10 Minutes

Attention deficit hyperactivity disorder (ADHD) and anxiety are two common mental health disorders affecting millions of individuals across various age groups. Both disorders are multifaceted and complex, often co-existing and creating a problematic interplay that complicates the diagnosis and management.

ADHD primarily includes symptoms of hyperactivity, inattention, and impulsivity, whereas anxiety is characterized by excessive worry, fear, and associated behavioral disruptions. The co-occurrence of these issues is not uncommon, as a substantial portion of people diagnosed with ADHD also suffer from anxiety disorder. [1] Understanding the intricate relationship between ADHD and anxiety and their compound impact on individuals can contribute to effective management.

Individuals with ADHD often find it hard to identify the underlying symptoms of anxiety as both conditions can mirror one another.[2] ADHD primarily affects their ability to concentrate, triggering various behavioral symptoms such as the following:

  • Forgetfulness
  • Hyperactivity
  • Unable to sit still
  • Easy distraction
  • Difficulty completing tasks
  • Trouble with time management and organization

Anxiety disorders, on the other hand, often revolve around worry and stress. These mental health issues include a sense of uneasiness or worry that is consistent and the potential to become intense with time. Anxiety disorders can often affect an individual’s well-being, relationships, employment, academics, and other areas of life. Following are some symptoms of anxiety disorder:

  • Tension and headaches
  • Fatigue
  • Tearfulness
  • Emotional exhaustion
  • Extreme stress
  • Impatience
  • Irritability and anger
  • Persistent fear or worry

The symptoms of ADHD and performance anxiety often differ, but may overlap, making it difficult for a person to ascertain whether it is ADHD or anxiety they suffer from. For instance, ADHD and anxiety can both lead to poor concentration, making task completion difficult. Moreover, both disorders can also make a person restless and struggle to settle down.

Scientists are still exploring the potential causes that link ADHD and anxiety. So far, the relationship seems to be driven by a combination of environmental, neurobiological, and genetic factors.

Environmental Factors

Various environmental factors, such as premature birth, prenatal exposure to toxins, and early childhood issues, are known to increase the risk of developing ADHD and anxiety.[3] Chronic stress due to previous trauma or ongoing stressful events can also cause their development or exacerbation.

Genetic Factors

Research has highlighted the significant role of genetics in determining the risk of ADHD and anxiety. [4] Various family studies have shown that people with a first-degree relative struggling with an anxiety disorder or ADHD are at an increased risk of acquiring these conditions. Many twin studies also confirm the heritability of both problems, suggesting a genetic component behind their occurrence.

Psychosocial Factors

The complex interplay between ADHD and anxiety is also influenced by various psychosocial factors, such as peer relationships, family dynamics, occupational stress, and academic issues. Children with underlying ADHD may face difficulties in social settings and school, triggering anxiety and stress. Conversely, chronic anxiety disorders can impair their performance and concentration, triggering ADHD symptoms.

Neurobiological Factors

Neuroimaging studies have highlighted various functional and structural differences in the brains of people with anxiety and ADHD. ADHD can cause abnormalities in the basal ganglia, prefrontal cortex, and cerebellum, leading to issues in impulse control and executive functions. Anxiety disorders, on the other hand, cause changes in the limbic system and amygdala, impacting how an individual processes fear and emotions.

The co-occurrence of anxiety and ADHD can lead to a profound impact on an individual and their families. Both conditions may affect various aspects of life, such as work performance, academics, social relationships, and overall quality of life.

Employment and Academic Issues

Children with anxiety and ADHD often face issues in school due to poor attention, organization, and time management. The underlying anxiety further hinders their academic performance through avoidant behaviors, excessive stress, and test anxiety. Adults with these disorders may also find it difficult to adjust in their workplace due to problems like poor focus, difficulty meeting deadlines, and issues with stress management.

Behavioral & Emotional Issues

The combination of ADHD and anxiety can trigger various behavioral issues and emotional dysregulation. Their co-existence may cause irritability, frustration, and mood swings. Moreover, they also force an individual to practice avoidant behaviors and acquire maladaptive coping strategies to manage their symptoms, such as drug use. These behaviors not only impact the overall mental health but also create additional challenges for treatment.

Interpersonal and Social Difficulties

Social interactions can be challenging to navigate for people with underlying ADHD and anxiety. Certain ADHD symptoms, like hyperactivity and impulsivity, may cause social conflicts and problems in establishing and maintaining good relations with others. The co-occurrence of anxiety with these symptoms exacerbates the underlying issues, triggering social withdrawal and problems with assertive communication. Ultimately, ADHD and anxiety contribute to poorer self-esteem and feelings of isolation.

Family Dynamics

The occurrence of ADHD and anxiety in a person can negatively affect the entire family. For instance, parents may experience frustration and stress in managing their child’s behaviors and symptoms. The siblings of such a child may feel overwhelmed or neglected by the excessive demands placed on parents. ADHD and anxiety can also strain relationships leading to communication breakdowns and conflicts. For such families to survive, providing education and support becomes crucial.

Effective management for people with co-existing ADHD and anxiety involves a multimodal approach to address both issues simultaneously. Following are some treatment options to consider:

Behavioral Interventions

Behavioral interventions, such as cognitive behavioral therapy (CBT), are well-known treatments for anxiety disorders tailored to an individual’s specific needs. CBT focuses on identifying and replacing negative thought patterns and developing healthy coping strategies. The therapy also exposes an individual to anxiety-provoking situations to help them regulate their response. In addition to CBT, behavior modification and training programs for ADHD management can also help manage the underlying symptoms of inattention and hyperactivity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494390/#:~:text=Reductions%20in%20core%20symptoms%20of,such%20as%20depression%20and%20anxiety.

Medication

Pharmacological treatment is an essential component for people looking for answers to how to calm ADHD anxiety. Stimulant medications, such as amphetamines and methylphenidate, are commonly used to control ADHD symptoms and reduce impulsivity and hyperactivity. Non-stimulant medicines, such as guanfacine and atomoxetine, have also been known to manage symptoms in some instances.

In terms of anxiety, experts may prescribe selective serotonin reuptake inhibitors (SSRIs) along with other anti-anxiety treatments. Careful monitoring is essential to adjust dosages, watch for side effects, and optimize treatment outcomes.

Lifestyle Modifications

Certain lifestyle changes can play an essential role in managing the symptoms of ADHD and anxiety. For instance, adequate sleep, a healthy diet, stress management, and regular physical activity can reduce symptoms and improve overall well-being. Adopting organizational strategies and establishing daily routines can also support symptom management.

Following are some lifestyle modifications to consider to manage ADHD and anxiety:

  • Learning Triggers: Factors like calling someone on the phone or speaking in public may trigger anxiety in certain people. Recognizing these triggers can make it easy to manage them with healthy coping strategies.
  • Adequate Sleep: Aim to get 7 to 8 hours of sleep every night. People with ADHD and anxiety can particularly struggle to get peaceful sleep at night, which further exacerbates their symptoms. Work with a doctor to improve overall sleep hygiene to minimize these issues.
  • Eat Healthily: Eating recklessly can worsen the symptoms of ADHD and anxiety, especially if certain foods trigger them. Experts recommend trying an elimination diet to identify potential triggers and plan out a balanced diet plan to ensure you are getting enough nutrients and minerals.
  • Creating a Schedule: Tackle poor concentration and the inability to complete tasks by creating a schedule. Forming a realistic schedule and sticking to it can ensure you complete your tasks in time. Achieving this can also reduce the associated anxiety.
  • Maintaining a Journal: Write a journal to clear your mind and pinpoint things you wish to discuss with a therapist or doctor.
  • Exercising Regularly: Studies support the role of exercise in lowering anxiety and improving overall mood and happiness levels. [5] High-intensity workouts are known to be more effective than low-intensity exercise. However, if you are a beginner, take things slow and start with mild to moderate physical activity at least 30 minutes a day.

To effectively cope with ADHD and anxiety symptoms, experts recommend coping strategies that focus on mindfulness techniques to improve focus, cultivate a sense of peace, and reduce stress.

Kickstart your day with mindfulness.

Consider beginning your day with a mindfulness technique, such as gentle yoga, deep breathing, or meditation. [6] This habit can ground you and give you a solid base for starting the day on a calmer note.

Practice mindful eating.

In addition to eating healthily, try eating more mindfully. Eat slowly, savoring each bite while appreciating the textures and flavors of each food you eat. This practice can make mealtimes more pleasant and reduce anxiety and stress.

Take mindful work breaks.

Try taking short breaks during study or work to practice mindfulness. This break can involve anything, such as a short meditative session, a few minutes of stretching, or a brief walking session. These little breaks may seem insignificant but can reset your focus while boosting mental health.

Try mindful listening.

Divert your full attention to the person who is speaking to you. Observe their tone, words, and body language instead of preparing an immediate response. Doing so can improve relationships, reduce conflicts, and reduce social anxiety.

Incorporate mindful movements.

Activities like tai chi, stretching, and walking can help you focus as you move your body and breathe while reducing the symptoms of ADHD and anxiety.

Take out time to reflect.

Always end your day with a few minutes of reflection. Think about your day, things you are grateful for, and what you have learned during the day. These reflective practices can shift your focus from anxiety and worries to positive growth and experiences, boosting mental health.

Choose a mindfulness reminder.

Choose a visual reminder or object to practice mindfulness throughout the day. This object can be anything, such as a sticky note, a desktop wallpaper, a picture, or a piece of jewelry. The idea is to breathe deeply and practice a few minutes of relaxation whenever you see this reminder.

Try mindful decluttering.

Take time to tidy up your workspace and house. Remember that an organized environment reduces stress and improves focus and concentration, which helps with anxiety and ADHD.

Come up with a mindful bedtime.

Design a soothing nighttime routine to slowly shut down your body, preparing it for sleep and rejuvenation. Some activities to include in your bedtime routine include journaling, reading, or listening to relaxing music. Try avoiding screens at least 60 minutes before bedtime to improve sleep quality.

Respond, not react

Take a break before responding to a stressful situation or trigger. This little break can help you 

process your response less impulsively and more thoughtfully, reducing anxiety levels and improving healthy decision-making.

Wrapping Up

The co-existence of ADHD and anxiety can bring unique challenges, often requiring an individualized and comprehensive approach to management. Understanding the associated complexities, such as the causes, overlapping symptoms, and impacts, can help people design an effective management plan. An effective treatment plan requires a fair balance of pharmacological, behavioral, and psychosocial strategies to achieve the best clinical outcomes in the long run.

1 Gair SL, Brown HR, Kang S, Grabell AS, Harvey EA. Early Development of Comorbidity Between Symptoms of ADHD and Anxiety. Res Child Adolesc Psychopathol. 2021 Mar;49(3):311-323. doi: 10.1007/s10802-020-00724-6. Epub 2021 Jan 6. PMID: 33404952; PMCID: PMC7878348.

2 D’Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan. Int J Psychiatry Clin Pract. 2019 Nov;23(4):238-244. doi: 10.1080/13651501.2019.1628277. Epub 2019 Jun 24. PMID: 31232613.

3 Froehlich TE, Anixt JS, Loe IM, Chirdkiatgumchai V, Kuan L, Gilman RC. Update on environmental risk factors for attention-deficit/hyperactivity disorder. Curr Psychiatry Rep. 2011 Oct;13(5):333-44. doi: 10.1007/s11920-011-0221-3. PMID: 21779823; PMCID: PMC3277258.

4 Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry. 2019 Apr;24(4):562-575. doi: 10.1038/s41380-018-0070-0. Epub 2018 Jun 11. PMID: 29892054; PMCID: PMC6477889.

5 Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Serv Res. 2018 Jul 16;18(1):559. doi: 10.1186/s12913-018-3313-5. PMID: 30012142; PMCID: PMC6048763.

6 Mitchell JT, Zylowska L, Kollins SH. Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions. Cogn Behav Pract. 2015 May;22(2):172-191. doi: 10.1016/j.cbpra.2014.10.002. PMID: 25908900; PMCID: PMC4403871.

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