ADHD, Anxiety Disorders And Other Comorbidities: A Diagnosis Guide

Medically reviewed by Paige Henry, LMSW, J.D.

Updated May 14, 2024by BetterHelp Editorial Team

According to the Centers for Disease Control and Prevention (CDC), the estimated number of childhood ADHD cases in the United States is approximately 6 million.

Moreover, the overall prevalence of ADHD in adults is thought to be 4.1%, with a lifetime prevalence reaching 8.1%.

This suggests that millions of people might manage symptoms of attention deficit hyperactive disorder every day—and in many cases, they also are managing another mental health disorder, such as major depressive disorder, personality disorder, or anxiety disorder(s).

People who live with comorbid diagnoses of anxiety disorders and ADHD can face daily challenges that can interrupt their ability to function normally, especially without medical treatment, like ADHD medications, anxiety medication, and therapy.

In this article, we discuss the different aspects of ADHD and anxiety disorders, including an explanation of signs and symptoms, possible ways to manage individual symptoms, and an explanation of when you might consider seeking mental health support.

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What is ADHD?

Attention deficit hyperactivity disorder (ADHD), formerly called attention deficit disorder, is considered by many to be a disorder of the brain. According to the Acad Child Adolesc Psychiatry, the primary symptoms are hyperactivity, impulsivity, and inattention. It can be diagnosed early, such as during childhood—however, some people are not diagnosed until they are adults.

According to one systematic review, approximately 25% to 50% of those diagnosed with ADHD might experience a psychiatric comorbidity of an anxiety disorder. Those who live with ADHD, experiencing anxiety disorders or not, might experience difficulties completing daily activities. Online therapy and other interventions can be helpful in this specific case.

ADHD symptoms and forms of ADHD

While the most common form of ADHD is a combination of the following behaviors, some people will only experience one or two primary symptoms. For a person to be diagnosed with this disorder, these symptoms must be chronic and impair a person’s ability to function. A child falling behind at work in school or being called out for hyperactive behavior that is interrupting the teacher’s ability to instruct is an example of ADHD impairing development.

Inattention

A child or adult will have difficulty staying on task, keeping focus, and being organized. The inattention is not caused by defiant behavior or lack of comprehension but simply is the nature of brain activity in someone with ADHD. If your child is making careless mistakes in their homework, does not seem to listen when spoken to, is easily distracted, and often loses things, they may be dealing with inattention due to ADHD. As an adult, this symptom will cause you to struggle with meeting deadlines and making appointments and make it difficult for you to follow through on duties in the workplace.

Impulsivity

A child or adult will have a difficult time with self-control and act without considering long-term consequences. You may seek immediate rewards and struggle with delayed gratification, which is resisting immediate pleasure in the hopes of a future reward. A person with ADHD may interrupt and frequently answer questions before they are asked. They may also make important decisions without much forethought and thinking of all possible outcomes.

Hyperactivity

This is characterized by a person moving constantly, fidgeting, and excessive talking or restlessness. A hyperactive adult may talk a lot and intrude on conversations. A common sign of hyperactivity is being unable to sit still and leave their seats at inappropriate times. A child may not be able to play quietly and spend time running around and climbing. Teens and adults will appear restless, while a child will fidget and squirm. Other signs of hyperactivity are impatience and not being able to wait your turn.

Keep in mind that there are several physical and mental health disorders that can cause these symptoms, including depression, anxiety, panic attacks, panic disorder, sleep disorders, and neurological disorders. People with other mental health conditions may also be dealing with undiagnosed ADHD. A qualified clinician should be consulted for diagnosis.

What are the causes of ADHD and anxiety?

Like many other disorders, research scientists are unsure about the exact cause of ADHD and coexisting anxiety. However, studies have shown that genetics and environmental factors can increase a person’s risk of developing this neurodevelopmental disorder.

Genetic

People who have someone in the family with ADHD are highly likely to also develop it. A genome-wide association study looked at the different genes that may be involved in the development of ADHD and found that 12 major areas or loci were associated. The genes that researchers found have abnormalities that may cause decreased brain volume and affect nerve development. Another major genetic connection involves the system that controls dopamine, a vital neurotransmitter that controls cognition, motivation, mood, attention, and learning.

Environmental

Several environmental factors at different stages of a child’s development (including in utero) have been associated with an increased incidence of ADHD. Premature birth increases a person’s risk due to its effect on neurological development and related low birth weight. Being deprived of oxygen right before, during, and after birth can also increase risk. Other environmental factors that increase a person’s risk during their early development include:

Inappropriate nutrition for brain development
Exposure to lead and other neurotoxic heavy metals
Exposure to pesticide
Tobacco use when pregnant
Alcohol use when pregnant

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Physiological

People with ADHD may have multiple altered neural pathways that can explain the neurodivergent behavior that typifies the disorder. For example, children with ADHD have been shown in brain-imaging studies to have atypical wiring in reward centers of the brain that control behaviors like impulsivity. While genetic and environmental factors can cause these alterations, biological risk factors and neurological injuries also may play a role in ADHD development. These include:

Developmental deficits
Injury to the brain
Stroke
Tumor
Brain disease

When looking at the different factors that can cause a person to develop ADHD, it comes as no surprise that there may be another psychiatric disorder that can also arise. The next section will dive into these different comorbidities to broaden your understanding.

Anxiety and ADHD comorbidity

Many people with ADHD also are managing a secondary condition or 'comorbidity' - a condition that coexists with attention disorder, which is the primary diagnosis. Depression, anxiety disorders, and personality disorders are all common psychiatric comorbidities that can co-occur with adult ADHD. Children also manage comorbidities, including learning disorders, stress-related, and mood disorders. The additional conditions have a profound effect on a child's academic development, self-esteem, and interaction with other children. The mind of a child with ADHD recognizes something is not right and will either try to compensate or retreat.

ADHD is statistically thought to be one of the most common neurodevelopmental disorders, with an approximate prevalence rate of 5 to 7% of all children—or one out of five.

Comorbidities can be prevalent within the condition, especially anxiety disorders—which can have a 47% prevalence, according to the National Comorbidity Survey Replication (NCS-R).

Online therapy can be a helpful support for many who are looking to address symptoms of comorbid disorders in their lives. Most might find that the first foundational step forward is to determine what they might be experiencing and seek a formal diagnosis from a professional.

ADHD and anxiety disorders

For those who are managing symptoms of mental disorders like anxiety combined with ADHD, daily tasks required in the workplace or at school can be difficult to complete and might increase stress. Online therapy, regimented routines, and support groups can all be helpful forms of intervention for those experiencing both.

ADHD and depression

ADHD and depression can co-exist in both adults and children. For example: People who might experience difficulty in professional or social settings may develop a sense of sadness and lack of hope. This, if left unaddressed, can manifest into depressive symptoms.

Treatment for attention deficit hyperactivity disorder and comorbid psychiatric disorders

ADHD may have some overlapping symptoms with anxiety disorders or depression. A healthcare provider can be a helpful resource to evaluate the patient to diagnose and treat them correctly.

Treatment for ADHD, anxiety disorders, or depression is generally something that should not be delayed. Those who have received anxiety/depression and ADHD treatment can learn how to cope with challenges so they can continue to live their lives with more functional outcomes.

Effective ADHD treatment options that can also treat comorbid conditions may include:

Individual or family therapy with a mental health professional
Cognitive behavioral therapy
Antidepressant medication
Anti-anxiety medication

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Children and adults who are diagnosed with ADHD can experience difficulties in many areas of life, including at work, school, and in personal relationships. Adding to these challenges, people who live with ADHD might also be diagnosed with coexisting mental health conditions such as anxiety disorder, mood disorder, and substance use disorder.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

If you believe that you are managing a comorbidity along with ADHD, you can make an appointment with a mental health professional to get the support you need. A patient living with comorbid ADHD, suspected anxiety disorders, or other comorbidities should undergo appropriate tests to get an accurate diagnosis.

How can online therapy support those living with both ADHD and anxiety disorder?

When you are managing any form of mental health disorder, making appointments and finding the right therapist can feel like “just another challenge” to your daily tasks. If you are worried that you do not have the time or mental fortitude to meet with an in-person therapist, you might consider online therapy.

With online therapy through BetterHelp, you can participate in therapy remotely through video call, voice call, or in-app messaging. Coordinating with your therapist can be easy for most through BetterHelp.

Research has found details that suggest that some type of behavior therapy can be a beneficial outlet for adults experiencing symptoms of ADHD.

For example, a study published in the Journal of Attention Disorders examined the efficacy of online cognitive behavioral therapy for ADHD in adults. Researchers found details that suggest that the online treatment significantly reduced symptoms that lasted at least six months. Cognitive behavioral therapy is generally considered to be a widely utilized type of talk therapy that can help individuals reframe negative thought patterns, like those that can lead to maladaptive emotions and behaviors related to ADHD.

If you are looking for support as you navigate ADHD or believe you may be dealing with untreated ADHD or another mental health-related concern, you might consider reaching out to a licensed therapist online.

Takeaway

The symptoms of ADHD can have a significant impact on an individual’s life, especially when combined with a diagnosis of another mental health disorder.

However, treatment can be made available for people living with ADHD and associated comorbid psychiatric disorders through professional mental health support. ADHD therapy with a licensed mental health professional can provide you with guidance and connect you with valuable resources as you address your symptoms. With the right support, you can stop internalizing symptoms, manage your ADHD, and live a happy, healthy, and productive life. BetterHelp can connect you with a therapist in your area of need.

However, treatment can be made available for people living with ADHD and associated comorbidities through professional mental health support. A licensed therapist can provide you with guidance and connect you with valuable resources as you address your symptoms. With the right support, you can manage your ADHD and live a happy, healthy and productive life. BetterHelp can connect you with a therapist in your area of need.

Frequently asked questions

Are people with attention-deficit/hyperactivity disorder more prone to anxiety?

Adults, children, and adolescents with ADHD are more prone to psychiatric disorders (including anxiety disorders), compared to people who do not have ADHD. Research shows that anxiety & ADHD comorbidity is one of the most common comorbidities in people with ADHD, with a prevalence of roughly 25 to 50%.

Comorbidity is when a person has more than one long-term condition at the same time. In addition to ADHD and comorbid anxiety, people with ADHD can experience other conditions, such as depression, OCD, and bipolar disorder.

Having ADHD with comorbid anxiety may make treating ADHD more difficult, because some medications used to treat ADHD symptoms may worsen anxiety symptoms. While both conditions need to be treated, your doctor may focus on treating the condition that is most disruptive to your life first.

What is the most common type of anxiety in adults with attention-deficit/hyperactivity disorder?

The most common types of anxiety disorders in adults with ADHD are:

Generalized anxiety disorder: Adults with ADHD are more than twice as likely to experience comorbid anxiety, compared to adults without ADHD.
Social anxiety disorder: As many as 60 to 70% of people with ADHD may experience social phobia.
Specific phobia: The rates of specific phobia are higher in adults with untreated ADHD, compared to adults who are getting treatment for ADHD.
PTSD (post-traumatic stress disorder): A review and meta-analysis of 28 research articles tells us that people with ADHD are 3.7 times more likely to experience PTSD than people who do not have ADHD.

What can attention-deficit/hyperactivity disorder be mistaken for?

While the most consistent symptoms of ADHD include inattention, hyperactivity, and impulsivity, ADHD can also present with different symptoms, such as:

Irritability
Emotional dysregulation
Unpredictable mood
Low tolerance for frustration
Low self-esteem
Sleep problems

Symptoms of certain mood and personality disorders may mimic the ADHD symptoms listed above, which may make it difficult to differentiate between different disorders and accurately diagnose someone with ADHD. Some disorders that have similar symptoms with ADHD include:

Why do people with attention-deficit/hyperactivity disorder have rejection sensitivity?

Rejection sensitive dysphoria (RSD), also referred to as rejection sensitivity, is a type of emotional dysregulation characterized by feeling intense or extreme emotional pain when experiencing rejection or failure. Emotional dysregulation (emotional reactions that are considered excessive when compared to the context and social norms) is a core symptom of ADHD. People with emotional dysregulation are described as experiencing emotions so intensely that they may feel overwhelmed and engage in impulsive behavior. People with rejection sensitivity are more likely to distort, misinterpret, and overreact to what others say and do.

Can attention-deficit/hyperactivity disorder cause crippling anxiety?

If left untreated, ADHD may contribute to symptoms of anxiety. Hallmark symptoms of ADHD, such as forgetfulness and misplacing or losing thing can contribute to stress and, over time, anxiety.

For example, someone with ADHD who has difficulty remembering when they have a test or a deadline may live in constant worry or anxiety that they may forget to study for a test or miss important deadlines.

What is Ring of Fire?

Ring of Fire ADHD is one of seven theoretical types of ADHD defined by Dr. Daniel Amen, a psychiatrist and brain imaging specialist who specializes in SPECT scans (imaging tests that show blood flow in targeted organs). Ring of Fire ADHD gets its name from the pattern of high brain activity seen in SPECT brain scans that resemble a ring.

People with Ring of Fire ADHD, in addition to the core symptoms of ADHD, may experience:

Irritability
Anger outbursts
Periods of mean or insensitive behavior
Unstable mood

Ring of Fire ADHD may be related to bipolar disorder, a common ADHD comorbidity. It’s also common for adults with bipolar disorder to have comorbid ADHD. Patients diagnosed with both ADHD and bipolar disorder may not benefit from stimulant medication. Research shows that stimulant medications may worsen symptoms of bipolar disorder.

Research shows that selective serotonin reuptake inhibitors (SSRIs) may be used as an effective adjunctive treatment (adding an additional treatment to a patient’s main treatment to increase its effectiveness) for children diagnosed with ADHD who have aggressive behavior.

Do meds help with anxiety?

Pharmacological treatment (prescription medications) can help children and adults manage ADHD symptoms. The two types of medications used to treat ADHD are stimulants, including amphetamines and methylphenidate, and non-stimulants, including atomoxetine. Stimulant medications are most commonly used to treat ADHD, because they are fast-acting and effective. However, while stimulants may help reduce anxiety symptoms for some people with ADHD, stimulant medications may worsen anxiety symptoms in others with ADHD and comorbid anxiety. If you experience anxiety symptoms while taking a stimulant, your doctor may recommend switching to a non-stimulant.

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