Differentiating Anxiety and ADHD
By Margaret M. Tripp, Ph.D. Clinical Child, Adolescent, and Adult Psychologist
At first glance, Anxiety and Attention Deficit appear to be two very different disorders, falling in two very distinct categories. Anxiety (generalized anxiety disorder, panic disorder, and/or social phobia) is characterized by chronic feelings of nervousness or worry (defined as more than would be expected for a situation or event) or fear without apparent cause, difficulty controlling the worry or fear, difficulty concentrating, difficulty sleeping, irritability, and physical complaints such as headaches or stomach-aches. Whereas, Attention Deficit Hyperactivity Disorder (ADHD) is depicted as chronic inattention, not giving close attention to details or making careless mistakes, difficulty sustaining attention during a task, difficulty listening or attending to instruction, disorganization, avoiding sustained mental effort, becoming easily distracted, and exhibiting frequent forgetfulness. Despite inherent differences, sometimes it can be difficult to distinguish Anxiety symptoms from ADHD symptoms.
Consider the following scenario: a 3rd grade child who is bright and exhibits enthusiasm over learning and knowledge away from school. Although identified as capable at school, his performance is lackluster. Sometimes he demonstrates great achievement but often he under performs on tests and fails to finish class assignments, even appearing to forget things or rush through things at times. This child can attend to interesting things well but often appears highly distractible and even irritable during some tasks. And finally, he is often high strung and hard to quiet at bedtime.
Or another scenario farther down the road: a 10th grade adolescent is experiencing difficulties in school. Her grades were okay through middle school but now appear to be declining with each successive semester and follow through on requests from parents is also worsening. This teenager frequently appears restless and distracted and is often very difficult to wake up for school in the morning. In addition, she exhibits strong reactions to events, seemingly out of proportion to the events themselves.
The behavior of both of these students offers an example of the overlap in symptoms between anxiety and ADHD in day to day functioning. Both demonstrate distractibility, difficulty concentrating, restlessness, poor academic performance, poor sleep onset, and hyperactive or excessive responses to situations. In fact, anxiety symptoms can be misinterpreted as child or teen behavior problems or attention seeking behavior that sometimes accompanies diagnoses of ADHD.
Due to the overlap in key criteria, the task of differentiating anxious feelings from chronic distractibility is important. A thorough evaluation should include the history of symptoms, including the duration and the context in which symptoms most frequently occur. Fidgety, unfocused moments occur for individuals with both disorders, however, for anxious individuals these episodes are more likely to be cyclical or occur in relation to other events in their lives. Unfocused, easily distracted individuals with ADHD are more likely to display this symptom consistently across settings and regardless of changes in teacher or classroom or event.
Related life events also have to be considered when differentiating causes of poor school performance, poor sleep onset, and strong reactions to events. Assessing the role that external, concurrent events play in evoking or exacerbating symptoms can shed light into anxious reactions versus hyperactive causes. Often sleep difficulties and performance declines can be linked to reactions to changes or stressors in the environment for anxious individuals. Family history can also help determine the potential causes of academic decline and restless, unproductive behavior. There is increasing evidence of strong genetic predispositions for anxiety or ADHD if parents or siblings are affected by one of these disorders.
Finally, tuning into key differences in symptom presentation can also help to distinguish anxious symptoms from ADHD symptoms. The consuming nervous or fearful thoughts that preoccupy anxious individuals typically result in avoidance of feared situations or compulsive actions to ward off feared situations. And the pressure to avoid and prevent these fears or worries often results in frequent physical symptoms like headaches and stomachaches for anxious individuals. Conversely, the chronic inattention and distraction displayed by ADHD individuals is often accompanied by impulsive and short sighted behavior.
To further complicate things, this is not an either or situation; Many studies show that anxiety and ADHD sometimes occur simultaneously. The question ultimately becomes: Inattentive versus preoccupied, or both? Bottom-line, if a child exhibits distractibility but acknowledges excessive worries, he or she is not likely to feel relief through ADHD treatment alone.
Non-pharmacological (therapy based) and pharmacological (medication based) treatments are available for both anxiety and ADHD, and in some cases individuals might require both treatments to control symptoms.
Therapy based treatments focus on helping a child (or adult) develop skills to manage and even compensate for symptoms that interfere with performance. For anxiety, this includes relaxation training and thought stopping strategies to reduce the influence that pervasive negative and fear-based thoughts can have on the child’s behavior. For ADHD, this includes organization training, distraction management, and reward based motivation techniques for the child and the family.
Medication based treatments focus on options to alleviate the most distressing aspects of the disorder. For anxiety, this includes but is not limited to medications to reduce worry, compulsions, and poor sleep quality. For ADHD, this includes options to increase focus and concentration, and in some cases, reduce hyperactivity.
Always seek an appropriate professional evaluation to best determine what issues are interfering with your or your child’s performance and day to day activities.
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