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The Connection Between ADHD and Anxiety

Do you struggle with anxiety? If you have Attention Deficit Hyperactive Disorder (ADHD), you're not alone. In fact, up to 50% of people with ADHD will experience anxiety at some point in their lives (Katzman et al., 2017). As someone who has lived with ADHD and anxiety myself, I know firsthand how challenging it can be to manage both conditions simultaneously. That's why I'm here to share the latest research on the link between ADHD and anxiety.

In this blog post, we will examine the high prevalence rates of co-occurring ADHD and anxiety, as well as the unique implications that arise from the interaction between the two conditions. We have discussed the challenges of diagnosing and treating ADHD-anxiety co-occurrence, as well as the impact on symptoms, severity, and treatment response.

Prevalence Rates of Anxiety Among ADHD

Anxiety is incredibly prevalent among people with ADHD, with estimates indicating that up to 50% of people with ADHD will experience anxiety at some point in their lives (Katzman et al., 2017). Furthermore, research has found that individuals with ADHD are at a higher risk for nearly all types of anxiety disorders, including Generalized Anxiety Disorder, Panic Disorder, Specific Phobias, Social Anxiety, and OCD (Katzman et al., 2017).

Several studies have explored the overlap between ADHD and anxiety, with varying prevalence rates reported. For instance, Katzman et al. (2017) found that nearly 50% of individuals with ADHD had an elevated risk for anxiety. Similarly, Tsang, et al. (2015) reported that 31% of individuals with ADHD met the criteria for Generalized Anxiety Disorder. Additionally, ADHD has been associated with higher rates of agoraphobia, simple phobias, separation anxiety disorders, social phobia, and OCD, particularly among children (Spencer et al., 1999). In fact, a study by Spencer et al. (1999) found that 27% of children with ADHD had more than one anxiety disorder, compared to just 5% of the control group.

Implications of Co-occurring ADHD and Anxiety

When an individual with ADHD also experiences another mental health condition, such as anxiety, depression, or PTSD, it is referred to as "complex ADHD." This co-occurrence creates a more complex clinical presentation that must be taken into account when developing treatment plans.

ADHDers with anxiety experience a unique set of symptoms, issues, and challenges that can make diagnosis and treatment more difficult. Missed diagnoses, treatment considerations, and medication implications are just some of the factors that must be carefully considered when addressing the needs of these individuals. In the following sections, we'll take a closer look at some of the specific symptoms and experiences that are unique to individuals with complex ADHD, and discuss strategies for managing these challenges.

Diagnosis Implications

The presence of anxiety can make it more likely for ADHD to be missed during diagnosis. This is due to several reasons.

✦ Firstly, anxiety symptoms may mask ADHD symptoms as anxiety can lower impulsivity. However, anxiety may also inhibit impulsivity but make inattention worse, which can complicate diagnosis (Pliszka et al., 1999).

✦ Secondly, individuals with anxiety and ADHD are often diagnosed later in life than those without anxiety, as anxiety may inhibit impulsivity, resulting in less off-task and hyperactive behavior that may be associated with ADHD diagnosis (Katzman et al., 2017).

✦ Lastly, co-occurring ADHD-inattentive type and anxiety are particularly challenging to diagnose, as the absence of hyperactivity can make it difficult to distinguish whether inattention is due to anxiety and worry or difficulty regulating attention due to ADHD (H)D.

ADHD and Anxiety Are Associated With More Inattention and Less Impulsivity

Individuals with ADHD and anxiety tend to experience more inattention and difficulty with focus than those without anxiety. This is because anxiety can create additional distractions, such as intrusive thoughts or excessive worry, that pull a person's attention away from the task at hand, increasing their "cognitive load" and adding to the demands on executive functioning, which is already strained in individuals with ADHD. Research by Hammerness et al., 2009 found that individuals with both ADHD and anxiety demonstrated more difficulties with inattention and working memory tasks compared to those with ADHD alone.

On the other hand, individuals with complex ADHD tend to exhibit less impulsivity and fewer issues with inhibition compared to those with ADHD alone. For example, in a study conducted by Hammerness et al. (2009), children with both ADHD and anxiety performed better on tasks requiring inhibition, which is a feature of impulsivity, compared to those with ADHD alone. Despite these findings, it's important to note that each individual's experience is unique, and the interplay between ADHD and anxiety can manifest in different ways for different people.

Medication Implications

Individuals with complex ADHD may respond differently to medication compared to those with ADHD alone, according to previous research. The presence of anxiety can predict a poorer response to stimulant treatment for ADHD (Hammerness et al., 2009). For instance, a study by Tannock and Schachar (1995) found that while methylphenidate improved working memory in non-anxious children with ADHD, it did not have the same effect on working memory in anxious children with ADHD.

These findings suggest that medication management for individuals with complex ADHD and anxiety requires careful consideration and a personalized approach. It's important for individuals with complex ADHD to work closely with their healthcare provider to determine the most effective treatment plan for their specific needs.

Co-occurring Substance Abuse and Other Mental Health Diagnoses

Research has shown that individuals with complex ADHD and anxiety are more likely to experience co-occurring mental health conditions and require more intensive mental health treatment compared to those with anxiety alone. For example, a study by Hammerness et al. (2009) found that children with both ADHD and anxiety had more co-occurring mental health conditions and required more mental health treatment compared to children with anxiety alone.

Additionally, individuals with complex ADHD and anxiety tend to have an earlier age of onset of anxiety, as well as a greater number of additional mental health conditions and substance abuse problems compared to those with anxiety alone (Katzman et al., 2017). These findings underscore the importance of addressing both ADHD and anxiety in order to effectively manage the range of challenges that individuals with complex ADHD may face. It's important for individuals with complex ADHD to work closely with their healthcare provider to develop a comprehensive treatment plan that takes into account any co-occurring mental health conditions and substance abuse issues.

More Negative Impact of ADHD Traits

The combination of anxiety and ADHD results in more severity of both anxiety and ADHD traits. ADHD symptoms that have been classified as "severely impairing" occurred at higher rates in the Anxiety plus ADHD group than in the ADHD-only group (56% compared to 45%) (Hammerness et al., 2009). ADHD and anxiety children also experienced more cognitive difficulties and required more support in education settings (Hammerness et al., 2009).

More Severe Anxiety Symptoms

Individuals with complex ADHD and anxiety tend to experience more severe anxiety symptoms compared to those without ADHD who have anxiety disorders. In addition, research has shown that the age of onset of anxiety tends to be earlier in individuals with complex ADHD and anxiety compared to those without ADHD who have anxiety disorders (Katzman et al., 2017). These findings suggest that the combination of ADHD and anxiety can result in more severe and complex mental health challenges, and may require more intensive and targeted intervention to manage effectively. It's important for individuals with complex ADHD to work closely with their healthcare provider to develop a comprehensive treatment plan that addresses both ADHD and anxiety symptoms in order to optimize their overall well-being and quality of life.

Follow-up Resources and Treatment Considerations

Individuals with complex ADHD and anxiety can benefit from a comprehensive treatment plan that takes into account their executive functioning needs, anxiety symptoms, sensory needs, and processing differences. While this is not a comprehensive list, there are several treatments and resources that can be particularly helpful for individuals with complex ADHD and anxiety, including:

• Medication (for ADHD: stimulants and non-stimulants; for GAD: antidepressants and anxiolytics)

• Executive functioning coaching

• Cognitive Behavioral Therapy and Acceptance Commitment Therapy (ACT)

• Regular physical exercise

• Mindfulness practices (apps like Headspace can be particularly helpful)

• Omega 3 6 9 supplements

• GABA supplements (brands like Thorne and NOW offer economical options)

It's important to note that each individual's experience is unique, and what works for one person may not work for another. It's important for individuals with complex ADHD and anxiety to work closely with their healthcare provider to develop a personalized treatment plan that meets their unique needs and addresses their specific challenges. By taking a holistic and individualized approach to treatment, individuals with complex ADHD and anxiety can optimize their overall well-being and improve their quality of life

Wrapping Up: Key Takeaways for Navigating ADHD and Anxiety

ADHD and anxiety commonly co-occur, with estimates suggesting that up to 50% of people with ADHD will experience anxiety at some point in their lives. When the two conditions are present together, it can create a more complicated clinical picture, which can result in missed diagnoses and more severe symptoms.

The co-occurrence of ADHD and anxiety have implications for diagnosis, treatment, and medication management. It also results in more significant ADHD traits, more severe anxiety symptoms, and more co-occurring mental health conditions. This overlap presents unique challenges for those living with ADHD and anxiety, including cognitive difficulties, educational support needs, and sensory processing differences.

To manage the complexities of ADHD and anxiety co-occurrence, a robust treatment plan is necessary, which considers executive functioning needs, anxiety, sensory needs, and processing differences. Some of the potential treatments and resources that can be helpful for ADHDers with anxiety include medication, executive functioning coaching, cognitive-behavioral therapy, exercise, mindfulness, Omega 3 6 9, and GABA supplements.

Overall, understanding the co-occurrence of ADHD and anxiety is critical in developing appropriate treatment plans and support for those living with both. By recognizing the unique challenges and implications of the interaction between the two, we can work towards better management and improved quality of life for those affected by these conditions.

Katzman, M.A., Bilkey, T.S., Chokka, P.R. et al. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 17, 302 (2017). https://doi.org/10.1186/s12888-017-1463-3

Hammerness, P., Geller, D., Petty, C. et al. Does ADHD moderate the manifestation of anxiety disorders in children?. Eur Child Adolesc Psychiatry 19, 107–112 (2010). https://doi.org/10.1007/s00787-009-0041-8

Tannock, R., & Schachar, R. (1995). Differential-effects of methylphenidate on working-memory in ADHD children with and without comorbid anxiety. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 886-896.

Mancini, C., Van Ameringen, M., Oakman, J. M., & Figueiredo, D. (1999). Childhood attention-deficit/hyperactivity disorder in adults with anxiety disorders. Psychological Medicine, 29, 515-525.

Pliszka, S. R., Carlson, C., & Swanson, J. M. (1999). ADHD with comorbid disorders: Clinical assessment and management. New York: Guilford.

Spencer, T., Biederman, J., & Wilens, T. (1999). Attention-deficit/hyperactivity disorder and comorbidity. Pediatric Clinics of North America, 46, 915-927