Certain behaviors may be the result of ADHD, anxiety, or both. But how can we tell the difference, and why does it matter?
Spot the difference
Many adults experience anxiety. They might be stressed and put off tasks that should be simple. Seeing others succeed makes those individuals feel inadequate. It’s easier to avoid challenges than risk failing again. Such people may have taken anxiety medication, although they often don’t help.
This hypothetical example illustrates a situation many people have faced. Social media abounds with stories of people who have, without success, taken medication for anxiety and are now wondering about possible undiagnosed ADHD.
So, how can you tell if it’s anxiety, ADHD, or both? And why does it matter?
ADHD and anxiety can go hand-in-hand
Anxiety and depression can mimic ADHD. Either can be associated with a lack of motivation and difficulty focusing attention. On the other hand, a pattern of being late, missing deadlines, and forgetting appointments due to ADHD may lead to anxiety and a sense of failure.
Anxiety and depression are both commonly associated with ADHD, particularly in women. Anxiety tends to be more severe and persistent and with a younger age of onset in people with ADHD. Generalized anxiety features symptoms such as frequent and excessive worry about different aspects of life (such as work, school, and family).
The worry can be difficult to control. Restlessness, fatigue, irritability, and sleep problems are common. For some, anxiety can be controlled through therapy, mindfulness techniques, a change in life or at work, and/or medication. For others, no amount of anxiety treatment seems to help. The problems persist. For these people, it could be worth investigating whether undiagnosed ADHD is a factor.
Successful treatment of co-existing ADHD may, for some, be the best way of getting relief from chronic anxiety.
Could ADHD be a factor?
ADHD is often subtle in girls and women, who are less likely to show the disruptive hyperactive behavior that draws attention to ADHD in men and boys. This matters because women with ADHD have higher rates of depression, anxiety, eating and sleep disorders.
However, not all adults with ADHD showed signs of it in childhood.
ADHD in adulthood
ADHD is generally diagnosed according to the criteria of the American Psychiatric Association. Problematically, these criteria require that to be diagnosed with ADHD, an adult should have experienced difficulties before the age of 12.
Studies have identified ADHD in adults who didn’t show evidence of it when previously assessed in childhood. And ADHD is generally assessed in adults as if it were a continuation of the childhood condition. The diagnostic criteria – such as interrupting, fidgeting, not completing tasks, losing things, and forgetting things – are derived from observations of children.
When applied to adults, these criteria still relate to behavior seen from the outside by an observer. They miss the depth and insight an adult can provide about their inner world and mind.
A woman with no history of ADHD-related problems in childhood and no overt signs of restlessness or hyperactivity may have had her ADHD missed, particularly if she’s developed coping skills to seemingly stay on track.
She may feel stigmatized by those who believe ADHD is being self-diagnosed in treatment-seeking adults who are over-influenced by social media.
If I suspect ADHD, what now?
If you suspect ADHD but are able to get on fine in life, you probably don’t need a diagnosis. You should only consider a diagnosis of ADHD if you’re facing significant difficulties. This could mean disorganization, inefficiency, difficulty with relationships at work or in the family, or depression or anxiety so severe it affects your ability to function.
To be assessed for ADHD, you’ll need a GP referral to a psychiatrist. However, many people who outwardly appear to be coping well may find it difficult to convince a GP an assessment is necessary. You could bring copies of school reports if they suggest ADHD. Checklists with ADHD criteria can help but cannot reliably either diagnose or exclude ADHD.
Clear descriptions of difficulties you experience when attempting mentally demanding tasks can help. These may include repeated lapses in attention or having to multitask to provide sufficient stimulation to keep working.
You might detail, for example, the average number of minutes per hour of your working day you are actually working productively or how long you can focus on a hard task before losing concentration. How often do you get distracted? How long does it take to get back on task? What strategies have you tried?
An ADHD diagnosis can be a relief for some, who may find treatment helps alleviate problems they’d previously blamed on anxiety. It can also provide an explanation for past difficulties attributed to personal inadequacy.
ADHD treatments can include medication, learning more about it, developing new strategies, counseling, and having an ADHD coach.
Do you think you might be confusing ADHD with anxiety? Has this article been of any benefit to you? Let us know in the comments.