ADHD and anxiety

Why they overlap so much

Some of the overlap is shared biology. Much of it is lived experience. If your working memory drops things, you learn to worry constantly so nothing is forgotten. If you are often late, unprepared or in trouble, you learn to dread every meeting. If you have been criticised for decades, you scan for the next criticism. Anxiety in adult ADHD is frequently a rational adaptation to an unreliable brain, which is why treating the anxiety alone tends to give partial relief: the generator is still running.

Symptoms that look the same

• Poor concentration: in anxiety, because worry occupies the mind; in ADHD, because attention itself is hard to regulate.
• Restlessness: anxious tension versus ADHD's need for movement and stimulation.
• Sleep problems: worry keeping you awake versus a racing, unbored ADHD brain and a delayed body clock.
• Avoidance: of feared situations in anxiety, of boring or effortful tasks in ADHD.
• Irritability, fatigue, overwhelm: common to both.

Clues that point to each

Clinicians look at onset, pattern and what happens when the stressor lifts.

• Onset. ADHD symptoms are present before age 12, even if they were called something else at the time. Anxiety can start at any age and often has an identifiable trigger.
• The holiday test. Anxiety often eases when the pressure is off. ADHD inattention persists on the beach.
• Interest. An anxious person can usually concentrate on something absorbing. A person with ADHD can too, but cannot reliably concentrate on something dull no matter how calm they are.
• Content of worry. Anxiety worries about what might happen. ADHD anxiety is disproportionately about what you have forgotten, lost or failed to do.
• Response to treatment. If anxiety treatment helps but the disorganisation, lateness and distractibility remain, ADHD is worth assessing.

Which to treat first

There is no single rule. If anxiety is severe, treating it first makes assessment and everything else easier. If the anxiety is clearly downstream of ADHD chaos, treating the ADHD often reduces anxiety without direct treatment. Many clinicians treat both in parallel: ADHD treatment plus cognitive behavioural therapy adapted for ADHD, which means shorter sessions, written summaries, and more focus on doing than on insight. The Australian ADHD Guideline recommends assessing for anxiety and other co-occurring conditions as part of every ADHD assessment.

A note on medication

People with anxiety are sometimes told ADHD medication will make it worse. For some it does, and for many it does the opposite, because a brain that is finally reliable has less to fear. This is an individual decision for a prescribing clinician who knows your history.

What Inner Help does

Our practitioners work with both conditions together rather than treating anxiety in isolation. If you have been treated for anxiety for years and still feel the ground is unreliable, the free ADHD self-test is a reasonable next step, and an assessment can settle the question.

Frequently asked questions