How can you tell the difference between ADHD and anxiety?

Key differences: In anxiety, difficulty concentrating happens BECAUSE of worry and rumination. In ADHD, it's a core symptom present across all contexts, even when not anxious. ADHD symptoms start in childhood (before age 12), while anxiety often develops later. ADHD involves chronic executive dysfunction (organization, time management), while anxiety centers on excessive worry about specific concerns.

Can you have both ADHD and anxiety?

Yes. About 50% of people with ADHD also have an anxiety disorder. This comorbidity is common because ADHD often leads to anxiety (fear of failure, social difficulties) and both conditions share some overlapping symptoms like restlessness and difficulty concentrating.

Does ADHD cause anxiety?

ADHD can contribute to anxiety development. Chronic struggles with organization, missed deadlines, social mishaps, and repeated failures create ongoing stress that can develop into an anxiety disorder. This is called secondary anxiety—anxiety that develops as a consequence of ADHD.

ADHD vs Anxiety: How to Tell the Difference

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ADHD and anxiety both cause difficulty concentrating and restlessness, but differ in key ways: anxiety-related concentration problems stem from worry and rumination, while ADHD inattention is present across all contexts regardless of anxiety level, with 50% of people having both conditions, according to research by Dr. Ryan Sultan at Columbia University.

Understanding the Overlap

By Dr. Ryan S. Sultan, Assistant Professor of Clinical Psychiatry at Columbia University
NIH-Funded ADHD Researcher | 411-Cited Publications

One of the most common diagnostic challenges in psychiatry: Is it ADHD, anxiety, or both?

Both conditions can present with restlessness, difficulty concentrating, and task avoidance—leading to frequent misdiagnosis. Understanding the key differences is crucial for proper treatment.

Based on Dr. Sultan's appearance on the Your Anxiety Toolkit podcast (Episode 381) discussing ADHD vs. Anxiety.

Why They're Often Confused

Overlapping Symptoms

Symptom	Appears in ADHD	Appears in Anxiety
Difficulty Concentrating	✓ Yes	✓ Yes
Restlessness	✓ Yes (hyperactivity)	✓ Yes (tension, agitation)
Task Avoidance	✓ Yes (executive dysfunction)	✓ Yes (avoidance of anxiety triggers)
Forgetfulness	✓ Yes (working memory)	✓ Yes (preoccupied with worry)
Sleep Problems	✓ Yes (racing thoughts)	✓ Yes (worry at night)
Irritability	✓ Yes (frustration tolerance)	✓ Yes (nervous tension)

⚠️ CRITICAL DISTINCTION: Having these symptoms doesn't mean you have both conditions. The KEY is understanding why the symptom occurs and when it started.

Key Differences: ADHD vs Anxiety

1. Source of Concentration Problems

🧠 ADHD Inattention:

Core symptom present across ALL contexts
Difficulty sustaining attention even when NOT anxious
Easily distracted by external stimuli
Trouble with boring tasks regardless of importance
Can hyperfocus on interesting topics
"My mind wanders even when I'm calm and relaxed"

😰 Anxiety-Related Concentration Problems:

Secondary symptom driven by worry
Concentration improves when anxiety decreases
Distracted by internal worries, not external stimuli
Can focus when anxiety-provoking situations are avoided
Rumination prevents attention shifts
"I can't concentrate because I'm worrying"

Dr. Sultan's Clinical Pearl: "In anxiety, difficulty concentrating happens BECAUSE of worry and rumination. In ADHD, it's a core symptom present across all contexts, even when not anxious. Ask: 'When you're relaxed and happy, can you still not focus?' If yes, think ADHD."

2. Age of Onset

ADHD	Anxiety Disorders
Onset: Childhood (before age 12) Pattern: Symptoms present since elementary school Developmental history: "Always been this way" School struggles from early grades Consistent across settings (home, school, activities) Often diagnosed in childhood (or should have been)	Onset: Variable (can develop at any age) Pattern: Often emerges in adolescence or adulthood Developmental history: "Started around age X" May have done well in school before anxiety developed Often triggered by life stressors Can have clear onset point

ADHD

Anxiety Disorders

Onset: Childhood (before age 12)

Pattern: Symptoms present since elementary school

Developmental history:

"Always been this way"
School struggles from early grades
Consistent across settings (home, school, activities)
Often diagnosed in childhood (or should have been)

Onset: Variable (can develop at any age)

Pattern: Often emerges in adolescence or adulthood

Developmental history:

"Started around age X"
May have done well in school before anxiety developed
Often triggered by life stressors
Can have clear onset point

Diagnostic Requirement: For ADHD diagnosis, symptoms MUST have been present before age 12. If concentration problems only started at age 20, it's not ADHD (though adult-diagnosed ADHD means symptoms were present in childhood but unrecognized).

3. Pattern of Symptoms

ADHD:

Chronic and pervasive - present most days, across situations
Symptoms relatively stable (don't fluctuate daily based on stress)
Executive dysfunction: planning, organization, time management struggles
Impulsivity: interrupting, blurting out, difficulty waiting
Restlessness: physical need to move, fidget

Anxiety:

Episodic or situational - worsens with specific triggers
Symptoms fluctuate based on stress level and situations
Excessive worry about specific concerns (health, performance, social)
Physical symptoms: racing heart, shortness of breath, muscle tension
Avoidance of anxiety-provoking situations

4. Content of Thoughts

ADHD: Mind wanders to random, unrelated topics

"I was thinking about what to have for dinner, then remembered a funny video, then noticed the bird outside..."
Thoughts jump rapidly between topics
Not particularly negative or worry-focused

Anxiety: Mind fixates on worries

"What if I fail? What if something bad happens? Did I make a mistake?"
Repetitive, circular thinking (rumination)
Future-focused catastrophizing

5. Response to Stress

ADHD: Symptoms often IMPROVE under pressure

Crisis mode can trigger hyperfocus
Deadlines create motivation (adrenaline helps focus)
Emergency situations: peak performance

Anxiety: Symptoms WORSEN under pressure

Stress intensifies anxiety
Performance degrades under pressure
Avoidance increases when stakes are high

Comorbidity: Having Both

The Statistics:

50% of people with ADHD also have an anxiety disorder
30% of people with anxiety disorders have ADHD
This comorbidity is one of the most common in psychiatry

Why They Co-Occur

1. ADHD Leads to Anxiety (Secondary Anxiety)

Chronic struggles with ADHD create anxiety-provoking situations:

Academic failures → fear of school, test anxiety
Social mishaps (interrupting, forgetting) → social anxiety
Repeated mistakes → performance anxiety, perfectionism
Disorganization → constant worry about forgetting things
Rejection Sensitive Dysphoria → fear of criticism

This is called secondary anxiety—anxiety that develops as a consequence of living with ADHD.

2. Shared Neurobiology

Both conditions involve:

Prefrontal cortex dysfunction
Dopamine and norepinephrine dysregulation
Executive function impairments

3. Genetic Overlap

Family studies show increased rates of both conditions in relatives, suggesting shared genetic vulnerabilities.

Diagnostic Challenges with Comorbidity

When both are present:

ADHD symptoms can be missed (overshadowed by more obvious anxiety)
Anxiety can be misattributed to ADHD
Treatment response helps clarify (if stimulants help concentration even when calm, think ADHD)

How to Tell Which One You Have

Questions to Ask Yourself:

Question	ADHD Answer	Anxiety Answer
Did you have concentration problems as a child (before age 12)?	YES	Usually NO
Can you concentrate when you're calm and not worried?	NO - still can't focus	YES - focus improves
What distracts you?	External stimuli (sounds, sights)	Internal worries
Do you struggle with planning and organization?	YES - chronic problem	Not typically
Do you interrupt people or blurt things out?	YES - impulsivity	Usually NO
Does stress make your focus better or worse?	Better (crisis mode)	Worse (overwhelmed)
Do you have repetitive, worry-filled thoughts?	Not usually	YES - rumination
Do you avoid situations that make you anxious?	Not typically	YES - avoidance

Treatment Implications

ADHD Treatment

First-line: Stimulant medications (methylphenidate, amphetamines)

70-80% response rate
Improve focus, organization, impulsivity
Learn about ADHD medications

Therapy: CBT for executive function skills, organizational strategies

Anxiety Treatment

First-line: SSRIs (sertraline, escitalopram) or therapy

50-60% response rate with medication
Reduce worry, physical anxiety symptoms

Therapy: CBT, exposure therapy for specific fears

When You Have Both

Treatment Approach:

1. Treat ADHD First (Usually)

Rationale: If anxiety is secondary to ADHD struggles, treating ADHD may reduce anxiety without needing anxiety-specific treatment.

2. Monitor Stimulant Response

Concern: Stimulants can worsen anxiety in some people
Reality: Most people with both conditions tolerate stimulants well; anxiety often improves as ADHD-related stress decreases

3. Consider Combination Treatment

Options:

Stimulant (for ADHD) + SSRI (for anxiety)
Non-stimulant ADHD med (atomoxetine, guanfacine) if stimulants worsen anxiety
Therapy addressing both (CBT for ADHD + exposure for anxiety)

4. Therapy is Essential

Both conditions benefit from:

Organizational skills training
Cognitive restructuring (challenging negative thoughts)
Mindfulness and stress management

Real-World Examples

Case 1: ADHD Only

Sarah, 28: "I've always been scattered. Even as a kid, I'd lose my homework, forget my lunch, couldn't sit still in class. Now I'm 28 and I still can't focus—even when I'm relaxed on vacation, my mind jumps around. I'm not anxious, just...easily distracted."

Diagnosis: ADHD (childhood onset, pervasive inattention, no worry content)

Case 2: Anxiety Only

Mike, 35: "I was a great student until college. Then I started worrying constantly—about grades, about what people think, about my future. Now I can't concentrate because my mind is always racing with 'what ifs.' When I'm on vacation and relaxed, I can focus fine."

Diagnosis: Generalized Anxiety Disorder (adult onset, worry-driven, improves when calm)

Case 3: Both ADHD and Anxiety

Jessica, 32: "I've always been disorganized and impulsive—got in trouble in school for talking, losing things. Then in high school, I developed bad test anxiety because I kept failing despite trying hard. Now I have both—I can't focus even when calm (ADHD) AND I worry constantly about messing up (anxiety)."

Diagnosis: ADHD + Generalized Anxiety Disorder (childhood ADHD led to secondary anxiety)

Getting the Right Diagnosis

What to Tell Your Doctor

Childhood history: "I struggled with X in elementary school"
Current symptoms: Describe when concentration is hardest
Worry content: Are your thoughts worry-filled or just random?
Pattern: Chronic and stable, or episodic with triggers?
Executive function: Do you struggle with planning, time management, organization?

Comprehensive Evaluation Includes:

Developmental history (childhood symptoms)
Symptom rating scales (ADHD-specific, anxiety-specific)
Functional impairment assessment
Ruling out other conditions (depression, medical causes)
Sometimes: neuropsychological testing

Schedule Evaluation with Dr. Sultan →

Frequently Asked Questions

Can anxiety mimic ADHD?

Yes. Severe anxiety can cause concentration problems, restlessness, and task avoidance that look like ADHD. Key differences: anxiety-related symptoms improve when anxiety decreases, while ADHD symptoms are constant.

Can ADHD cause anxiety?

Yes. Chronic ADHD struggles (academic failure, social mishaps, disorganization) create ongoing stress that can develop into an anxiety disorder. This is called secondary anxiety.

Should I treat ADHD or anxiety first?

Usually ADHD first, especially if anxiety seems secondary to ADHD struggles. Treating ADHD may reduce anxiety without needing separate anxiety treatment. Discuss with your psychiatrist.

Will ADHD medication make my anxiety worse?

Most people tolerate stimulants well even with anxiety. For some, anxiety improves as ADHD-related stress decreases. If stimulants worsen anxiety, non-stimulant ADHD medications are available.

Can I take ADHD medication and anxiety medication together?

Yes. Stimulants (for ADHD) and SSRIs (for anxiety) are commonly prescribed together and generally safe. Always consult your doctor about medication combinations.