ADHD and anxiety

The short answer

ADHD and anxiety can look similar. Both can affect concentration, sleep and the ability to settle, and many people have both. The key difference is usually why the difficulties happen. With anxiety, attention is taken up by worry. With ADHD, attention is hard to direct and hold even when a person feels calm, and the difficulties go back to childhood.

Adults with ADHD, and females in particular, are often treated for anxiety before anyone considers ADHD. If treatment has eased your worry but the difficulties with focus and organisation remain, an ADHD assessment may help. The free adult screening is a useful first step. A screening questionnaire is not a diagnosis.

How ADHD and anxiety overlap

People with either condition may describe:

• Difficulty concentrating, or a mind that will not settle
• Restlessness and finding it hard to relax
• Trouble getting to sleep
• Irritability and feeling easily overwhelmed
• Avoiding or putting off tasks

The two also feed each other. Living with ADHD can mean missed deadlines, lost items and a constant sense of being behind, and many people describe anxiety building up over years as a result. NICE guideline NG87, the national guidance on ADHD, asks professionals to be aware that ADHD is more common in adults who have a mental health condition.

How they differ

No single sign separates them, but a clinician will look at patterns like these:

• Where attention goes. With anxiety, attention is pulled towards worries and possible threats. With ADHD, attention drifts to whatever is most interesting at the time, and boredom is often a bigger problem than worry.
• When it started. ADHD symptoms begin in childhood, and the diagnostic criteria require several symptoms to be present before the age of 12. Anxiety can begin at any age, and often becomes worse at particular times or in particular situations.
• What happens when things are calm. If anxiety is the main cause, concentration often improves when worry eases. With ADHD, the difficulties with focus, organisation and forgetfulness usually remain on calm days too.
• The kind of restlessness. Anxious restlessness tends to feel tense and on edge. ADHD restlessness is more often described as a need to move, fidget or find stimulation.

Why ADHD is often first treated as anxiety

When an adult sees a GP, they usually describe how they feel: stressed, overwhelmed, unable to switch off. Those are signs of anxiety, and it is right that they are taken seriously. However, the question of why the anxiety started is not always asked, and adult ADHD was for many years less widely recognised than it is today.

This is particularly common in females. Females are more likely to have the inattentive presentation of ADHD and to mask their difficulties by working harder, checking repeatedly and over-preparing. That effort can produce anxiety, which is then what others see. Our guide to ADHD in females explains why it is so often missed.

Signs that it may be worth looking further include:

• Treatment for anxiety helped with worry, but focus, organisation and forgetfulness did not improve
• You recognise the same difficulties from school, long before the anxiety began
• The difficulties appear at home, at work and in relationships, not only in stressful situations
• A close family member has been diagnosed with ADHD

Hormonal changes can add another layer. Anxiety and difficulty concentrating are both recognised symptoms of perimenopause, which we cover in our guide to ADHD and menopause.

How an assessment tells them apart

NICE guideline NG87 says ADHD should not be diagnosed from a rating scale or questionnaire alone. A full assessment builds a picture of your whole life, so that anxiety can be properly considered. It usually includes:

• A detailed clinical interview about your childhood, school, work and relationships
• Rating scales completed by you and, where possible, someone who knows you well
• At ADH-Me, the QbCheck test, an objective measure of attention, activity and impulsivity
• Questions about mood, worry, sleep and other conditions that can look like ADHD

The outcome may be ADHD, anxiety, both, or neither. Your report explains the reasons and makes recommendations, including any that are for your GP. Our guide to what happens in an ADHD assessment sets out each stage, and our page on ADHD tests for adults explains why an online test cannot separate the two.

Getting the right support

Anxiety has its own NICE guidance and its own treatments, and your GP is the right first contact for it. They can discuss the support available to you, including talking therapies.

ADH-Me assesses and treats ADHD. It does not provide treatment for anxiety or a crisis service. If you are diagnosed with ADHD and also live with anxiety, both should be considered when planning your support. Stimulant and non-stimulant medicines are only one part of ADHD support, and medication is not right for everyone. Our guide to ADHD medication in the UK explains how prescribing and reviews work.

Anxiety is also common alongside other neurodevelopmental conditions. If you recognise autistic traits as well, read our guide to ADHD and autism.