ADHD, Anxiety, And Mental Health: Understanding Their Connections And Comorbidities

According to the Centers for Disease Control and Prevention (CDC), the estimated number of childhood cases of attention-deficit/hyperactivity disorder (ADHD) in the United States is approximately 6 million. Moreover, the overall prevalence of ADHD in adults is estimated to be around 4%.

This suggests that millions of people manage symptoms of attention-deficit/hyperactivity disorder every day—and in many cases, they also are managing another mental health disorder alongside ADHD, such as major depressive disorder, a personality disorder, or an anxiety disorder. 

This article focuses on comorbid diagnoses of anxiety disorders and ADHD, which can substantially interrupt people’s lives without medical treatment such as ADHD medications, anxiety medications, lifestyle alterations, and behavioral therapy for anxiety or ADHD.

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD), formerly called attention deficit disorder, is considered a disorder of the developing brain. Primary ADHD symptoms relate to hyperactivity, impulsivity, and inattention. It can be diagnosed early, such as during childhood—however, some people are not diagnosed until they are adults. In addition, approximately 25% to 50% of those diagnosed with ADHD experience a comorbid anxiety disorder.

ADHD symptoms and forms of the disorder

While the most common form of ADHD is a combination of inattentive and hyperactive symptoms, some people will primarily experience symptoms from one subtype or the other. Symptoms of impulsivity are present in both categories.

To diagnose a child or adult with attention-deficit/hyperactivity disorder, these symptoms must be chronic and impair a person’s ability to function. A child falling behind at school or being called out for hyperactive behavior that is interrupting the teacher’s ability to instruct is an example of ADHD impairing function. 

Attention-Deficit/Hyperactivity Disorder Symptoms: Inattention

A child or adult will have difficulty staying on task, keeping focus, and being organized. The inattention is not caused by defiant behavior or lack of comprehension. 

How inattention due to ADHD manifests itself

If a child is making careless mistakes in their homework, does not seem to listen when spoken to, is easily distracted, and often loses things, they may be dealing with inattention due to ADHD. ADHD in adults might look more like struggling to meet deadlines at work, pay crucial bills on time, maintain intimate relationships, or remember key appointments.

Symptoms: Impulsivity

A child or adult may have a difficult time with self-control and may act without considering long-term consequences that they should be able to consider at their stage in development. They may seek immediate rewards and struggle with delayed gratification (resisting immediate pleasure in the hopes of a future reward). A person with ADHD may interrupt and frequently answer questions before they are asked. They may also make important decisions without much forethought.

Symptoms: Hyperactivity

This category of symptoms includes moving constantly, fidgeting, excessively talking, feeling persistently restless, or having a hyperactive mind. An adult with ADHD may talk a lot or always appear to be on the go. A child may not be able to play quietly and may spend time running around and climbing despite continued instruction and attempts to sit still. Other signs of hyperactivity common in all age groups are impatience and not being able to wait one’s turn.

What causes comorbid ADHD and anxiety?

Like many other disorders, research scientists are unsure about the exact cause of ADHD or anxiety, though some evidence suggests that genetics and environmental factors can increase a person’s risk of developing ADHD.

Genetic causes of ADHD comorbidity

People who have someone in the family with ADHD are more likely to develop it themselves. A genome-wide association study looked at the different genes that may be involved in the development of ADHD and found that 12 major areas or loci were associated with ADHD. These genes can express abnormalities that may cause decreased brain volume and affect nerve development. Another major genetic connection is dysfunction in the system that controls dopamine, a vital neurotransmitter that affects cognition, motivation, mood, attention, and learning. 

Environmental causes of ADHD comorbidity

Several environmental factors at different stages of a child’s development (including in utero) have been associated with an increased incidence of ADHD.  Premature birth increases a person’s risk. Being deprived of oxygen right before, during, and after birth can also increase risk.

Other environmental factors that increase risk of ADHD comorbidity during early development include:

• Inappropriate nutrition for brain development 
• Exposure to lead and other neurotoxic, heavy metals 
• Exposure to pesticides
• Tobacco use during pregnancy
• Alcohol use during pregnancy

Physiological causes of ADHD

People with ADHD may have multiple altered neural pathways that can explain the behaviors that typify the disorder. For example, children with ADHD have been shown in brain-imaging studies to have atypical wiring in reward centers of the brain that control behaviors like impulsivity. While genetic and environmental factors can cause these alterations, biological risk factors and neurological injuries also may play a role in developing ADHD.

ADHD, anxiety disorder, plus depression comorbidity

Many people with ADHD also are managing a secondary condition, or 'comorbidity'. Depression, anxiety disorders, and personality disorders are all common psychiatric comorbidities that can co-occur with child or adult ADHD. Someone may also have a co-occurring learning disorder, stress disorder, or mood disorder. 

ADHD is thought to be one of the most common neurodevelopmental disorders, with an approximate prevalence rate of 5 to 7% of all children—or one out of every fourteen to twenty children.

ADHD and anxiety disorders comorbidity

Anxiety disorders can exacerbate the unpleasant effects of ADHD symptoms and might discourage someone from engaging in activities—such as support groups or therapy—that can help with both disorders. Up to half of people with ADHD experience an anxiety disorder.

ADHD and depression comorbidity

People who experience difficulty in professional or social settings may develop a sense of sadness and lack of hope. This, if left unaddressed, can manifest into persistent depressive patterns. Almost two in five people with ADHD experience a comorbid mood disorder.

Treatment for attention-deficit/hyperactivity disorder, anxiety disorders, and comorbid psychiatric disorders

ADHD may have some overlapping symptoms with anxiety disorders or depression. A healthcare provider can be a helpful resource for accurately evaluating your symptoms and providing a correct diagnosis.

Treatment for ADHD, anxiety disorders, or depression is generally something that should not be delayed. Those who receive anxiety/depression and ADHD treatment can learn how to cope with challenges so they can continue to live their lives with more functional outcomes—delaying treatment can also delay one’s progress in areas of life such as work, relationships, and education.

Effective ADHD treatment options that can also be effective for treating co-occurring mental disorders like anxiety include:

• Individual or family therapy with a mental health professional
• Cognitive behavioral therapy
• Antidepressant medication
• Anti-anxiety medication

Children and adults who are diagnosed with ADHD can experience difficulties in many areas of life, including at work, school, and in personal relationships. Adding to these challenges, people who live with ADHD might also be diagnosed with coexisting mental health conditions such as anxiety disorder, mood disorder, and substance use disorder. 

If you are struggling with substance use, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) to receive support and resources. Support is available 24/7.

If you believe that you are managing comorbidity along with ADHD, you can make an appointment with a mental health professional to get the support you need.

How can online therapy support those living with ADHD, anxiety disorder, and other mental health disorders? 

When you are managing any form of mental health disorder, making appointments and finding the right therapist can feel like “just another challenge” to add to your long list of daily tasks. If you are worried that you do not have the time or mental fortitude to meet with an in-person therapist, you might consider online therapy as an alternative for managing ADHD and anxiety.

With online therapy through platforms such as BetterHelp, you can participate in therapy remotely through video calls, voice calls, or in-app messaging. Research suggests that behavior therapy—whether in person or online—can be a beneficial outlet for adults experiencing symptoms of ADHD and anxiety. 

Cognitive behavioral therapy for navigating ADHD and anxiety and their symptoms

Cognitive behavioral therapy, for example, is a widely utilized type of talk therapy that can help individuals reframe negative thought patterns, like those that can lead to maladaptive emotions and behaviors related to ADHD and anxiety. 

If you are looking for support as you navigate ADHD and anxiety or believe you may be dealing with untreated adolescent or adult ADHD or another mental health–related concern, you might consider reaching out to a licensed therapist online.