It is estimated that attention deficit hyperactivity disorder (ADHD) and anxiety disorders have a 33% comorbidity rate (Abdelnour et. al, 2022). 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. In this article, we will explore several treatment options for comorbid anxiety and ADHD, as well as tools for accurate diagnosis and ongoing monitoring.
In recent years, ADHD has become a larger part of public health conversations. Recent studies suggest that as many as 75% of adults with ADHD were not diagnosed in childhood, suggesting that diagnoses are now being more actively sought in adulthood (Faraone et al., 2004; Abdelnour et. al, 2022).
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 anxiety worldwide (World Health Organization, 2022). 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 Telepsychiatry is quoted as saying, “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.”
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 (Michielsen et al., 2020; Farzam et. al, 2023). Effective mental health assessment tools can assist clinicians in identifying the root cause of symptoms and improving health outcomes.
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.
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 (van der Meer et al, 2017).
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):
Worldwide, an estimated 15.5 million adults are currently diagnosed with ADHD (Staley et. al, 2024). 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 for either inattention, impulsivity, and/or hyperactivity.
These are just a few examples of ADHD symptoms as listed in the DSM:
Up to 5% of adults worldwide experience symptoms of ADHD, including inattention, hyperactivity, and impulsivity (Staley et. al, 2024). 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.
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 (Suhr et al., 2017; Garb, 2021).
Creyos includes the VADRS questionnaire for those aged 6-11, the SWAN questionnaire for those aged 12-17, and the ASRS for adults 18 and over.
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 (Robinson et al, 2023).
An estimated 4% of the global population currently experiences an anxiety disorder, but only about 1 in 4 of these people receive medical help (World Health Organization, 2023).
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:
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.
Providers must be sure if a patient has ADHD, an anxiety disorder, or both. These are a few key indicators that a patient is experiencing ADHD symptoms and not those of an anxiety disorder:
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.
When treating ADHD and anxiety in adults, a patient-centered care approach ensures that patients’ unique needs and preferences are taken into consideration. Managing comorbid disorders often requires a multi-dimensional approach, with a combination of medication management, therapy, and integrative methods.
Patients with anxiety and ADHD comorbidity are often treated with a combination of medication and therapy, with the focus of treatment addressing the most severe condition first. This treatment plan may include a combination of ADHD medication, CBT therapy, and lifestyle changes.
According to a 2023 study from the National Center for Health Statistics Rapid Surveys System, 50.4% of people with adult ADHD were prescribed ADHD medication in the previous 12 months (Staley et. al, 2024).
When it comes to reducing ADHD symptoms, there are two primary classes of ADHD medication:
Cognitive behavioral therapy (CBT) is a type of therapy 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 (Chand et. al, 2023).
For anxiety, CBT can help to identify and challenge negative thought patterns, reduce worry, and build coping strategies (Kaczkurkin et al, 2015). 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 (American Psychological Association, 2019).
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 make a big difference as well.
Some of these changes could include:
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 (Hennessy et. al, 2024). This also applies to anxiety disorders, which can impair executive functioning, memory, attention, and more (Hampshire et. al, 2012).
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 General Anxiety Disorder Questionnaire (GAD-7) offered through Creyos Health, patients and providers receive deeper insight into patients’ mental and cognitive health.
These scientifically-backed solutions simultaneously gather both objective and subjective data while reducing administrative workload, and can help providers with:
Up to 80% of adults with ADHD have at least one comorbid psychiatric disorder—the most common of which include substance use disorder (SUD), mood disorder, and anxiety disorder (Choi et. al, 2022).
Along with anxiety and ADHD screeners, our suite of standardized mental and behavioral health questionnaires includes:
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 about how our solutions can help set up treatment for patients with anxiety and ADHD. -- CTA PANEL
Many adults with ADHD do not receive a diagnosis until later in life, but when they do, research shows that it measurably improves their lives and self-esteem (Pawaskar et. al, 2020). 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.
Avi Meehan is an author, editor, and SEO copywriter based in Ontario, Canada. They write about a wide range of topics, including nonprofit and event management, cognition and mental health, and more. Through their legacy memoir writing service, Recollections, they help aging individuals explore and document their life stories.
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.