ADHD and Anxiety

By Roberto Olivardia, Ph.D.

ADHD (Attention Deficit Hyperactivity Disorder) rarely travels alone. It is more the rule rather than the exception that you will see an accompanying condition or disorder, such as anxiety. About 30% of those with ADHD will have significant experiences with anxiety. Understanding the lived experience of ADHD makes it easy to understand how anxiety could be along for the ride. The problems with regulating attention, as well as problems with executive functioning, affects virtually every life domain.  Therefore, people with ADHD can often feel behind, overwhelmed, and stressed. This is especially true if they do not have a proper diagnosis or resources to work through these challenges. In addition, even if the anxiety is not caused by ADHD, it can exacerbate ADHD symptoms. 

Jim* is a 16-year-old high school junior with ADHD.  He reports: “I always feel a baseline level of anxiety. Even when things feel in control, I am worried that at any given moment, I have forgotten something or are actively procrastinating on something I can’t find the motivation to do.” Deidre*, 18, feels similarly. “I have to put in 2-3 times more energy to get something done than my peers, it can be exhausting. It is hard having ADHD and being a perfectionist. I wonder if I am a perfectionist because I have ADHD.” Jim and Deidre’s experiences are ones most, if not all, people with ADHD can relate to. As someone with ADHD myself, I can add numerous personal examples, but this is a blog post, not a novel.   

In addition to the anxiety caused by ADHD symptoms, people with ADHD could have anxiety disorders, such as Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, and panic disorder. Any time there is more than one diagnosis in the picture, it requires a careful examination. Does one cause the other? Are they both independent of each other in their etiology, yet will still impact each other? How does one navigate treatment? Do you treat the ADHD, the anxiety, both, and how?  

Many times, when there is a comorbidity, one diagnosis may not even be identified. There are many overlapping symptoms between ADHD and anxiety. It is important to distinguish whether a symptom is more related to ADHD or anxiety, or as I often say “Who is driving the bus?” This can inform treatment. When there is more than one condition experienced, it can feel bigger than just the sum of its parts. Instead of 1+1=2, it is more like 1+1=4. The good news is that with proper identification and diagnosis, there are empirically derived treatment strategies that help people like Jim and Deidre. Many of the tools used to conquer anxiety can truly benefit anyone. So, in this way I say to my patients they are getting a head start.  

*Names have been changed to protect identities 

 

If you are interested in learning more on this subject, I will be presenting a free webinar on August 19th. Click here to learn more and sign up. 

About the Author

Roberto Olivardia, Ph.D.

Dr. Roberto Olivardia is a clinical instructor of psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of ADHD, executive functioning issues, and issues that face students with dyslexia. He also specializes in the treatment of eating disorders, body dysmorphic disorder obsessive-compulsive disorder (OCD) and personality disorders. He currently serves on the professional advisory boards for CHADD, the Attention Deficit Disorder Association (ADDA), and the National Association for Males with Eating Disorders.

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