Anxiety and ADHD are very different, but sometimes the symptoms can look similar. The correct diagnosis is critical to guide treatment and to make sense of things when kids seem to be struggling or when something doesn’t feel quite right. As much as the right diagnosis can heal, the wrong one can also harm. Understanding how anxiety might look like ADHD, and the telltale differences between the two, can make an important difference in avoiding a misdiagnosis, and helping kids deal with the symptoms that might be getting in their way.
ADHD is one of the most diagnosed childhood conditions, and it seems to be increasing. The Centre for Disease Control reports that 11% of children between 4-17 have been diagnosed with ADHD at some point in their lives. Reports suggest that about 8% currently have ADHD and about 6% are taking medication. The prescription of medications for ADHD has increased by 800% in the last two decades.
ADHD has been the firestarter for plenty of hearty debate, with some questioning whether or not it actually exists. Let’s start by putting that argument to bed, or somewhere less cosy and far away so it won’t find its way back. ADHD absolutely does exist, and there are pictures to prove it. Brain imaging shows definite differences between a brain with ADHD and a brain without.
Researchers don’t know exactly what causes ADHD, but they know for certain that it’s is a neurobiological condition. It has nothing to do with bad behaviour, bad parenting, too much sugar, not enough sleep, fairy dust, wearing too much yellow – or whatever other crazy theories are out there. Fortunately, these theories have been debunked, which means now researchers can get on with finding out what’s really going on, which they are.
Perhaps something that has given buoyancy to the ‘does it exist or doesn’t it’ debate is the overdiagnosis of ADHD, or the misdiagnosis of symptoms that look like ADHD. A major problem facing doctors and clinicians is that there is currently no widely available objective physiological assessment for the presence of ADHD. At the moment, brain imaging can’t be used for diagnosis, but researchers are working on developing a more accurate and objective diagnosis tool.
In the meantime, diagnosis relies on reports of the child’s behaviour from two different environments, typically school (from teachers) and home (from parents). If your child seems to struggle at school but seems fine at home, it’s not ADHD, and vice versa. Diagnosis of ADHD is based on a list of 18 possible symptoms, all of which exist on a spectrum, and all of which could apply to any child at some point in time. The 18 symptoms are divided into two clusters with nine symptoms in each cluster (‘inattentive’ and ‘hyperactivity/impulsivity’ cluster). A formal diagnosis of ADHD comes down to a question of degree. To be diagnosed, a child has to have most of the symptoms from both clusters (combined inattentive and hyperactivity/impulsivity) or one of the clusters (predominantly inattentive or predominantly hyperactive) most of the time, and they have to intrude significantly into day-to-day life.
Studies that have looked at the way ADHD is assessed by clinicians have found that a large majority of practicing clinicians did not regularly follow assessment procedures that are in line with best practice guidelines. One of these guidelines is to use multiple methods to diagnose but only 15% of clinicians reported doing this.
Research has also found that the youngest children in a year level are more likely to be diagnosed with ADHD and medicated than older children in the year level. Interestingly, this trend is only found with preschool and primary school (elementary) age children, not adolescents. Researchers suggest this may be because younger children, because of their age and stage of development, don’t quite yet have the neurocognitive development of their older classmates and may wrongly be diagnosed with ADHD.
Without a reliable objective measure of ADHD, there will inevitably be times when a cluster of behaviours in a child is labeled as ADHD, but isn’t. The key symptoms of ADHD – inattention, distraction, fidgeting, problems at school, problems focusing – don’t automatically mean ADHD. They can indicate several other conditions, one of which is anxiety.
The problem with misdiagnosis.
No parents wants their child to be diagnosed with ADHD. Understandably though, it can be a massive relief when there is finally an explanation for behaviours that don’t seem to make sense, or which are causing problems at school, at home and with friendships.
Having a correct diagnosis is vital. It can bring clarity and guide the management of symptoms in ways that see important parts of a child’s life (relationships, academics, behaviour, self-esteem) improving significantly. But as much as a diagnosis can heal, it can also harm. When a child is misdiagnosed, the fallout can be immense. Not only might the child be exposed to unnecessary medication, but the wrong diagnosis can mean that the child isn’t receiving the support or treatment that actually would help their symptoms.
Misdiagnosis can set a path for treatment that is unhelpful or detrimental, and it runs the risk of overlooking the true cause of any difficulties the child is having. Labeling a child with the wrong diagnosis also has the potential to shrink the expectations of teachers or other adults as to what that child is capable of. Children will live up to expectations or down to them. They’ll look to the important adults in their lives for clues about how hard they should try, and whether the reach is in them.
But then there’s the overlap.
The overlap between the symptoms of ADHD and other conditions can also add to the potential for misdiagnosis. As many as 75% of children with ADHD meet the criteria for another diagnosis. About a third of children who have ADHD will also have clinical levels of anxiety. The presence of anxiety seems to be related to more severe ADHD, so it’s massively important that the diagnostic process is open to this. If anxiety is present, it’s vital that it is given the attention it needs, and not overlooked or treated as part of the ADHD.
The Masquerade – When anxiety looks like ADHD.
Anxiety and ADHD are very different, but the symptoms can sometimes look similar. This is because both have symptoms are driven by changes in the pre-frontal cortex BUT the nature of those changes and the processes behind those changes are different. With anxiety, the symptoms are brought about by the fight or flight response. This response can be enduring and intense, and it can happen even when there is no threat and no real need for fight or flight. With ADHD, the symptoms are brought about by structural, functional and chemical changes in the brain.
When there are changes in activity in the prefrontal cortex, as happens during anxiety and ADHD, symptoms can include inattention and distraction; impulsivity and hyperactivity; and difficulty controlling emotions, impulses and habits.
But if the symptoms are the same, does it matter how it’s treated?
Yes. Yes. Yes. It matters. The symptoms aren’t the problem. The condition driving the symptoms is the problem. Understanding whether it’s ADHD, anxiety, or both is the first and most important step in making sure your little person is getting what he or she needs to move forward. Although both anxiety and ADHD are manageable, they need different types of support to improve.
ADHD is generally treated with medication that boosts the necessary neurochemicals and stimulates the parts of the brain that need to work a little harder. This may be effective for ADHD, but if the symptoms are being driven by anxiety, the use of ADHD medication is massively heavy-handed and fails miserably to give the child the skills or resources needed to best manage the symptoms. Even if anxiety and ADHD are happening together, it’s important to also treat the anxiety as a separate condition. A growing body of highly regarded research is showing that mindfulness and exercise are both powerful ways to do this.
If the symptoms are from ADHD, what’s driving them?
An ever-increasing body of research has found that there are widespread structural and functional, electrical and neurochemical differences in the brains of children with ADHD. Researchers aren’t exactly sure what causes these changes, but there’s a lot of research happening in the area to get us closer to the answers.
The changes are particularly in the areas of executive functioning (planning, organising, concentration, impulse control, focusing attention, remembering instructions, inhibition, self-control) and sensorimotor processing (using the information that we receive through our senses, to produce an effective motor response).
The frontal cortex and other parts of the brain are smaller in children with ADHD. Size makes no difference at all when it comes to intelligence, and many kids with ADHD will have above average IQ’s. What it does affect is behaviour. An ADHD brain is powerful, intelligent, and very capable, but it’s not able to filter the ‘noise’ from the relevant information coming in. A brain with ADHD is like a beautiful, high-powered, high performing sports car, but without any brakes.
In any brain, the different parts interact with each to form different networks that control processes such as behaviour, movement and attention. These networks are like a symphony – they increase in activity or decrease in activity depending on what we are doing. For a brain to do what it needs to do effectively, the networks need to work together and increase activity or decrease activity just enough to make things happen. When we are trying to learn something, for example, the networks that process information increase in activity, while at the same time the networks involved in daydreaming decrease in activity. In a child with ADHD, some networks switch on too much and some don’t switch on enough. When this happens, they may struggle with tasks or behaviour.
Many people seem to grow out of ADHD, and there seems to be a good reason for this. Research suggests that with ADHD, the brain is delayed in some areas by about three years. It still develops in a normal pattern, but some areas will take a little longer. Eventually, the functioning in these areas catches up, which is when the symptoms of ADHD seem to lessen or disappear.
And if the symptoms are from anxiety?
Anxiety comes from a part of the brain called the amygdala. It’s a tiny almond-shaped part at the back of the brain and its job is to keep us safe by warning us when there might be danger. When the amygdala senses threat, the brain immediately switches to auto-pilot and initiates the fight or flight response. It hands the bulk of the workload to the more primitive, instinctive, impulsive lower brain (at the back of the brain). At the same time it organises for the pre-frontal cortex to sit out for a while until the threat has passed. When this happens, behaviour becomes less planned, more instinctive, and more impulsive.
There’s a very good reason for sending the pre-frontal cortex offline when there’s an immediate threat. The amygdala doesn’t want the pre-frontal cortex to use valuable survival time thinking, planning, deciding – it just wants to get you safe. If there’s a wild dog with gnarly teeth running at you, there’s no time to think about whether it might be lost, angry, hungry or misunderstood, or to imagine how cute it would be if it was wearing one of those cute dog jackets that all the cool dogs are wearing. Your brain just wants you out of there – fast.
It’s important to remember that the fight or flight response doesn’t only happen when there’s a threat. For kids with anxiety, it can feel constant. Sometimes, the amygdala gets a little too overprotective and initiates the fight or flight response too many times, too unnecessarily – just in case. It’s evidence of a strong, healthy brain switching into survival mode, but just a little more than it needs to. That’s evolution for you … sometimes it gives us opposing thumbs, and sometimes it gives us anxiety.
Anxiety, ADHD and the look-alike symptoms.
Even though the symptoms of ADHD and anxiety might look the same, they will be driven by different processes. It’s also important to remember that not all ADHD looks the same and not all anxiety looks the same, but there are versions of both that can look similar. Let’s go through the symptoms:
Difficulty in class, makes careless mistakes, distraction, inattentiveness, restless, difficulty focusing/ planning.
If it’s caused by anxiety:
When anxiety hits in class, it can shut down the pre-frontal cortex, the part of the brain that is important for thinking, learning and remembering. Anxiety is all about protecting you from threat, so the brain shuts down to detail. Instead, it becomes focussed on staying safe. Anxiety can make kids so distracted by worrying thoughts, that they are unable to apply themselves to whatever they are working on. This can make kids appear restless, distracted and make it difficult to focus, retain information or pay attention. When kids are highly anxious, their thoughts are consumed with their worries. They might have trouble writing, sitting still, staying focussed or copying from the board. They might also be reluctant to ask questions or ask for guidance.
If it’s caused by ADHD:
With ADHD, the symptoms are thought to be because in the prefrontal cortex, the levels of the neurotransmitters norepinephrine and dopamine, aren’t quite what they need to be. Neurotransmitters are the chemicals in the brain that help brain cells communicate with each other. Everything we do depends on the levels of these neurotransmitters being at the right levels. Even the smallest changes in norepinephrine and dopamine levels can have a big effect on the capacity of the prefrontal cortex to do its job effectively. Norepinephrine increases the signals for appropriate response. Dopamine decreases any irrelevant ‘noise’ that might get in the way. When the levels of these neurotransmitters are out, kids can have difficulty ignoring irrelevant stimuli. It’s not that they are unable to pay attention, it’s that they are paying it to different things, or too many things at once.
Hyperactivity, fidgeting, squirming, talking or moving too much, extra movement when doing simple tasks.
If it’s anxiety:
When the brain feels there might be a threat, it surges the body with neurochemicals to ready the body for fight or flight. The idea is to get the body faster, stronger and more powerful so it can fight or flee the danger. If there is no need for fight or flight, these neurochemicals build up. The energy created has to go somewhere. Sometimes this can look like ‘too much movement’, such as fidgeting, foot tapping, wringing hands, or pacing.
If it’s ADHD:
The part of the brain that puts the brakes on behaviour is a little slower to activate, meaning there aren’t enough messages instructing the body to stop or slow down.
If it’s anxiety:
When the sensations of fear or anxiety are strong, the surging of fight or flight chemicals sends the pre-frontal cortex (the seat of self-control) offline. The impulsive, instinctive amygdala takes charge. When this happens, the prefrontal cortex isn’t available to help calm big feelings or plan a more considered, less impulsive response. When the anxiety passes, the pre-frontal cortex will take charge again and guide healthier responses. Impulsive behaviour can also look like aggression, which is the ‘fight’ part of the fight or flight response. Anxiety and big emotions come from the same part of the brain so when anxiety is on full volume, other emotions, such as anger might also be switched up to high. Something else to be mindful of is that being silly, which can sometimes look like impulsive behaviour, might be used as a mask by kids to cover up their anxiety or nervousness.
If it’s ADHD:
Differences in the parts of the brain that manage self-control mean that behaviour might be more impulsive. This isn’t because of bad behaviour, but because of a brain that’s not quite doing what it needs to.
Not able to finish schoolwork, poor time management.
If it’s anxiety:
Kids with anxiety might have trouble completing their schoolwork. Anxiety can cause kids to worry about making mistakes. Because of this, they might do things over and over, or take plenty of time to make sure their work is right or as close to perfect as it can be. It’s more about the need to produce perfect, mistake-free work than about ability, failure to focus or failure to plan.
If it’s ADHD:
Kids with ADHD are unable to keep their attention on a task, most likely because of an ability to manage impulses or to shut out irrelevant distractions. Because of the regular shifts in focus, the work doesn’t get completed.
Difficulty organising tasks and activities and managing sequential tasks, disorganised work.
If it’s anxiety:
The left brain loves logic and sequences, and it helps to give structure and order to our experiences (‘this, then this, then this …’). The right brain is more concerned with emotion and the big picture of ‘what does this mean for me?’. It’s heavily directed by sensations in the body and messages from the lower brain, which is the major player in anxiety. We need both sides of the brain to work well together, but sometimes in all of us, one side will become dominant for a little while. If a child is feeling anxious in class or in relation to a specific task, the right ’emotional’ brain can take over and temporarily disconnect from the left side. While the anxiety is high, there will be higher emotion and a greater focus on ‘what does this situation mean for me’, and less concern for order or logic.
If it’s ADHD:
Insufficient levels of neurochemicals make it difficult for the brain to screen out irrelevant stimuli. There’s too much irrelevant information coming in and creating noise. This means that however hard kids with ADHD try to organise their work and do what’s expected, their busy brains will make organisation difficult.
Anxiety or ADHD? How can I tell the difference?
If you suspect ADHD, it’s really important to get a proper assessment from someone who is qualified to diagnose. Be mindful that many of the symptoms we’ve discussed might always point louder to ADHD than anxiety. In some instances, it may be that both anxiety and ADHD are driving behaviour. Whatever’s happening, getting to the bottom of it is the most important step in getting your child the support they need to push forward.
Because a diagnosis of ADHD depends on observation and interpretation of the behaviours, be open to the possibility that if you go to an ‘ADHD specialist’ or a doctor who specialises in ADHD, they may be more likely to read the symptoms as ADHD. Certainly they can be an important and wonderful support for kids with ADHD, but always be ready to seek a second opinion if that’s what you need for clarity. Ask as many questions as you need to ask and remember, you are the expert on your child. If something doesn’t feel right, keep chasing it down until things make sense to you.
Here are some clues that the symptoms might be more indicative of anxiety (or perhaps anxiety and ADHD) than ADHD.
- Kids with anxiety are generally more sensitive to social cues, and to what other people are thinking and feeling, or what they need.
- Anxiety can create physical symptoms such as a racy heart, clamminess, tense muscles, tummy aches, headaches, nausea, or dizziness. This is the physiological basis of anxiety. When the neurochemicals that are there to ready you for fight or flight build up, they lead to physical symptoms. These symptoms feel awful, but if they are driven by anxiety they are all completely safe.
- Children with anxiety don’t tend to have as many problems with impulsivity. Their impulsive behaviour generally happens in isolated bursts when they are anxious, and is less likely to happen when they are feeling calm and safe.
- Children with anxiety will be unlikely to show problem behaviours when they are feeling calm, safe, and doing things they enjoy. Children with ADHD might struggle even when they are doing the things they want to be doing.
- Children with anxiety are more likely to talk about feeling worried, even if they can’t articulate exactly what they are worried about. This is because anxiety comes from a brain that thinks there might be a threat, not necessarily because there actually is one.
And finally …
The importance of a correct diagnosis is so important to make sure that kids with ADHD receive the best possible support to manage the symptoms and limit the intrusion into their day-to-day lives. You will always be the expert on your child, and you’re their voice when something doesn’t feel right. There will be times when you’ll need other experts on your team, but for certain, the glue that will hold it all together will be you – your questions, your questioning, your answers, your second opinions – whatever it takes for things to make sense.
All kids need a support crew, made up of the adults around them who are ready to help lift them to full flight. The support crew will look different for every child, but will likely involve family, teachers, coaches and sometimes therapists, specialists and doctors. ADHD can be tricky to diagnose, but there are many wonderful clinicians out there who, with you by their side, will be able to widen your child’s opportunity to be the very best that he or she can be.
You might also like …
‘Hey Warrior’ is the book I’ve written for children to help them understand anxiety and to find their ‘brave’. It explains why anxiety feels the way it does, and it will teach them how they can ‘be the boss of their brains’ during anxiety, to feel calm. It’s not always enough to tell kids what to do – they need to understand why it works. Hey Warrior does this, giving explanations in a fun, simple, way that helps things make sense in a, ‘Oh so that’s how that works!’ kind of way, alongside gorgeous illustrations.
this is very serious problem!!
Hi Karen, thank you for your article. It confirms what I have been suspecting for years regarding my son being diagnosed with ADHD nine years ago. The pychologists report spoke of medication being unlikely to help but behavioural therapy could. However, he was treated as an ADHD child and consequently his schooling along with friendship groups have suffered. Needless to say GSCE study has been extremely frustrating for my son. I am absolutely convinced it is anxiety because this all started as soon as he went into the education system, he was fine at home. It makes me very sad that he has not received the right kind of support having relied on the experts in Education and knowing now the driver is very different between Anxiety and ADHD. We have experienced some awful couselling which did not help my son”s self-esteem whatsoever. We have an appointment coming up next week and your article has given me hope. Thank you.
Karen you’re very welcome. I hope your appointment goes well and gives you the support and answers you have been seeking for your son.
I don’t know if you’re still responding to comments since this article is from a little while ago, but I’m looking for advice. I’m a 16 year old girl that is currently overwhelmed by school and the stress of ap classes etc. etc. Honestly, I’m quite intelligent which is probably how I’ve made it this far- the only issue is that I can’t seem to make myself do my homework. I completely shut down, and am a wonderful procrastinator. I then end up spiraling into a negative streak where I try to do my work, and then feel guilty that I can’t, then get to school and do fine anyways, making me feel like I don’t deserve the success I’m getting. To sum it up, being unable to start tasks is what is causing most of my issues. I find it difficult to concentrate when I do start my homework, and find myself multitasking- but never effectively. I am incapable of reading textbooks, but I with other books I finish them in an hour. I have a lot of nervous energy, but only really when there’s something triggered by anxiety. I’ve done a lot of research and it seems like adhd presents itself very differently in girls, but my symptoms could be attributed to anxiety, since I experienced a lot of that as a child (unable to sleep because of fear of dying in various ways, a need to do perfect on all my schoolwork etc), and have a family history. All this could be either of those, or just teenage hormones. So yeah, I’m just looking for advice. What should I pursue? Even though I do well in school I feel terrible and like I’m trapped by this inability to start my homework (I mean really, I haven’t done homework at home in weeks and I’m taking three AP classes), so although my GPA doesn’t reflect the issue, something needs to change in my life. So sorry about the novel I wrote, but whenever I try to talk with my therapist I forget what I wanted to discuss or silence myself because of my crippling fear of being wrong (yay!), so this is the best way I can express all this? Also I do very well on tests, but often have to relearn math on the review guide (I pick it up again very quickly though), and occasionally have the fuzzy brain numbing feeling when I feel unprepared (but that’s only natural). Thanks for reading this, I guess? I loved your article (so intelligent and in depth!) but as you can see I’m still a bit confused when it comes to defining myself.
Emma I’m so pleased the information in the article was helpful. I can hear how confused you are, but know that above everything, your brain is strong, healthy, powerful and magnificent. It’s just a matter of making it work for you. With anxiety, the things that help it are great for anyone to do. They are the things we all should be doing to feel strengthen ourselves. Here is an article that might be helpful for you https://www.heysigmund.com/anxiety-in-teens/. It might also be helpful for you to speak with somebody you trust – maybe a parent, a teacher, or a school counsellor.
Hi, I am 60 years old and finally dealing with adhd. I have been learning all I can, started adderall 3 months ago and go to a therapist to help sort things out. I would like to share some of my observations.
I was an adult when the term add began and children began getting medication to treat. I was sure that if I was back in first grade they would have surely drugged me and that it was all so the teachers job would be easier.
What I thought was anxiety, mostly when I laid down to sleep, finally made me go to my doctor after many episodes like false heart palpatations, and choking, and vertigo, on and on.
I remember being asked what I was afraid of and the answer was nothing, it seems like unexplained anxiety. Turns out it was hyperactivity and the proof was in the medications.
It turns out that giving amphetamine salts to someone with adhd actually can calm them down where a person without adhd gets high and very speedy. This takes a while because you can get high or jittery at first either way.
After a couple months on adderall my life is so much better and headed in the right direction. What I thought was anxiety is mostly gone and I am using the therapy to address the remaining anxiety which ironically are mostly caused by not dealing with the adhd.
95% of people my age that get a diagnosis of adhd knew well before their doctors and 88% are helped by amphetamines.
There are consequences of not treating adhd and while I largely opted for a stress free life I could have done so much better.
The only real way to verify adhd is if the drugs work. The very small doses given to children is small risk for a trial period if adhd symptoms are real.
Getting it right is not easy.
A very informative and thought provoking read which has come to me at the perfect time as I am taking my 9yr old son to a paediatrician next week and my gut tells me it is not ADHD even though he has symptoms of the condition. It has also proved to me that my opinion on ADHD diagnoses is correct with way too many children being diagnosed with ADHD and medicated as an ‘easy fix’ for children with behavioural problems.
This helps so much. My child is 5. After 2 years in EI and preschool inclusive program with special needs (he was a typical peer model), we were told during our parent teacher conference there may be more going on and to seek an evaluation for ADHD, ODD, and OCD. It wasn’t out of the blue, we had noticed his need for deep pressure and how much he loved a lot of sensory input for a while. The doctor didn’t typically test at 4, but with all of the expert OT’s, teachers, and psychologists and their testing results, the pediatrician made an exception. Since then, we have started seeing a psychiatrist, a home-based therapist, and a counselor. We had built an amazing support team at his preschool and just transitioned into Kindergarten this year. It has been awful. He spends nearly every day in PEAK (where they send kids who misbehave) and his teacher honestly tries to help. His struggles are never during work time, they are all with impulsiveness during free-play, lining up, lunch, basically anytime there isn’t structured activities. The psychiatrist thinks it’s anxiety driven so we have tried 3 different anxiety meds (Zoloft, Prozac, and I forget the first one). My gut tells me it’s not. I genuinely think it’s just the impulsiveness of the ADHD, but I’m not a doctor. The teacher seems like she wants to help, but I just don’t know what to do. All of the ideas from our old OT are for his desk and that’s not where he’s struggling. I’ve spent the last few hours crying. We had finally had okay days at school for a few weeks, but today was right back to his old behavior – PEAK most of the day, came home and punched his sister square in the gut after losing a board game. I’ve spent countless hours on JAMA, reading IDEA to see if he could qualify under Emotional Disturbed – but do I want that? I don’t know what to do anymore. Please help in anyway you can.
This sounds so confusing and frustrating for you. It also sounds as though you have fought hard to try to find the right explanation for your son’s diagnosis. Human behaviour is complex, so if a diagnosis doesn’t feel right for you, keep searching until it feels right. Sometimes this is a case of clarifying, or finding agreement between the professionals who are supporting your son. Keep going. I know none of it makes sense now, but keep going until you have all of the information you need for it to start to make sense.
Excellent article Karen . I found it very informative and now I’m questioning my 16 year old daughters diagnosis of Adhd and anxiety .
She is fearful or anxious of going to school . In some clases like maths she does well and completes all her work.
In English she struggles to copy of the board as she forgets what shes just read . In another class she loves ceramics and wants to be at school to finish her project . When it comes to a class she had no choice in Science Engineering (she wants to be a make up artist) she has to leave class to get some fresh air as she feels overwhelmed . She just cant cope with it .
So the fact that when shes doing something she enjoys she is as happy as anything.
I’ve had no teacher tell me she has difficulty sitting still . At home she can sit for hours watching her teen series on Netfix . There is no fidgeting. Complete stillness .
At school her worries are with her friends . She has friends but worries about stuff like will they think im saying something silly ,that kind of uncertainty.
Ok her room was tidy while on vyvance and she read a few pages of a book .However she said she felt numb and emotionless on them
Also she lost her apertite and ate hardly anything for weeks.
The other night she was so distressed she took too much sleep medication and then told me . So an ambulance was called but she stayed home for the night . She was ok next day .
So I’m thinking its just anxiety . What do you think?
If you have any doubt at all, I would strongly encourag another opinion. What you have described makes a lot of sense. ADHD can be difficult to diagnose, but always if there is any doubt, keep exploring. 16 can be a difficult age to navigate – there’s so much going on. It sounds as though she has solid support in you.
I am often asked if and why I think ADHD is over diagnosed and/or misdiagnosed. While it may seem that more people than ever are being diagnosed, I believe that due to the fact that it is genetic and those of us with the ADHD “brain style” have children, it is only natural that there will be more of us as time goes on. As far as misdiagnosis, women and girls are often given the incorrect dx of bipolar, mood disorders, etc., which is extremely unfortunate. Talk about not getting the correct treatment and/or medication. Of course comorbidity is often found with ADHD and is it any wonder that one may also have anxiety and/or depression when, for years, they try their very best and still come up short due to the inability to stay on task,etc…only to hear, yet again, that they just aren’t living up to their potential. Thanks again for such a great article!
Thanks Diane. I really value your thoughts on this. I hope we are able to move closer to a better understanding of ADHD as the research continues. Hopefully then there will be more children who are able to get the support they need, whether that support is for ADHD, anxiety, both or something else altogether.
This article was sent to me by my sons teacher. He was diagnosed with Anxeity and Depression 5 years ago. Recently he’s symptoms have become worse. As the work in school becomes harder the worry of not understanding it or getting a bad grade if he tries, the outburst of stress and anxiety has been more extreme. After an outburst of yelling , cursing, slamming doors, ripping up schoolwork or homework comes the remorse. Since the school and I understand that it’s out of his control he still doesn’t believe that we understand and forgive him. At that point depression comes in and he feels awful, from there he then goes into negative talk about himself saying his an awful child for the outburst. We are currently in in therapy and that seems to be helping a lot, we are also looking into medication for his anxiety and depression. We had two visits not too long ago with a psychiatrist. He talked with him the first day and requested forms to be filled out by his teacher and I. He also requested emails from his current therapist and from the social worker at school that he sees often . I made sure that he had all the information he needed three days before our next appointment. He proceeded to open up the information on his computer and read it in front of us and after 10 minutes decide that with my son really needs is to be on ADHD medication. Now mind you my son has been in a few different schools because of a move and has seen two different therapist and social workers in school and has had a few teachers, as he is currently in 4th grade. Not one of them in all these years have ever asked me to have him tested or inquired if he was tested for ADHD.
I was so upset that two visits and 10 minutes within the second visit the Dr diagonsed him with ADHD and ready to medicate my child. Of course at that point I said what was on my mind and he smugly replied that I can get a second opinion. Which is where we are at this point. I appreciate this article explaining the differences because it makes it even more clear to me that is anxiety and not ADHD. I completely agree with your statement that they’re ready to diagnose and medicate right away without doing the proper testing. I have a support team at his school and outside of school that all understand what he goes through and is trying to help us at every turn. I am very lucky and so is he. Given that this diagnosis of ADHD was just given to us this week reading this article was shared with me at a perfect time. Thank you!
Dawn here is an article that I think might be important for you https://www.heysigmund.com/anxiety-or-aggression-children/. It explains why anxiety sometimes shows itself as aggression, and it also gives some strategies to deal with you. You are a wonderful advocate for your son.
I learned more from this article than i have last 10 years from professionals working with my son. The help and support for these children is very poor. Especially in the school system. I have learned things are what they are and dont expect to get any answers quick or at all. Still waiting for a proper assessment of my child which i know he will never recieve since once they become school age all supports are dropped. Frustrated mother.
Kelly I hear you! I wish there was more support for these kids and it’s so frustrating when the support they need falls short. Keep being a voice for your son.
One of the best and more informative articles I have read on both ADHD and anxiety! My son battles with both and it is so interesting to see how similar yet so different they are! Also some really great practical ideas of how to help him! Thank you!!! Also as a Play Therapist this article is invaluable in clarifying how best to assist and guide children and parents battling in these areas!
Thanks so much Gillian. Yes it’s pretty amazing how similar they can appear, even though they’re so different. I’m pleased this has been able to give you some ideas.
Thanks so much for this article. I am working with a Psychologist to try and help my 9yo old daughter get a handle on her big, disruptive emotions. One question… do you think that rude responses, attitude, answering back, shouting, insults, slamming doors etc etc are visible signs of “fight”. She has never tried to physically hurt us but we do get a lot of the above behaviour. Is this just a symptom of her anxiety and heightened levels of adrenalin etc. Or a result of our parenting?
It really depends on the context. If your daughter feels under threat, and if these responses come with high emotion it might be the ‘fight’ response, but it might also be part of her exploring her boundaries and finding where her limits are. Experimenting with boundaries is a really normal and important part of growing up and different kids will do it in different ways.
Whatever is driving your daughter’s behaviour, it’s important that she realises that she has to manage her emotions in ways that aren’t harmful for other people or for her relationships. Here is an article that will explain when anxiety looks like aggression and what to do https://www.heysigmund.com/anxiety-or-aggression-children/.
It’s very normal for children to explore where their limits are and they need gentle guidance when they go too far. Acknowledge whatever she is feeling ‘I understand that you’re frustrated/ upset/ angry.’ Then let her know that you’re happy to talk to her about anything, and you want to understand how she feels, but you won’t do this until with speaks respectfully to you. You might need to be clear about what behaviour is disrespectful and what a more respectful way to behave would be. It might seem obvious to us but it’s all a learning process for our kids.
Thank you so much for this information. My oldest child (11) has been diagnosed since 5 with ADHD and I’m in the process of getting my 8 year old into some psychology sessions as I’m concerned about ADHD and anxiety. I’ve been totally confused about what I’m seeing with him but after reading this it’s making a lot more sense!!
You’re so welcome Kate. I’m so pleased this has helped to make sense of things.
Very informative and well written article like all the earlier ones you wrote. Thank you very much.
Thank you. I’m pleased the article was helpful.
I wish the article addressed how to deal, help or treat the anxiety.
Wendy you’ve come to the right place! There are plenty of articles here about how to do this. This is perhaps the most important one to read https://www.heysigmund.com/anxiety-in-kids/. You’ll also find more articles on this link that will hopefully give you many more strategies https://www.heysigmund.com/?s=anxiety+children.
Do you have a recommendation for a qualified therapist/psychologist in the Minneapolis/St. Paul area to refer us to who can sort out the nuances? We have been struggling with this for 7 years. Reading your article makes me think our 10 year old son has a combination of both, but possibly more anxiety. We’ve ‘tried’ so many things/therapies, I need a solid referral to get to the bottom of this.
Courtney no I’m very sorry. I wish I could help you out with this, but I’m in Australia so I’m not familiar with practitioners over there. An idea might be to speak with the school counsellor at your son’s school for a referral, or a doctor. Otherwise, I’ve found this link for the psychological society in Illinois (most areas have one) https://illinoispsychology.org/. It might be worth contact them and asking for someone who specialises with children your son’s age.
So happy to see this article. With so many kids being misdiagnosed and not diagnosed until Adulthood – more understanding is needed to help access helpful and key supports.
Thanks Loreen. I absolutely agree – hopefully the more research that’s done and the more information that gets out there, the support people can get to live the very best version of their lives – and we all deserve that.
You didn’t mention ADHD symptoms being associated with early childhood trauma. Having been a follower of Bruce Perry I have seen numerous children who exhibit impulsesivity, inattentiveness and hyperactivity along with aggressiveness and/or withdrawal who have a history of trauma. Treatment for trauma includes a different array of interventions. What are your thoughts on early childhood trauma?
Yes absolutely early childhood trauma can drive the symptoms that look like adhd and/or anxiety. Here is an article that talks about the ADHD and trauma https://www.heysigmund.com/adhd-trauma-helene-goble/.
As a primary school chaplain your articles are invaluable to me as I do my best to support children and parents (and teachers!). This article is particularly useful and I will add it my handouts. I often recommend your articles to other chaplains and child workers.
Thanks so much Sheryl! I’m pleased the articles are helpful for you and the children, parents and teachers you work with.
This is such an informative article thank you.
As a biofeedback / neurofeedback therapist I often have clients who have either ADHD / Anxiety or both. In recent years I have realised that addressing autonomic balance through Heart Rate Variability training improves both conditions. Ongoing research into HRV suggests it is a valid intervention for many issues, and is an easy to teach, easy to learn process.
This is the best distinction I have read between anxiety and ADHD. I love having it spelled out this way. Thank you.
Thanks very much Bonnie.
Excellent article. I see misdiagnosis too often at work. I would like permission to copy and pass out to coworkers as a reference tool.
Thanks Jodi. Yes of course – you’re very welcome to hand out hard copies of the article to your coworkers. The green button at the bottom of the share buttons (on the left hand side of the article) is the print button. I hope it’s helpful for them.
What about TOVA8? Isn’t that a reliable and objective instrument? My experience is that it helps a lot with a diagnose. It is usually used before NFB training (and later to evaluate the treatment).
The TOVA is a measure of attention. Used with other assessment tools it can help with diagnosis, but it isn’t enough on its own to make a diagnosis of ADHD.
Thank you!! As always, your articles are so informative!
I really appreciated you hashing out the details of the nuanced differences between Anxiety and Adhd. It was incredibly informative. I do have a question about whether or not freezing is explained. I mean this in the sense that the amygdala isn’t just in control of fight or flight, but also freeze i.e. standing still to avoid a predator.
However, in my Adhd Primarily Inattentive, i seem to not be able to initiate action which from the outside looks like just being lazy and procrastinating but perceptively it feels like i’m telling my body to move and get up but it won’t.
Long story short, I wanted to know if this was an accurate distinction and or/ if it’s adhd related at all. Thanks.
This is a good question. Feezing is more a symptom of anxiety rather than ADHD. The other question to ask is, is it a freeze response, which would likely be driven by anxiety or fear, or Or is it more like an inability to stick to the task?
Hi Jon, Have you ever heard of PDA (Pathological Demand Avoidance Syndrome )? It is an ASD sub-type that may interest you. I relate to your freeze response and have learnt that, for me, it is an autistic shutdown. http://www.pdasociety.org.uk
All the best,
As an adult ADD sufferer I can tell you that you aren’t the only one who feels that way. My daughter and myself both do eh same thing. I believe it comes from the inattentiveness, because the project seems so big and we have so many ideas or ways to tackle it but we can’t decide the best one or how to start. So it becomes stressful and then we avoid it because we can’t grasp HOW to attack it. I have learned to just make a decision and go. If I have to change things later, at least I have started.
I hope that helps, or at least lets you know you aren’t alone.
Thank you for a most informative article. I wish I had known this 30 years ago for my son.
Thanks Jeanette. Technology has made it easier for us to see what’s happening in the brain and this has given us a lot of answers in the last decade or so. There’s some great research happening in the area so hopefully we’ll just keep getting more and more answers.
Hi i was misdiagnosed with ADHD when I was younger and I am now diagnosed “correctly” or at least thats what I’m told I’m not sure, with anxiety specifically social anxiety at age 15. Idk for over a year and a half I have been chronicly worried though that maybe I have ADHD over anxiety which terrifies me as hyperactive behaviour idk you look at it or at least i do and pray thats not me and ever since I was misdiagnosed i have been pondering whether it really was a misdiagnosis or not. Everyone tells me I don’t have ADHD that I’m not hyperactive and inattentive but when I look back to when I was younger around 12 and I see myself and see that I have problems keeping still which I don’t know if it was from the medication I was taking which I am told had no effect on me or if it was something else. This causes me to second guess myself and I start to wonder if I really did and still do have ADHD. But then i rebut myself with well i didn’t and still don’t have problems paying attention. I really don’t know no matter how many times the doctors and 4 phycologists tell me I don’t have ADHD and that it is my anxiety getting in the way I just can’t get it through my thick skull and accept it allowing me to move on with life. Im very worried I’m one year away from my HSC and I don’t know if i can do it with so much shit going through my head. What Im asking is if you think that what you wrote in this article describes my condition because all my life so far its just been a winding road that has left me depressed confused and unsure of what the hell is wrong with me.
apologies for the grammar I had to do a lot of editing on that comment.
Zach if the professionals you have seen are sure you don’t have ADHD, I would really listen to that. Anxiety has a way of trying to convince us that something is wrong, when there isn’t. Here is an article on anxiety that might be helpful for you https://www.heysigmund.com/anxiety-in-teens/. I would really encourage you to try a regular practice of mindfulness. The Smiling Mind app is a free app with guided meditations that might be a great way to get started https://smilingmind.com.au/smiling-mind-app/. A lot of research has shown that mindfulness is excellent for anxiety. Anxiety tends to pull the brain into the future, worrying about the ‘what-ifs’. Mindfulness can help the brain to find calm. Here is any article that explains how that works https://www.heysigmund.com/overcoming-anxiety-mindfulness/.
Finally, I really want you to know that anxiety doesn’t mean something is wrong with you. Anxiety comes from a strong, healthy brain that is a little overprotective. Your brain is doing exactly what brains are meant to do – keep you alive by warning you when there might be trouble. Anxiety is just a sign that it’s hitting the warning button a little too often and a little unnecessarily. You can certainly manage this, and stop it being less intrusive. Know that you are brave, strong, and healthy. And you’re going to be okay in your HSC – I can hear how important it is to you that you do well, and you’re going to be okay.
Just found this post via Google and sorry to butt in on Zach, but I think I have some of the same issues… and I think I might have had it my whole life.
At the age of 38, this is hard to accept or understand for me…. sometimes I even worry, that I’m making this up for myself for some reason, like I want there to be something wrong with me :S
I went to the gen. prac. and he has sent me onwards to a psychiatrist which I will see in two weeks time. I said I suspected having ADD. But having read this article and what Zach writes… now I’m not sure.
How well will the psychiatrist be able to distinguish between the two… me reading this have a really hard time telling if I’m either or both.
Will she be able to see if both are occurring at the same time?
What I worry about the most though is her coming to the conclusion that nothing is wrong with me….. that would literally floor me I think 🙁
Even as I write this, I had to look out the window to see what that truck was that was backing up, my foot it tapping away like I’m playing drums and just the fact that I’m writing at all is me procrastinating from doing my job…. Been here two hours and have gotten nothing done 🙁
The psychiatrist will be able to distinguish between the two. I can hear how important it is to you to get some answers and hopefully the psychiatrist will be able to make sense of things for you. Ask as many questions as you need to feel satisfied and understood. Remember they are there to support you.