ADHD or Anxiety? How They Overlap and Differ in Adults

ADHD and anxiety can look alike in adults: both can bring restlessness, poor concentration, irritability and trouble sleeping, and many adults have both. Two clues help tell them apart. ADHD symptoms begin in childhood, before age 12, and are a lasting pattern, while anxiety centers on worry or fear and often gets worse under stress.

Sorting out which one you have, or whether it's both, is part of adult ADHD treatment in Ocala at Padgett Medical Center. Care starts with a 30-minute evaluation, always in person, that covers your history and medications, not just your symptoms.

Which symptoms do ADHD and anxiety share?

Quite a few. ADHD (attention-deficit/hyperactivity disorder) is a persistent pattern of inattention, hyperactivity or impulsivity that begins in childhood. Generalized anxiety disorder (GAD), one type of anxiety disorder, is excessive, hard-to-control worry about everyday things.

To be diagnosed with GAD, the National Institute of Mental Health (NIMH) says, a person must find worry hard to control on most days for at least 6 months and have at least three of these: feeling restless or on edge, fatigue, trouble concentrating, irritability, muscle tension or sleep problems.

Several of those fit adult ADHD, too. NIMH lists getting distracted often, trouble sitting still and feelings of restlessness among adult ADHD symptoms, and says adults with ADHD may be irritable, with a low tolerance for frustration and stress. Sleep problems affect up to 70% of them. NIMH even lists anxiety as a possible cause of ADHD-like symptoms.

How can you tell ADHD and anxiety apart?

Look at when it started, what fills your mind, how it comes and goes and what your body does. No single clue settles it, and you can have both.

When it started. ADHD symptoms must begin before age 12, even if no one named them then. GAD usually starts in early adulthood, though it can begin at any age, NIMH says. But a childhood start doesn't rule out anxiety: social anxiety disorder usually begins in childhood or the teen years.

What fills your mind. NIMH says adults with GAD are often highly nervous about everyday matters such as their job, health, money, family or being late. A 2019 European expert consensus statement describes ADHD mind wandering differently: unfocused, short-lived thoughts that jump from one topic to another, with no pattern of repeated thoughts.

How it comes and goes. GAD symptoms may rise and fall and are often worse during stress, such as an illness or a family conflict, NIMH says. The consensus statement calls adult ADHD a chronic, trait-like condition whose emotional flare-ups, such as irritability, tend to be brief: often set off by daily events and gone within a few hours.

What your body does. NIMH's list of GAD signs includes headaches, stomachaches, muscle tension, trembling, sweating and feeling out of breath. None of those is on its list of adult ADHD symptoms.

How often do adults have both ADHD and anxiety?

Often. In a national U.S. survey of adults ages 18 to 44, published in 2006, 47% of those with ADHD had an anxiety disorder in the past year, versus 19.5% of adults without ADHD. The most common was social anxiety disorder (social phobia in the study): 29% versus 8%.

It works the other way, too: 9.5% of adults with an anxiety disorder had ADHD, versus 2.8% of those without one. The consensus statement reports that across 20 World Mental Health surveys, 34% of adults with ADHD had an anxiety disorder, and puts the lifetime rate of other psychiatric conditions in adults with ADHD at 60 to 80%.

Shared symptoms don't explain it: the survey's authors, citing earlier methods research, wrote that these high rates are not due to overlapping symptoms or imprecise diagnostic criteria. Emerging evidence cited in the consensus statement suggests one link: years of setbacks tied to ADHD symptoms can shape negative thinking that feeds avoidance, procrastination and anxiety.

Can anxiety be mistaken for ADHD, or ADHD for anxiety?

Yes, both ways. Trouble concentrating is one of the GAD symptoms, so worry alone can make your focus slip in ways that look like ADHD. That is one reason a provider asks when each problem began.

ADHD can hide behind anxiety, too. The consensus statement says adult ADHD may be missed partly because other psychiatric conditions are so common, and it recommends screening adults with long-term conditions such as anxiety or depression. In the U.S. survey, just 10.9% of adults with ADHD had been treated for ADHD in the past year. NIMH adds that ADHD symptoms in girls and women are especially likely to have been missed in childhood; see why ADHD is often missed in women.

Why does an ADHD evaluation look at anxiety too?

Because the answer shapes your treatment. NIMH says a provider evaluating an adult for ADHD may have you report on your mood and on current and past medical conditions, to rule out other diagnoses and set up an overall treatment plan. ADHD also often co-occurs with other mental disorders and can make them harder to treat.

Order matters, too. The consensus statement says all co-occurring conditions should be identified before treatment starts, so you and your provider can decide together what to treat first. Severe anxiety is usually treated first, it says, while milder anxiety may respond to ADHD treatment and can be treated at the same time.

What should you tell your provider?

Specifics about timing, what the trouble feels like and everything you take. Did a teacher or parent notice daydreaming, restlessness or lost homework before age 12? Since symptoms must date back to childhood, NIMH says diagnosing an adult leans heavily on reports of past behavior, so a provider may look at school reports or ask to talk with a partner or relative. How adult ADHD is diagnosed explains more.

Describe how your focus slips. Is your mind stuck on one worry, or hopping from thing to thing? Does it happen everywhere, or mostly under stress? When did the worry begin? Mention a racing heart, tense muscles or sudden waves of fear, and any past treatment for anxiety or depression and what helped.

Finally, list everything you take, including over-the-counter medicines, supplements, caffeine, alcohol and cannabis. NIMH says medications for anxiety and depression can interact with stimulants, and the consensus statement notes that some adults with ADHD use cannabis or alcohol to ease restlessness or sleep problems. See how ADHD and sleep are connected, too. If you have thoughts of suicide, call or text 988.

How are ADHD and anxiety treated when you have both?

With one plan, in an order you and your provider agree on. NIMH names medication, usually a stimulant, and psychotherapy such as cognitive behavioral therapy (CBT) as the most common treatments for adult ADHD. GAD is typically treated with psychotherapy, medication or both, and NIMH calls CBT the gold-standard choice among talk therapies.

Therapy can help on both fronts. NIMH says it is especially helpful when ADHD occurs with anxiety, and the consensus statement says CBT reduces core ADHD symptoms in adults along with related anxiety and depression. It recommends CBT mainly alongside medication, though it may suit adults who don't want or can't tolerate medication.

Medication choices take anxiety into account. The consensus statement suggests the non-stimulant atomoxetine may be a good choice when a stimulant might worsen anxiety, citing a trial in adults with ADHD and social anxiety disorder in which both conditions improved more than on a placebo. Your provider weighs this with you; see adult ADHD medication options.

What happens at a Padgett ADHD evaluation in Ocala?

The first visit, always in person at our clinic at 200 SW 8th St., Suite A, Ocala, is a 30-minute evaluation with Sarah Weir, APRN (advanced practice registered nurse). It covers your symptoms and when they began, including in childhood; how they affect work and home; your health history; current medications; and any prior records. That is the time to bring up worry, panic or past anxiety treatment.

Neither a diagnosis nor a medication is promised in advance. Treatment, if it makes sense for you, may include non-medication strategies and medication chosen with your provider. Anything prescribed is filled at your own pharmacy and is not part of the visit fee.

The first visit for new patients is $260, or $169 if you book online with a card on file (35% off). For college students who book online with a card on file and a valid college ID, the first visit is $130 (50% off rather than 35%), and the ID is checked at the visit; see ADHD care for college students. Each follow-up is $136, the same for everyone, in person or by telehealth while you are physically in Florida; ADHD treatment by telehealth in Florida covers those visits.

You aren't charged anything when you book, and there's no contract. A card on file holds the appointment; if you book without one, it isn't confirmed until staff reach you by phone. The only other charge is a $50 no-show fee, for a missed visit or one not canceled or rescheduled at least 24 hours ahead.

Questions first? Ask for a free 15-minute phone call with the medical staff; it is not a visit with the provider and nothing is prescribed on it. To get started, book your ADHD evaluation online or call (352) 369-0104, Monday to Friday, 9:00 AM to 5:00 PM.

This article is educational and is not medical advice. Talk with a licensed provider about your own health, medications and treatment options.