ADHD And Anxiety: Are They Connected?

While attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders are separate conditions, they often have overlapping symptoms, and it is not uncommon to be diagnosed with both. ADHD and anxiety comorbidity can create unique challenges for those living with these conditions, and can have significant implications for treatment.

Here, you’ll learn why anxiety and ADHD so often coexist, as well as understand how symptoms of each can interact with one another. You’ll also find helpful tips for managing them, and available treatment options for both. 

Understanding attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. 

Common symptoms of ADHD:

• Difficulty sustaining attention
• Fidgeting or restlessness
• Impulsive decision-making
• Challenges with organization and time management 

ADHD is frequently diagnosed in childhood and persists into adulthood in approximately half of diagnosed cases. Symptoms can vary between individuals, and often evolve over time. ADHD can often be managed effectively with treatment, which can include medication, psychoeducation, and talk therapy.

Understanding anxiety disorders

Anxiety disorders encompass a range of mental health conditions characterized by persistent and excessive fear, worry, and related behavioral disturbances. There are several types, such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and specific phobias. 

Common symptoms of anxiety:

• Excessive worrying or irrational fears
• Agitation, irritation, or restlessness
• Sleep disturbances
• Trouble concentrating
• Physical symptoms such as increased heart rate, trembling, or sweating
• Avoidance of situations that might induce anxiety

Effective treatment for anxiety disorders typically involves a combination of therapy, such as cognitive-behavioral therapy (CBT), medication, and lifestyle modifications. This often involves learning to identify triggers, maintaining healthy habits, and practicing appropriate coping skills and relaxation techniques. 

Understanding the connection between ADHD and anxiety

Developmental factors

Both ADHD and anxiety can originate from certain developmental issues. For example, pretermbirth is known to increase the risk for both conditions. Additionally, adverse childhood experiences can impact brain development and contribute to the emergence of ADHD and anxiety.

Neurobiological factors

ADHD and anxiety have some common brain dysfunctions: Neurotransmitter imbalances, particularly involving dopamine and serotonin, play a role in both conditions. These neurotransmitters are crucial for controlling mood, attention, and emotional responses, and their imbalances can contribute to the symptoms observed in both ADHD and anxiety.

Bidirectional effects

Anxiety symptoms can cause or exacerbate ADHD symptoms like distractibility and restlessness; similarly, the impairments associated with ADHD, such as academic and occupational difficulties, social struggles, and organizational challenges, can lead to increased stress and anxiety. This is called a bidirectional relationship, meaning that each condition influences and exacerbates the symptoms of the other.

Impact of combined ADHD and anxiety

Research indicates that when anxiety and ADHD occur together, they create unique brain changes that go beyond the individual effects of each condition, resulting in a more complex impact on brain function and behavior than if each disorder were present alone. 

Here are a few key takeaways from the current body of research:

• ADHD and anxiety can have significant implications for a person’s ability to function in academic and professional contexts. The organizational difficulties that often accompany ADHD (e.g. trouble managing time or keeping track of tasks) can trigger anxiety, which may in turn worsen ADHD symptoms. Test anxiety, for example, is known to be higher in those with ADHD.
• The presence of anxiety in individuals with ADHD significantly alters brain activity. The presence of anxiety in individuals with ADHD significantly alters brain activity—particularly in areas critical for working memory and information processing—leading to lower neural activity in key regions during tasks that require these functions. This means that individuals may experience greater difficulties with tasks that require concentration, organization, and memory.
• ADHD and anxiety comorbidity can alter symptoms and outlook across different life stages. In children, anxiety can counteract the usual inhibitory dysfunction seen in ADHD. Adolescents may find that anxiety worsens the working memory deficits associated with ADHD, while anxiety may exacerbate sleep deficits in adults with ADHD.
• Youth with ADHD and anxiety diagnoses may experience unique challenges related to social functioning. such as reduced social skills and increased social problems. These challenges are influenced by various factors, including the severity of anxiety symptoms, age, sex, ADHD subtype, and other mental health comorbidities.
• In people with ADHD, anxiety can sometimes help control impulsive behaviors. This means that anxiety might make it easier for them to stop and think before acting. 

ADHD and anxiety: management and treatment

Treating ADHD and anxiety can be complex, requiring a multifaceted approach that addresses both conditions simultaneously. Here are some key components of an effective treatment plan:

Medication

Medications can play a crucial role in managing symptoms of both ADHD and anxiety. Stimulant and non-stimulant medications are commonly prescribed for ADHD, while antidepressants and anti-anxiety drugs may be used to manage anxiety symptoms. 

Note, however, that the stimulant medications often used to treat ADHD can make anxiety symptoms worse; as such, it’s important to carefully select and monitor medications to ensure they effectively address both conditions without exacerbating either.

Psychotherapy

Psychotherapy is a vital component in treating both ADHD and anxiety. There are a few types of therapy that may be especially beneficial for those living with both conditions:

• Cognitive behavioral therapy (CBT): CBT helps individuals develop coping strategies, improve executive functioning, and manage symptoms. In CBT, individuals learn to identify and alter the unhelpful thoughts and behavior that contribute to their challenges, helping them improve their overall functioning. It is widely regarded as an effective treatment for ADHD and anxiety alike. 
• Mindfulness-Based Stress Reduction (MBSR): MBSR involves using targeted interventions to help individuals cultivate mindfulness, giving them greater control over their thoughts, feelings, and behaviors. This may include body scanning, mindfulness meditation, and yoga. MBSR has been found effective for treating both anxiety and ADHD.
• Psychodynamic therapy (PDT): Psychodynamic therapy is another approach that has been clinically validated for treating ADHD and anxiety disorders. PDT focuses on developing self-awareness and emotional control by helping them recognize the unconscious processes that may be influencing their thoughts and behavior.

Skills training

Skills training can be beneficial in managing ADHD symptoms. This might include time management techniques, self-monitoring practices, environmental modification, and anxiety coping skills. Consistent implementation of these strategies can help improve daily functioning and reduce stress for those with ADHD and anxiety.

Lifestyle modifications

• Regular physical activity: Physical exercise has been found to help manage symptoms of ADHD and anxiety, likely due to how it enhances neurotransmitter function, reduces stress, and improves overall brain health. Thus, it may be important for individuals with these disorders to prioritize vigorous physical exercise for at least 30 minutes per day.
• Balanced diet: Research has found that a nutritious diet can positively impact the symptoms of ADHD and anxiety by stabilizing blood sugar levels, reducing inflammation, and supporting optimal brain function.
• Sleep: Sufficient sleep are essential components of overall well-being, and are known to be beneficial for improving symptoms of both anxiety and ADHD. Good sleep hygiene has been found to significantly improve symptoms in children with ADHD due to improved sleep quality, while similar effects have been observed in individuals with anxiety disorders.

Online counseling for ADHD and anxiety

While medication management may require consultation with a doctor, online therapy may be a worthwhile option for other components of treatment. Through platforms like BetterHelp, you can attend weekly sessions with a licensed mental health professional specializing in treating ADHD and anxiety. 

Extensive research has found ADHD can respond well to online interventions, with similar findings indicating the effectiveness of online CBT for treating anxiety disorders. 

Many prefer the convenience, flexibility, and relative affordability of BetterHelp, and with tools and features like guided journaling, group sessions, and digital CBT worksheets, you can make progress faster and get the most out of your time in therapy.