Attention Deficit Hyperactivity Disorder, or ADHD, and anxiety disorders often go hand in hand. ADHD can make everyday life difficult. Impulsive behavior is characteristic to ADHD and makes it hard for people to focus on one thing. This can be problematic when it gets in the way of your daily life, like making deadlines or remembering to make lunch for your kids.
Those with ADHD are often overwhelmed by fear and worry of forgetting something or being judged by others for their behavior. I’ve found that many of my ADHD patients need to be treated for their anxiety as well.
What is ADHD?
According to the DSM-5, ADHD occurs when someone shows persistent patterns of inattention and hyperactivity or impulsivity. There are several symptoms that contribute to the assessment of ADHD, including:
- Poor listening skills
- Fidgety behavior
- Excessive talking
Neurologically, ADHD is due to an impairment of the right prefrontal cortex. This part of the brain helps regulate executive functions such as attention and goal-oriented activities. Planning, memory, attention, problem solving, verbal reasoning, multi-tasking, inhibition, and monitoring of actions are all cognitive functions that occur in the prefrontal cortex.
Anxiety, on the other hand, has different criteria. The DSM-5, outlines generalized anxiety with excessive worry, difficulty controlling thoughts, restlessness, being easily fatigued by over thinking, difficulty concentrating, and possible sleep disturbances. Looking at these two disorders side by side, you can see how the challenges caused by impaired problem solving can trigger restlessness, a sense of being overwhelmed, and excessive worry. In fact, The Anxiety Disorders Association of America estimates that as many as 50 percent of people with ADHD have an anxiety disorder.
Clinical Findings of ADHD and Anxiety Comorbidity
In my therapy practice, most ADHD adults report anxiety driven by personal dissonance they feel between knowing what they want to accomplish and the struggles they face focusing their attention, planning a course of action, and problem solving to get the task done. When posed with a project or task they are flooded with uncertainty, confusion, lack of confidence, and the resulting anxiety that comes with these emotions. Social anxiety can result because of a dissonance between what they know they are capable of achieving and how they feel others perceive them. Stumbling over simple tasks that others do with ease can leave ADHD adults feeling frustrated, out of control, left- behind, judged and overwhelmed.
Luckily, people with ADHD tend to be high performers in other areas. They tend to have strong analytical skills and be creative thinkers, all qualities that can be used to help combat anxiety.
How to Manage ADHD and Control Anxiety
There are five things that I have found helpful in working through anxiety in ADHD clients:
- Be realistic about the challenges you face: No one is good at everything. The sooner you work through the process of identifying, articulating and acknowledging the areas which you find challenging, the faster you can find ways to better manage them and reduce the anxiety they create.
- Lead with what you’re good at: One of the best ways people with ADHD can combat their anxiety is by doing what they are good at and seeking help with the tasks with which they struggle. ADHD adults are more likely to be creative thinkers, making intuitive mental leaps to new understandings of problems and solutions. While it might be hard for someone with ADHD to complete routine tasks, they are able to hyper focus on subjects of interest to them. My advice to ADHD adults with anxiety is to pursue careers that welcome and reward this kind of fresh thinking.
- Learn your personal process: The next piece of advice I have is to learn your personal process for completing tasks. Many ADHD adults think in a more circuitous manner, starting several tasks at once rather than taking a more linear approach and tackling one at a time. You might start a few things at once and slowly finish each task in a random order. The sooner you can get a feel for your personal rhythm, the sooner you can appreciate and plan your unique work style and stop comparing yourself to more conventional linear patterns. If you know it takes you longer to complete several tasks and need time to stop along the way, you can plan for that, your anxiety will go down and your confidence will go up the next time.
- Acknowledge your anxiety: Next, I encourage my ADHD clients to welcome their anxiety. You will likely feel anxious before you have to complete any task and that’s OK. Learning to acknowledge and welcome anxiety will allow you to anticipate the challenging feelings rather than impulsively acting on them or becoming derailed by them. I often work a lot with clients on building skills to do this.
- Train your brain through meditation: I feel confident that the most effective way to combat anxiety is through a regular meditation practice. The brain is like any other muscle, the more you work it out, the stronger it gets. By meditating every day you are training your brain to focus for longer amounts of time, affording you the opportunity to be more patient and pragmatic about prioritizing and executing tasks. However, meditation is a technique that needs to be practiced regularly – daily, for a minimum of five to twenty minutes. There’s little benefit, if you only meditate occasionally.
ADHD and Anxiety are Treatable
Fortunately, these disorders can be treated and managed. Living with these disorders does not have to halt your life. If you or a loved one has ADHD, consider getting a mental health screening. Acknowledging anxiety before it becomes a serious issue can lead to faster results and a healthier life. Challenges can be readily identified and strategies employed that will lead to a more successful and satisfying life. All it takes is some open mindedness and patience.
Lexi Frank Newhall is a licensed Marriage and Family Therapist, co-founder of The Well Clinic in San Francisco. She specializes in women's health and incorporates psychodynamics, object-relations, mindfulness, and holistic medicine in her therapy. Lexi emphasizes empowering patients to find their inner strength and wisdom to overcome challenges. Previously, she worked as a Behavioral Health Counselor at Burton High School, assisting youths with issues like loss, gang affiliation, and abuse.