be caused by anxiety, she adds.
“Some women feel angry that their symptoms of ADHD have been dismissed this way.”
The difference between ADHD and anxiety
A clear difference between the two conditions is that ADHD is a neurodevelopmental disorder present from birth, while anxiety develops later, explains Associate Professor John Kasinathan from the Royal Australian and New Zealand College of Psychiatrists.
“ADHD isn’t obvious at first. It’s not until the demands of school begin that the signs start to appear. Anxiety can develop in childhood and can sometimes be a result of ADHD – if you’re at high school and struggling to stay on task, this can generate anxiety.
“ADHD can also co-exist with generalised anxiety disorder where someone worries excessively about multiple things, and they can become inattentive if they’re expending considerable energy on this.”
But it’s complicated.
“Anxiety isn’t the only condition that can occur with ADHD: depression and bipolar disorder can develop too, although not usually until after puberty. With depressive disorder, a major symptom is being unable to concentrate, so assessment needs to be careful, not just ticking boxes,” says Kasinathan.
It is possible that anxiety can be overlooked or mistaken for ADHD, but with a comprehensive psychiatric assessment that includes consideration of other diagnoses – ideally via face-to-face consultation with a psychiatrist – it’s unlikely, Kasinathan says.
“Audiovisual appointments are great for follow-up, particularly for regional and rural patients. But telephone-only practice isn’t supported by the RANZCP due to the potential to miss clinical signs with audio alone.”
What are the signs of anxiety?
There are several common symptoms of anxiety. “Excessive worry and fear, and possibly physical symptoms like heart palpitations and sweating. Avoiding doing things is another, but not just because you feel you need to watch a cool YouTube reel first, which is typical of ADHD,” says McCann who was diagnosed with ADHD in her 40s herself.
“With kids, it might be stomach aches, avoiding social situations or excessive fear about things they didn’t used to worry about.”
Along with cognitive behaviour therapy, acceptance and commitment therapy can also help with both ADHD and anxiety, she adds.
“One way acceptance and commitment therapy can help is by teaching mindfulness skills, which can help with attention and self-regulation in ADHD.
“Learning strategies to manage ADHD is important too, as is exercise – there’s evidence that when kids exercise, especially before school, they’re more regulated and focused, and walking to work is also great for an anxious mind.”
When Melissa Webster, chief executive of ADHD Australia first experienced anxiety, there was no mistaking its symptoms for those of her ADHD.
“The way I experience ADHD is consistent. When I’m struggling, I might find it harder to focus, regulate my thoughts, or get started on tasks. My mind can race. But when I developed anxiety following a relationship breakdown, it felt different. I knew immediately it wasn’t my ADHD,” she says. “I felt constantly agitated, I experienced panic attacks, my chest would tighten, and at times it felt difficult to breathe.”
But living with ADHD itself can sometimes contribute to anxiety, she adds. “It can create pressure. I sometimes interrupt people or lose focus, and you can worry about how others perceive that.”
One strategy that helps Webster manage both ADHD and anxiety is running outdoors.
“I run in the morning before work. It helps regulate my thinking and brings a sense of calm. Being outside gives me space to think differently. The gym doesn’t have the same effect – I need the openness and quiet of being outdoors.”
What to be wary of
There can be pitfalls with social media’s current obsession with ADHD, if people are reading posts about it and assuming that ADHD is the reason they can’t focus, when there can be other psychiatric issues driving inattention, Kasinathan says.
There’s also a potential problem with prescribing ADHD medication for someone whose symptoms are caused by something else, he adds.
“Stimulant medication can increase adrenalin and dopamine transmission in brain circuits, and make both anxiety and depressive disorders worse. If someone has bipolar disorder, it can trigger a manic episode.
“But if someone has anxiety or depression along with ADHD, it’s important to treat the anxiety or depressive disorder first because once anxiety or depression are treated, apparent inattention might improve without any need for specific ADHD treatment. Anxiety and depression can both be treated by cognitive behaviour therapy (CBT) or medication if psychological approaches are ineffective.”
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