By the clinical team at Next Step Psychiatry • Lilburn, GA
Why They Are So Often Confused
Anxiety and ADHD share several overlapping symptoms that make misdiagnosis common. Both conditions cause difficulty concentrating, restlessness, sleep problems, irritability, and avoidance of challenging tasks. Research shows that approximately 50 percent of adults with ADHD also have an anxiety disorder, and many people with anxiety are misdiagnosed with ADHD because their worry-driven inattention looks like the distractibility of ADHD. Getting the diagnosis right matters enormously because the treatments differ and giving stimulant medication to someone with anxiety but not ADHD can significantly worsen their symptoms.
Key Differences in How They Affect Attention
The quality of inattention differs between the two conditions. In ADHD, attention problems are consistent across situations and driven by understimulation. The ADHD brain struggles to focus on anything that is not inherently interesting or urgent. In anxiety, inattention is driven by preoccupation with worry. The anxious brain can focus perfectly well when not anxious but becomes distracted when worry monopolizes cognitive resources. A person with ADHD might zone out during an interesting conversation because a passing thought derailed them. A person with anxiety might zone out because they are catastrophizing about something that happened earlier.
Restlessness: Different Flavors
Both conditions produce restlessness, but the subjective experience differs. ADHD restlessness feels like excess energy that needs an outlet, a physical need to move, fidget, or do something. Anxiety restlessness feels like nervous tension, an inability to relax because your body is braced for danger. ADHD restlessness often improves with physical activity and stimulation. Anxiety restlessness may worsen with stimulation and improve with calming activities. Some patients describe ADHD restlessness as wanting to go and anxiety restlessness as wanting to escape.
| Feature | ADHD | Anxiety |
|---|---|---|
| Inattention cause | Understimulation, boredom | Preoccupation with worry |
| Restlessness type | Excess energy, need to move | Nervous tension, on edge |
| Onset | Childhood (often before age 12) | Can start at any age |
| Task avoidance | Boring or tedious tasks | Tasks that trigger worry |
| First-line medication | Stimulants | SSRIs |
When Both Are Present
Having both ADHD and anxiety simultaneously is common and creates particular treatment challenges. ADHD-related failures and disorganization can generate legitimate anxiety. Anxiety can mask ADHD symptoms by imposing worry-driven focus that compensates for ADHD inattention. Treatment typically starts with the condition causing more impairment. Sometimes treating ADHD with stimulants reduces anxiety because the patient is no longer failing and stressed. Other times, treating anxiety first reveals the underlying ADHD that was hidden by compensatory worry.
Getting an Accurate Diagnosis
At Next Step Psychiatry, our diagnostic evaluation carefully distinguishes between anxiety, ADHD, and co-occurring presentations. We take a detailed history of when symptoms began, how they manifest across different settings, what makes them better or worse, and how they affect daily functioning. This thorough approach prevents misdiagnosis and ensures you receive the right treatment from the start.
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This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider. If you or someone you know is in crisis, call 911 or the 988 Suicide & Crisis Lifeline.