How To Know If You Have Generalized Anxiety Disorder – ADHD and anxiety share a complex relationship. There is a strong link between anxiety and ADHD. Estimates vary, but it is estimated that up to 50% of people with ADHD will experience anxiety at some point in their life (Katzman et al., 2017). The risk for almost all anxiety disorders is higher among ADHDers (Katzman et al., 2017). They also share similar symptoms, which can cause diagnostic confusion, especially when both are present.
The inattentive type of ADHD appears to have higher rates of co-occurring anxiety, which can create a particularly complex clinical picture. A co-occurring type with ADHD and anxiety are the most difficult to detect diagnostically. Without the presence of hyperactivity, it can be particularly difficult to ascertain whether inattention is due to worry and anxiety or to difficulty in regulating attention due to AD(H)D.
How To Know If You Have Generalized Anxiety Disorder
Another challenge is that ADHD often comes with secondary anxiety (anxiety related to ADHD difficulties), unlike generalized anxiety disorder. Secondary ADHD anxiety means worrying about difficulty functioning (worry about school and work, missing details, timelines, the stress that comes with difficulty managing time and tasks, etc.).
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ADHD anxiety is often related to executive functioning tasks (finances, health, relationships, school and work), while generalized anxiety is more global and pervasive in nature. People with generalized anxiety will experience uncontrollable worry on most days; the anxiety will be out of proportion to the actual stressor.
So, let’s dive into the coincidence, overlapping features, and how to differentiate between the two. But first, an overview of both (feel free to skip the next two sections if you don’t need the overview):
ADHD is classified as a neurodevelopmental disorder, which means that the onset occurs during the developmental period (usually early childhood) and has a strong genetic component. The areas of the brain that regulate emotions, attention and focus are affected in the context of ADHD. ADHD is characterized by persistent inattention, hyperactivity, and impulsivity (American Psychiatric Association 2015). There are three classifications of ADHD that a person can be diagnosed with: ADHD – predominantly inattentive type, ADHD – predominantly hyperactive-impulsive, or combined type.
The Criteria for diagnosing ADHD include the presence of inattention, impulsivity, and hyperactivity (or just inattention in the case of inattentive type ADHD). The symptoms must interfere with daily functioning in at least two contexts (for example, home and school or work and home) (American Psychiatric Association, 2000). Some of the common symptoms of ADHD include:
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While present from birth, ADHD symptoms may not become apparent until the demands exceed the capacity. And many children develop sophisticated compensatory strategies to offset areas of struggle. In these cases, the person’s ADHD is recognized even later in life.
ADHD has a global prevalence of 5.2 % among children and young people (Polanczyk et al. 2007). Based on the (CDC), current estimates estimate that 6.1 children in the US are diagnosed with ADHD, approximately 9.4% of children, making ADHD one of the most common developmental disorders in the US states
Generalized anxiety is characterized by pervasive, excessive and uncontrollable worry. The anxiety and worry must be excessive, occurring for more days than not for at least six months, about several events or activities (such as work or a school performance). The intensity, duration, or frequency of the anxiety and worry is out of proportion to the likelihood or actual impact of the anticipated event. What distinguishes GAD from everyday anxiety and worry is the excessive nature and interference with work, school, and everyday life. When a person experiences GAD they often have significant difficulty completing life’s daily activities and responsibilities, leading to problems with school, work, relationships, and more (American Psychiatric Association, 2013).
As well as difficulty controlling anxious thoughts, the person experiences three of the following symptoms associated with their anxiety:
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To meet the diagnostic criteria for GAD the anxiety must not be the result of substances, another medication condition, or another better explained mental health condition (American Psychological Associates, 2013).
Many people who experience symptoms of anxiety do not seek help, and therefore it may go undiagnosed at high rates. Around 20% of people who experience anxiety seek help. The lifetime risk of generalized anxiety disorder is 9% (American Psychiatric Association, 2013). The risk of GAD is highest in middle age and decreases during the last years of a person’s life. At 12 months, the prevalence of GAD among adolescents is 0.9% and 2.9% among adults.
ADHD and anxiety are separate conditions but often co-occur. Although estimates vary, around half of people with ADHD also have anxiety (Katzman et al., 2017). The right treatment will help improve the symptoms of ADHD and anxiety.
When anxiety is also present, this can cause ADHD symptoms to worsen. A person experiencing ADHD and anxiety may experience worsening symptoms of:
Anxiety Disorder # 1: Generalized Anxiety Disorder
The most common misdiagnosis is likely to occur either because one condition is missed or when attention deficit type with ADHD is misdiagnosed as anxiety or vice versa. Attention deficit type ADHD and GAD clinically present with similar symptoms and can therefore be misdiagnosed.
Another misdiagnosis that can occur is when GAD is diagnosed; however, the person experiences anxiety secondary to ADHD. A secondary concern stems from the fact that the person needs to work ten times harder than everyone else to get the job done. Anxiety can be related to missing details, assignments, or social misunderstandings, and this is different from “primary anxiety.”
There are many overlapping symptoms and experiences that can cause these conditions to look alike or cause a single diagnosis to be missed. Some of the overlapping experiences are:
Excessive anxiety can make it difficult to concentrate. The brain can be overly focused on signs of fear and less willing to pay attention to other signs and cues. Difficulty regulating attention is a key feature of ADHD.
Anxiety And Anxiety Disorder Symptoms
Sleep problems are common among ADHDers, and anxiety can interfere with sleep. Sleep problems, especially insomnia and nightmares, are higher in people with GAD (Staner, 2003). Sleep problems are also common among people with ADHD; approximately 25-50% of people with ADHD struggle with circadian rhythm sleep disorders, insomnia, narcolepsy, restless leg syndrome, sleep-disordered breathing, and insomnia (Wajszilber et al., 2021). Nightmares and insomnia are also common among ADHD children (Grünwald and Schlarb, 2017). And up to 70% of children with ADHD have sleeping difficulties (Sciberras, 2020).
Experiencing intrusive thoughts can be a common symptom of many anxiety disorders. Intrusive thoughts are also more common in the context of ADHD (Abramovitch and Schweiger, 2009).
ADHD has more digestive problems (Kedem et al., 2020). Digestive problems are also common in the context of anxiety and mood disorders (Shah et al., 2009).
ADHDers tend to be more SNS dominant, meaning they spend more time in the activated part of the nervous system and have a harder time getting into the “rest and digest” part of the system nervous (parasympathetic). When anxiety is present, it is also common to exist primarily in Compassion mode. (To watch a video about the autonomic nervous system, see this great Khan Academy series on it)
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Speaking of the nervous system, anxiety and ADHD are associated with low levels of GABA. Gaba is the main inhibitory neurotransmitter in the central nervous system (Lydiard, 2003). GABA plays an important role in processing sensory information and selecting the appropriate behavioral response (Edden, 2012). When the GABA-Glutamate cycle is off, this can lead to hyperactivity within the central nervous system (hence why a person with ADHD and anxiety tends to be predominantly sympathetic nervous system).
These are common among both conditions (also associated with GABA and central nervous system activation), among other things.
Both conditions involve difficulty with concentration; however, the origin will be different. Someone with anxiety may be so overwhelmed with worrying thoughts that their executive functioning suffers, and they may have difficulty processing additional information. For the ADHDer, even in a state of calm or relative calm, they continue to have difficulties with attention and concentration.
ADHD can be difficult to distinguish from anxiety, and there are several things the clinician should consider.
Generalized Anxiety Disorder: When Worry Gets Out Of Control
One of the things for the clinician to determine is whether the person is suffering from primary or secondary anxiety. ADHD can cause anxious thoughts and worry about doing things or the ability to do things. If the person’s anxiety and stress are specifically linked to executive functioning difficulties, be aware that this may be secondary anxiety related to ADHD (versus primary generalized anxiety disorder). . Alternatively, the person may be experiencing an underlying anxiety disorder that co-occurs on top of ADHD. In the case of the second option, the person’s anxiety and worry will likely be more global than ADHD concerns. People with an anxiety disorder, on top of ADHD, experience a wider and more general anxiety. The anxiety is not specifically linked to ADHD difficulties and will be more general and pervasive in nature. They are also likely to have many physical manifestations of anxiety (restlessness, sleeping difficulties); however, given these all-mimicking ADHD symptoms, the clinician must understand the triggers for anxiety and understand the inner and mental experience of the anxious thoughts.
Determine the proportion of anxiety to risk/stress. In the context of generalized anxiety disorder, the proportion of anxiety and worry to the actual risk will be disproportionate.
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