Attention deficit hyperactivity disorder (ADHD) and anxiety disorders are frequently co-occurring conditions, with an estimated 33% comorbidity rate, according to a review of ADHD diagnostic trends. Because both disorders share symptoms such as restlessness and struggles with focus, it can be challenging to determine the root of patients’ symptoms.
When determining how to treat ADHD and anxiety in adults, healthcare providers benefit from scientifically backed, digital assessments that make efficient use of limited appointment time while collecting the data necessary for whole-person care.
This article is for primary care providers and mental health professionals treating adults. Comorbid anxiety and ADHD is often treated with a combination of medication and therapy, addressing the most severe condition first. The sections below cover treatment options, ways to tell overlapping symptoms apart, and tools that support diagnosis and ongoing monitoring.
Article Highlights
- ADHD and anxiety disorders have an estimated 33% comorbidity rate, and up to 80% of adults with ADHD have at least one comorbid psychiatric disorder.
- As many as 75% of adults with ADHD were not diagnosed in childhood.
- Overlapping symptoms such as restlessness, trouble focusing, forgetfulness, and poor sleep can lead to misdiagnosis, including stimulant prescriptions that worsen anxiety.
- Treatment usually combines medication, cognitive behavioral therapy (CBT), and lifestyle changes, addressing the most severe condition first.
How common are ADHD and anxiety in adults?
Research, including a physician survey and a review of diagnostic trends, suggests that as many as 75% of adults with ADHD were not diagnosed in childhood, a sign that more people are seeking diagnosis in adulthood.
Along with this, anxiety disorders have been on the rise over the past few years, with the COVID-19 pandemic triggering a 25% increase in the prevalence of anxiety and depression worldwide, according to the World Health Organization. With the rapid onset of this mental health crisis, many people may not fully understand the root of their symptoms.
Regarding the challenges this presents to healthcare providers, Dr. Ozan Toy of Telapsychiatry said:
During the pandemic, so many adults came to us with trouble focusing, with no history of ADHD. It was difficult to make an assessment using only subjective evaluation.
— Dr. Ozan Toy, Telapsychiatry
Because anxiety may be present with ADHD or exacerbate existing ADHD symptoms, these conditions are often misdiagnosed. Misdiagnosis can lead to inappropriate or ineffective treatments, like the prescription of stimulant medication that can increase anxiety, as noted in attention disorders research and a clinical reference on stimulants. Effective mental health assessment tools can assist clinicians in identifying the root cause of symptoms and improving health outcomes.
Symptoms of ADHD and anxiety comorbidity
The first step in distinguishing between ADHD and anxiety is recognizing the differences between the symptoms, as well as how they influence each other. Symptoms of anxiety can also exacerbate ADHD symptoms and vice versa. For example, those with ADHD frequently have heightened anxiety levels, which are linked to poorer performance on working memory tasks, according to a working memory study.
In many cases, treatment for one of these mental disorders may actually help to manage another, breaking the vicious cycle.
Here are some of the similarities and differences between symptoms of ADHD and generalized anxiety disorder (GAD):
Symptoms of attention deficit hyperactivity disorder (ADHD)
In the United States, an estimated 15.5 million adults are currently diagnosed with ADHD, according to a CDC report on adult ADHD. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosis of ADHD requires an adult to report or display at least 5 of the 9 listed symptoms of inattention, hyperactivity-impulsivity, or both.
These are just a few examples of ADHD symptoms as listed in the DSM:
Inattentive ADHD indicators
- Struggling to stay focused, especially on tasks like reading or work.
- Difficulties meeting obligations due to time management.
- Missing details or seeming like they’re not listening.
- Losing things, forgetting plans, or struggling to organize tasks.
- Avoiding things that require long periods of mental effort, like reports or paperwork.
Hyperactive and impulsive ADHD indicators
- Feeling restless or unable to sit still for long.
- Talking a lot or interrupting others.
- Acting without thinking, like making snap decisions or overspending.
- Challenges with waiting or sitting through meetings or traffic.
Up to 5% of adults worldwide experience symptoms of ADHD, including inattention, hyperactivity, and impulsivity, according to CDC data. However, in order to meet the standard for a diagnosis as determined by the DSM-5, symptoms must be noticeable for at least 6 months, start before age 12, occur in multiple settings (like home and work), and clearly interfere with daily life.
Symptoms of anxiety disorders
According to the DSM-5, generalized anxiety disorder (GAD) is a mental health condition classified by excessive and intrusive worry about many aspects of life, even when there is little or no clear reason to worry. There is a strong relationship between anxiety and the brain, which can produce mental, emotional, and cognitive challenges, according to a review of anxiety and cognition.
An estimated 4% of the global population currently experiences an anxiety disorder, but only about 1 in 4 of these people receive medical help, according to WHO data.
While it is normal for most people to feel anxiety at some point in their lives, anxiety disorders are distinct and cause interruption or distress in patients’ daily lives.
These are a few of the anxiety disorder symptoms listed in the DSM-5:
- Worrying most days, and finding it hard to control or stop.
- Feeling on edge, restless, or easily fatigued.
- Struggling to concentrate or feeling like their mind “goes blank.”
- Feeling frequently irritable or overwhelmed.
- Experiencing muscle tension, headaches, or aches from being tense.
- Struggling with sleep, whether that be falling asleep, staying asleep, or feeling unsatisfied by sleep.
For a diagnosis, the worry must be hard to manage, occur on most days for at least 6 months, and cause significant stress or problems in daily life (at work, school, or in relationships). It also must not be better explained by another condition, medication, or substance use.
How can providers tell ADHD and anxiety apart?
Providers need to determine whether a patient has ADHD, an anxiety disorder, or both. The same symptom often has a different driver in each condition:
| Symptom | ADHD | Anxiety |
|---|---|---|
| Focus issues | A patient’s mind might drift off due to distraction or boredom. | Focus might be disrupted by excessive worry. |
| Restlessness | Might feel more like an intense and impulsive drive. | Might feel like being tense, jittery, or on edge. |
| Forgetfulness | Typically a result of inattention or poor organizational skills. | Might be due to overthinking or mental fatigue. |
| Difficulty sleeping | Might present as trouble settling down for the night. | May involve racing, anxious thoughts. |
With ADHD comorbidity, there will likely be overlap between these and other symptoms, which may end up exacerbating both conditions. Quick and trustworthy ADHD assessment can give providers more time to talk with patients and clarify the details of their symptoms.
How do you treat ADHD and anxiety in adults?
When treating ADHD and anxiety in adults, a patient-centered care approach ensures that patients’ unique needs and preferences are taken into consideration. In clinical practice, managing ADHD alongside a comorbid anxiety disorder often combines medication, cognitive behavioral therapy (CBT), and lifestyle changes, with treatment addressing the most severe condition first.
ADHD medications
According to a 2023 study from the National Center for Health Statistics Rapid Surveys System, 50.4% of US adults with ADHD were prescribed ADHD medication in the previous 12 months.
When it comes to reducing ADHD symptoms, there are two primary classes of ADHD medication:
- Stimulant ADHD medication: These are the most common type of medication that healthcare providers may prescribe to treat ADHD, and are either amphetamine or methylphenidate-based. They’re fast onset, short or long-acting, and can be effective, but can cause side effects such as trouble sleeping, decreased appetite, headache, or stomach ache. This runs the risk of worsening anxiety symptoms.
- Non-stimulant medication: Non-stimulant medication is another option. These can help manage norepinephrine levels in patients with ADHD who can’t tolerate stimulants or aren’t a good fit for them.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a form of psychotherapy that has been around since the 1960s and explores the way thoughts, feelings, and behaviors are interconnected. The core idea is that, by changing unhelpful thought patterns and behaviors, people can improve their emotional well-being, according to a clinical overview of CBT.
For anxiety, CBT can help to identify and challenge negative thought patterns, reduce worry, and build coping strategies, according to a review of CBT for anxiety. These strategies can also be applied to ADHD-related goals like reducing impulsive behavior and improving the habits of a patient’s daily life.
Many mental health professionals practice CBT with their patients, but there are also many apps on the market for supporting patients between sessions or as a part of a larger treatment plan, according to the American Psychological Association.
Lifestyle changes
As primary care providers and mental health professionals get to know patients, they can take a more personalized approach to ADHD treatment options. While ADHD medication and therapy may be appropriate treatment options for some patients to help manage anxiety and treat ADHD symptoms, certain lifestyle changes can also help.
Some of these changes could include:
- Regular exercise. Having an “exercise prescription” while taking ADHD medication may make treatment more effective, according to a meta-analysis on exercise.
- Structured life routines and time management strategies to lower ADHD-related overwhelm that can make anxiety worse, according to research on time management.
- Mindfulness meditation practice. A study of mindfulness training suggests that mindfulness meditation can be an effective tool for managing both adult ADHD and anxiety disorders.
- Practicing sleep hygiene by lowering caffeine intake, setting consistent sleep and wake times, and reducing naps during the day, according to Harvard Health Publishing.
How do cognitive tests support ADHD and anxiety treatment?
While self-report questionnaires have long been used to inform ADHD and anxiety disorder diagnoses, integrated cognitive screening tools can support greater diagnostic accuracy.
Along with behavioral symptoms, ADHD can affect cognitive functions including processing speed, concentration, and reaction time, according to research on ADHD and cognition. This also applies to anxiety disorders, which can impair executive functioning, memory, attention, and more, according to a large online cognition study.
Gathering objective cognitive data from patients who present with symptoms of anxiety and/or ADHD gives evidence-based insight into patient cognition. While an ADHD brain scan can also provide objective information about brain structure and function, it’s important to note that imaging is often expensive and time-consuming for both providers and patients, and therefore not typically used to diagnose ADHD.
The Creyos ADHD Assessment Protocol utilizes standardized behavioral questionnaires alongside 5 cognitive tasks that measure 14 key markers of ADHD. When integrated with the Generalized Anxiety Disorder 7-item scale (GAD-7) offered through Creyos Health, patients and providers receive deeper insight into patients’ mental and cognitive health.
The Creyos ADHD Protocol supports ADHD diagnoses with a combination of online cognitive tasks and trusted behavioral health questionnaires. The objective data it gathers is especially beneficial in reducing self-report bias, gender bias, and racial bias that often arise during ADHD diagnoses, according to research on self-report bias and a review of diagnostic bias.
Creyos includes the VADRS questionnaire for those aged 6–11, the SWAN questionnaire for adolescents aged 12–17, and the ASRS for adults 18 and over.
These scientifically-backed solutions simultaneously gather both objective and subjective data while reducing administrative workload, and can help providers with:
- Ongoing symptom monitoring: Our assessment protocols and screeners are effective for retesting patients to monitor treatment success and patient progress.
- Tracking treatment effectiveness: The longitudinal data gathered by our testing tools can track the positive or negative impact of medication or other treatment plans on patients’ mental and cognitive health.
- A diagnostic aid for patients of all ages: Our age-appropriate tests can be administered to adults, teenagers, or children as young as 5.
- Care coordination: Our reports automatically integrate into electronic health records (EHR) so primary care providers can seamlessly share data with psychologists, psychiatrists, neurologists, and more.
With the help of the Creyos ADHD Assessment Protocol, Dr. Toy was able to reduce ADHD overdiagnosis by over 30%. This allowed him to more quickly determine appropriate treatment and effective medication plans, thereby improving patients’ symptoms within 2 to 3 months.
Screening for co-occurring conditions
Up to 80% of adults with ADHD have at least one comorbid psychiatric disorder. The most common are substance use disorder (SUD), mood disorders, and anxiety disorders, according to a review of adult ADHD comorbidity.
Along with anxiety and ADHD screeners, our suite of standardized mental and behavioral health questionnaires includes:
- Drug Abuse Screening Test (DAST 10)
- Alcohol Use Disorders Identification Test (AUDIT)
- Opioid Risk Tool (ORT)
- Mood Disorder Questionnaire (MDQ)
- Patient Health Questionnaire (PHQ-9) for depression
All of these questionnaires are offered by Creyos and can be completed in under 15 minutes each, either in-clinic or remotely. For patients with ADHD and anxiety, remembering or attending appointments can be a challenge. Our remote options make screening accessible and can gather patient data without adding stress to the diagnostic experience.
Contact us today to learn how our solutions can help establish treatment for patients with anxiety and ADHD.
Treating adult ADHD and anxiety symptoms
Many adults with ADHD do not receive a diagnosis until later in life, but when they do, published research shows that it measurably improves their lives and self-esteem. An integrated clinical and personalized approach gives providers a full look at patients’ unique cognitive and mental health needs.
By facilitating conversations about treating anxiety and ADHD, healthcare providers can help adults overcome ADHD stigma and thrive with both conditions.
Reviewed by Sydni Paleczny, Staff Scientist at Creyos
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.