Many people struggle with ADHD. Studies estimate that as many as 5-10% of children and up to 5% of adults are diagnosed with this condition. Likewise, anxiety is also a common condition, impacting upwards of 30% of people at some point in their life. So, yes, it makes sense that people with ADHD would also have anxiety. In fact, about 50% of people with ADHD also have another diagnosis, which may include anxiety or depression.
An Accurate Diagnosis is Important
Some people who seem to have ADHD may have anxiety instead. For example, the inattention, impulsivity, and restlessness that characterize ADHD can be caused by worry and restlessness. Worry and restlessness are hallmark symptoms of anxiety disorders. Distinguishing between ADHD and an anxiety disorder requires a full evaluation by a professional, such as a psychologist, psychiatric nurse practitioner, or psychiatrist who is trained and experienced in these areas.
Rumination can Look Like ADHD.
Rumination happens when people overthink or become preoccupied with worries and concerns. It can be quite distracting and upsetting for people. For example, Clyde, a second-grader, was often restlessness in class. He stood frequently, and rushed through his work without looking at the quality. Thus, his parents and teachers worried that he had ADHD.
However, this wasn’t clearly the case. Clyde had been worrying about his grandfather, as he was very ill. Clyde also felt nervous about his homework, and tried to avoid it by not doing it or rushing through it. He ruminated about his parents and dogs when he was at school, wondering if they were ok. Thus, he was not listening very well when his teacher was talking or when he was supposed to be doing his work. After undergoing a thorough evaluation, Clyde was determined to have an anxiety disorder, which interfered with his ability to concentrate and work steadily at school and home.
ADHD Can Cause Anxiety
ADHD is a very stressful disorder. This condition makes it harder to concentrate, and it often means that people work harder to have the same success as everyone else. People with ADHD may find themselves in bad situations due to their difficulty regulating impulsivity. They may say things they didn’t mean, lose their temper easily, and struggle in relationships. They may struggle with school work work performance. All of these scenarios are stressful, and it is no wonder that anxiety is higher in a person with ADHD.
For example, James had trouble falling asleep at night. He laid in bed while the thoughts were spinning in his head. He worried about his homework, and whether he would “get in trouble” the next day at school. His was often impulsive, loud, and overactive in the classroom. Yet, he was frequently surprised and embarrassed when he got into trouble. He often got low grades, even though he studied hard. James was later determined to have ADHD, as well as anxiety. The problems that he faced with ADHD certainly increased his anxiety.
Which came first, the chicken or the egg? Or which to treat first?
With careful testing and an accurate diagnosis, this information will guide your provider’s decision on which condition is present, ADHD or anxiety. Often, both conditions occur separately at the same time. This is called, “co-morbidity” in the medical jargon. Although the word sounds scary, it is really a very common occurrence. For example, often times depression and anxiety go together. In this case, the same medications are often effective to treat both conditions.
With a common comorbidity, like ADHD and anxiety, the provider is faced with the age-old dilemma, “Which came first? The chicken or the egg? (Anxiety or ADHD). If an anxious person also has ADHD, medications used to control ADHD symptoms can worsen their anxiety. In these cases, it is important for the provider to treat the anxiety first.
Sometimes treating anxiety alone will improve ADHD symptoms significantly. Along with behavioral interventions, sometimes ADHD medicines are not needed. In other cases, once the anxiety symptoms are treated and ADHD symptoms are still causing problems, ADHD medications can be safely started with a lower chance of worsening anxiety.
If it sounds complicated, well, it is.
But to a provider who specializes in treating ADHD and mood disorders, these are common situations. We take a lot of satisfaction in doing the detective work to find the most effective solutions. There is sometimes a period of trial and error with finding the most effective treatments for everyone. It takes time, patience and careful listening to determine the best course of action taken in the right order. But with a committed team approach, you and your providers can find the best treatment for anxiety and/or ADHD, whether it is just one or both conditions you are dealing with.
What should you do if you suspect that you (or your child) have ADHD and Anxiety?
- Make sure that you are paying attention to both symptoms. Although one condition can make the other one worse, it is often important to understand (and treat) both of them.
- Consider an evaluation by a professional skilled at identifying (and treating) both conditions.
- Communicate well with your providers. Make sure you notice and explain what situations or factors make your symptoms better or worse.
- Communicate any side effects that you have from medications or other interventions. These effects are very important. If your provider doesn’t listen or take your concerns seriously, then it is time to keep looking for another provider with whom you can work with more easily.
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