What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a behavioral condition that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. It tends to be diagnosed in childhood and often difficulties persist into adulthood, although symptoms often improve with age.
The precise cause of ADHD is not known, but there appears to be a familial link. Research has identified a number of possible differences in the brains of people with ADHD when compared with those without the condition; and those with ADHD often tend to score differently on IQ testing than those without, specifically in the areas of working memory and processing speed. Other factors implicated in ADHD include:
- premature birth (before 37 weeks' gestation)
- low birth-weight
- substance or alcohol use during pregnancy
Having ADHD can be very stressful for the sufferer. Executive functioning issues (difficulties with planning, organization, time management, inhibiting behavior, working memory, problem-solving, flexibility, for example) can lead to a state of anxiety for individuals with this disorder. People with ADHD often have issues with working memory, organization and time management that make it hard to follow daily routines and reliably meet regular responsibilities and commitments. For example, they may struggle to hold down jobs, remember to pay bills, maintain relationships etc., and this can lead to chronic stress. Interestingly, those with ADHD may also experience more difficulty managing stress than those without as they often experience difficulties with regulating and managing their emotions. Often emotions can be overwhelming and people can feel “flooded” and they can struggle even more than most to deal with the intensity.
ADHD and anxiety: Prevalence
A recent study of 264 patients in an anxiety disorders clinic found the prevalence of lifetime ADHD was more than 40 percent and higher than that found in the general population. ADHD was most commonly associated with social phobia amongst all the anxiety disorders.
Another study also found that the prevalence of ADHD in adult outpatient psychiatric clinics is substantially higher than in the general adult population – a difference of more than 20 percent to 4 percent. Among the patients with ADHD in this study, 93% had two or more co-morbid disorders and anxiety disorders such as PTSD, panic disorder, and GAD had a prominent role.
Another study found that childhood ADHD features were reported in more than 23 percent of panic patients and two-thirds of those reported that their ADHD symptoms had continued into adulthood; fewer had married or completed formal college-level education than those with panic alone.
ADHD and anxiety: Key diagnostic issues
1. ADHD may have been diagnosed, but the co-morbid anxiety has not.
2. Anxiety has been identified and diagnosed, but the ADHD has not been recognized.
3. Increased anxiety may be a side effect of stimulant medication for ADHD, such as Ritalin. Nervousness, insomnia, appetite issues, weight loss, dizziness, nausea and/or vomiting and headaches are all listed as side effects of the medication. They are also symptoms of anxiety, which further confounds diagnosis.
Symptom overlap with ADHD and anxiety
- Poor Concentration. Someone with anxiety may appear detached or preoccupied because they are distracted by worries; whereas someone with ADHD struggles with focus and attention due to cognitive differences.
- Restlessness. An anxious person may display psychomotor agitation due to nervous energy; whereas someone with ADHD may be fidgety due to issues with hyperactivity or impulse control.
- Slow work pace. Someone with anxiety may work slowly due to perfectionist tendencies; whereas a person with ADHD may struggle because of difficulties initiating tasks and maintaining interest and focus.
- Difficulty completing assignments. Someone with anxiety may struggle with a task or aspect of their work or life but be too anxious to ask for help; whereas someone with ADHD will be experiencing issues with planning and working memory.
- Relationship issues. Both those with anxiety and ADHD can struggle socially and with relationships. The key difference again lays in the process behind it: someone with ADHD may struggle to pick up on social cues, with impulse control or with emotional outbursts owing to their neuro-diversity; someone with anxiety may too, but for different underlying reasons.
- Sleep difficulties. Insomnia is often present in both anxiety and ADHD, again with differing etiology.
What can be done for those with ADHD and anxiety?
The first and important approach is for individuals to identify areas of difficulty that might be causing anxiety. Strategies to manage executive function deficits can then be employed, leading them to feel more in control, which is likely to reduce any anxiety secondary to ADHD.
Pharmacotherapy has long been the treatment of choice for ADHD for many clinicians but this may need to be rethought, especially if the medication itself is the cause of the anxiety. Furthermore, some studies indicate that those with ADHD and co-morbid anxiety may respond less favorably to the standard stimulant treatment and may be more likely to experience higher rates of side effects so need a different approach.
Psychological approaches often offer the best approach for treating co-morbid disorders, and unlike other conditions where it may be difficult to know which to tackle first, approaches for anxiety and ADHD could arguably be used concurrently. Many people with ADHD find that social skills training is one of the most beneficial approaches to managing the impact that the disorder has on their lives and this can be carried out at the same time as psychotherapeutic approaches for anxiety such as cognitive behavioral therapy or mindfulness-based approaches.
Increasingly people are also looking to alternative therapies (such as diet, exercise, herbs or supplements) to manage disorders and ADHD and anxiety are no exception. Theorists have proposed that specific diets and use of certain supplements such as Omega oils can impact upon ADHD symptomatology. One area of burgeoning interest is the use of CBD oil as anecdotal reports and the research conducted so far (albeit as yet in its infancy) suggest many benefits for both conditions.