ADHD and Anxiety: How to Tell the Difference (and What to Do When You Have Both)

Nearly half of adults with ADHD also have an anxiety disorder, and the symptoms overlap more than you'd think. Discover how to untangle ADHD from anxiety, why misdiagnosis is so common, and how targeted treatment can help with both.

Two Conditions, One Overwhelmed Brain

ADHD and anxiety are two of the most common mental health conditions in adults, and they co-occur far more frequently than chance would predict. Research published in the Journal of Psychiatric Research estimates that up to 50% of adults with ADHD also meet the criteria for an anxiety disorder. That is roughly five times the rate in the general population.

But the overlap goes deeper than simple co-occurrence. ADHD and anxiety share many surface-level symptoms — restlessness, difficulty concentrating, irritability, sleep problems, and a sense of being overwhelmed — which makes them easy to confuse. Many people are diagnosed with anxiety alone when ADHD is actually the primary condition, and vice versa. Getting the distinction right matters because the treatments are different, and treating only one while ignoring the other tends to produce limited results.

How ADHD Causes Anxiety

For many people, anxiety is not a separate condition alongside their ADHD — it is a direct consequence of living with unmanaged ADHD. When your brain constantly struggles with organisation, time management, and working memory, the result is a near-constant state of stress. You are always behind, always forgetting something, always worried that you have missed a deadline or upset someone.

Common Ways ADHD Drives Anxiety

• Chronic overwhelm: The sheer volume of tasks, decisions, and stimuli that the ADHD brain struggles to filter creates a persistent sense of drowning. This is experienced as anxiety even though the root cause is an executive function deficit.
• Fear of forgetting: When you have a history of forgetting important things — appointments, deadlines, promises to friends — you develop a constant background hum of worry about what you might be forgetting right now.
• Past failures: Years of underperformance, missed opportunities, and negative feedback create a catalogue of evidence that things will go wrong. This learned helplessness fuels anticipatory anxiety.
• Social anxiety from masking: The effort of hiding your ADHD symptoms in social and professional settings generates anxiety about being "found out." For more on this, see our article on ADHD masking.
• Rejection sensitivity: The intense emotional pain of rejection sensitive dysphoria creates anxiety about future social interactions.

How to Tell Them Apart

Distinguishing ADHD from anxiety — or working out how much of each you have — is important because the treatment approaches differ. Here are some key differences to consider, though a proper clinical assessment is always needed for an accurate diagnosis.

Attention Difficulties

In ADHD, difficulty concentrating is present across all areas of life and has been there since childhood. In anxiety, difficulty concentrating is typically driven by worry and tends to improve when the source of anxiety is removed. If you can concentrate perfectly well when you are relaxed and the stakes are low, anxiety may be the primary driver. If you struggle to concentrate even when doing something you enjoy, ADHD is more likely.

Restlessness

ADHD restlessness is often physical — fidgeting, tapping, needing to move. Anxiety restlessness is more often internal — a feeling of being keyed up or on edge. Both can co-exist, of course.

The Nature of the Worry

In generalised anxiety, worry tends to be about future events and is characterised by "what if" thinking. In ADHD, the worry is often about things you have already forgotten, tasks you are behind on, or a general sense of being overwhelmed. ADHD worry is often reactive and practical rather than abstract and anticipatory.

When You Have Both

Many people genuinely do have both ADHD and an independent anxiety disorder. In these cases, NICE guidelines recommend treating the condition that is causing the most impairment first. In practice, treating ADHD first often reduces anxiety significantly, because much of the anxiety was being driven by ADHD-related difficulties. However, if the anxiety is severe, it may need to be stabilised before ADHD treatment can be effectively implemented.

Treatment Approaches

Medication Considerations

Stimulant ADHD medications can sometimes worsen anxiety, particularly in the early stages of treatment or at higher doses. For this reason, clinicians may start with a lower dose and titrate more slowly when anxiety is present. Non-stimulant medications like atomoxetine can be a good option for people with significant co-existing anxiety, as they are less likely to exacerbate anxious symptoms. For a full overview, see our ADHD medication guide.

Therapy

CBT is effective for both ADHD and anxiety, though the approach differs. For anxiety, CBT focuses on challenging anxious thoughts and reducing avoidance. For ADHD, CBT focuses on building practical strategies for organisation, time management, and task initiation. An experienced therapist can work on both simultaneously.

Lifestyle Strategies

• Exercise: Regular physical activity is one of the few interventions that benefits both ADHD and anxiety. Even a 20-minute walk can significantly reduce both anxious symptoms and ADHD-related restlessness.
• Mindfulness: While traditional meditation can be challenging for the ADHD brain, adapted mindfulness practices — such as body scans, walking meditation, or short guided sessions — can help reduce anxiety without requiring sustained stillness.
• Reducing caffeine: Caffeine worsens anxiety and can also interfere with ADHD medication. If you are using caffeine to self-medicate your ADHD (as many people do before diagnosis), this is worth discussing with your clinician.
• Sleep: Poor sleep worsens both ADHD and anxiety. Addressing ADHD-related sleep problems can have a positive ripple effect on both conditions.

Getting the Right Diagnosis

If you have been treated for anxiety for years without fully resolving your difficulties, it is worth considering whether ADHD might be part of the picture. Equally, if you have been diagnosed with ADHD but find that medication alone is not enough, anxiety may need to be addressed alongside it.

At Clearmind, our psychiatrists are experienced in assessing both ADHD and co-existing conditions. A comprehensive assessment looks at the full picture, not just one piece of the puzzle. You can start with our free ADHD screener or book an assessment directly.