Parents and clinicians often ask:
Is my child anxious? ADHD? Both?
And sometimes the more accurate answer is: yes — and it's complicated. This is an area where clinical understanding is evolving — and where the DSM may eventually catch up. | Anxiety and ADHD frequently overlap in children, especially in younger ones. But the relationship isn't just comorbidity. In many cases, there are developmental, neurological, and emotional pathways connecting the two. |
"The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is designed to evaluate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents, based on DSM-IV criteria. It collects information from both parents and teachers, providing a multi-environment perspective on the child’s behavior. The scale also screens for comorbid conditions such as oppositional-defiant disorder, conduct disorder, and anxiety/depression."
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The SCARED inventory is a valuable tool for assessing anxiety-related disorders in children. It includes a list of sentences that describe how people feel, and children are asked to indicate their level of agreement with each statement. The inventory helps identify symptoms such as panic, generalized anxiety, separation anxiety, social phobia, and school avoidance. A total score of 3 or more may suggest the presence of an anxiety disorder, with higher scores indicating more severe symptoms. The SCARED inventory is designed to be used by clinicians as a screener for anxiety disorders in children and can be used to track symptoms over time."
ADHD and Anxiety: Comorbid or Causal?
The short answer: Both are possible.
There are at least three common pathways where ADHD and anxiety overlap.
Pathway 1: ADHD Leads to Anxiety (Very Common)
This is probably the most common developmental pattern.
A child with ADHD may: Miss instructions Get corrected frequently Forget things Struggle socially Feel "in trouble" often Fall behind academically
| Over time, this creates: Chronic stress Low confidence Fear of failure Avoidance Generalized anxiety
|
This is sometimes called secondary anxiety — anxiety that develops as a result of ADHD struggles.
You might see: Perfectionism "I don't want to get it wrong" Avoidance of schoolwork Somatic complaints (stomach aches, headaches) Increased emotional sensitivity
| This pattern is especially common in: |
These children often become anxious about disappointing others.
Pathway 2: Anxiety Creates ADHD-Like Symptoms
This is where things get confusing. Severe anxiety impairs executive functioning, including: Attention Working memory Processing speed Task initiation
| This can look like: But the underlying issue is anxiety, not ADHD. |
When the brain is focused on threat detection, executive functioning decreases. The child's mind is busy worrying, scanning, or anticipating.
In other words:
The child isn't distracted because they're bored — they're distracted because they're worried.
Pathway 3: Shared Neurobiology
Research increasingly suggests that ADHD and anxiety share overlapping neurological features:
Executive function differences
Emotional regulation challenges
Increased amygdala reactivity
Differences in frontostriatal circuits
Some researchers propose that ADHD may neurologically predispose children to anxiety, not just psychologically.
This helps explain why:
ADHD and anxiety frequently occur together
Emotional dysregulation is common in ADHD
Some children develop both early
Emotion Dysregulation and ADHD: The DSM Gap
One of the biggest debates in ADHD right now is emotion dysregulation.
Emotion dysregulation is: Many clinicians see emotional dysregulation as central to ADHD, not just an associated feature. | This may include: Frustration intolerance Emotional impulsivity Rapid mood shifts Meltdowns Rejection sensitivity Low distress tolerance
|
Russell Barkley and others have argued that ADHD is fundamentally a self-regulation disorder, not just an attention disorder.
This would include: Attention regulation Behavioral regulation Emotional regulation
So why isn't it in the DSM?
| There are a few reasons: Diagnostic overlap (with bipolar, anxiety, DMDD, etc.) Measurement challenges The DSM tends to be conservative and slow to change
|
However, many clinicians already conceptualize ADHD as a self-regulation disorder that includes emotional regulation.
When Severe Anxiety Looks Like ADHD
This is especially important in young children. But the pattern is different.
| Severe anxiety can look like ADHD, including: Difficulty focusing Forgetfulness Restlessness Task avoidance Slow completion
|
Clues That It May Be Anxiety Instead of ADHD
1. Situational variability
Anxiety often: | 2. Situational consistency ADHD must be consistent across settings.
|
2. Undercontrol vs. Overcontrol
ADHD: Impulsive Fast but sloppy Careless mistakes
| Anxiety: Slow Perfectionistic Hesitant Avoidant
|
3. Cognitive "Freezing" Anxious children may: Go blank Say "I don't know" Shut down Become overwhelmed
This can look like inattention. | 4. Somatic Symptoms More common in anxiety: Stomach aches Headaches Sleep issues School refusal
|
5. Later Onset
If attention problems begin after stress or life changes, consider anxiety.
ADHD symptoms typically begin early in childhood, often in preschool.
When It's Both
Many children genuinely have both ADHD and anxiety.
These children may: Be impulsive and worried Show emotional dysregulation Avoid tasks but also struggle to organize Experience both frustration and fear
| Sometimes: Both pathways can be true. |
These are often the most complex children — and also the ones who benefit most from careful assessment.
Anxiety in Young Children Can Look Like Hyperactivity
Young children with anxiety often appear: Restless Irritable Hyperactive Emotionally reactive
| This is especially true in: |
So anxiety can sometimes look like hyperactive ADHD, not just inattentive ADHD.
A Helpful Clinical Question
Ask yourself:
Is the child distracted because their brain is bored?
(ADHD)
Or distracted because their brain is worried?
(Anxiety)
Often, the answer is:
Both.
Where the Field Is Heading
Many clinicians now view ADHD as: A self-regulation disorder Involving attention, behavior, and emotion
| As research evolves, we may see: Greater recognition of emotional dysregulation Better differentiation between anxiety and ADHD More nuanced diagnostic models
|
Until then, thoughtful clinical observation remains essential.
Final Thought
When children struggle with attention, it's important not to assume ADHD immediately — or dismiss ADHD when anxiety is present.
The overlap between anxiety and ADHD is common, complex, and clinically meaningful.
And understanding that overlap can lead to better support, better interventions, and better outcomes for children.
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