The Connection Between Anxiety and ADHD

A frustrated student snapping their pencil over a pile of books. Having both anxiety and ADHD is hard.

Your big research paper is due on Friday. It was assigned weeks ago, but you haven’t started yet. You didn’t mean to procrastinate, but each time you try to sit down and work on it, you can’t focus. Plus, whenever you so much as think about tackling this project, it overwhelms you. Too big. Too many steps. And none of your ideas seem good enough anyway. Now, with the deadline looming, you’re starting to panic. This, of course, only makes things worse. As your anxiety ramps up, your ability to focus diminishes even further, and knowing that you can’t focus enough to get the work done makes your anxiety even worse.

This can be what it’s like to have anxiety and ADHD: Your ADHD makes your anxiety stronger, and your anxiety makes your ADHD symptoms worse.1

They feed off of each other in a vicious cycle:

A feedback loop showing that worsening ADHD leads to increased anxiety, which leads to worsening ADHD

Another common experience for students with ADHD and anxiety is to struggle taking tests, and here they feed off of each other too. If you have trouble staying focused during exams, then you know that you’re not going to do as well as you otherwise could. And thinking that you’re not going to do well is likely to trigger anxiety, which makes it even harder to focus because rather than thinking about what the questions are asking, you’re thinking about how poorly you’re doing. Whereas most test anxiety is simply about being unprepared, this is a case where clinical issues are relevant. (Though studying effectively in order to be well prepared would still help.)

A Common Comorbidity

An anxious student working on a laptop and in a notebook

Having both of these conditions is very common. About 30 percent of children with ADHD also experience anxiety, according to The National Resource Center on ADHD, and around half of adults with ADHD have an anxiety disorder, according to the Anxiety and Depression Association of America.1

Thus, any parent of a child with ADHD should be aware of the increased likelihood that their child will also struggle with anxiety.

What is Anxiety?

“A person with an anxiety disorder is likely to experience long-lasting feelings of nervousness, fear, and worry. … They may have difficulty identifying and controlling their specific fears and worries. These feelings tend to be out of proportion to the situation, and can interfere with people’s daily lives and relationships with others.”1

This is distinct from the normal fears, worries, and nervousness that most people experience from time to time. If you feel butterflies in your stomach before giving a presentation, it doesn’t mean you have an anxiety disorder.

This is also distinct from ADHD, which is characterized by difficulty paying attention, hyperactivity, and poor impulse control.1 However, anxiety can lead to increased mind wandering, which may look similar to difficulty focusing.2 And both anxiety and ADHD can lead to apparent difficulties with executive function, such as not getting things done on time, failing to keep appointments, and otherwise struggling to play the game of school.

Treating ADHD When You Have Anxiety

It’s important to know whether or not you have anxiety when you determine an ADHD treatment plan.  Children with both ADHD and anxiety sometimes respond differently to ADHD medication than those without anxiety.3 And the stimulant medications that are often used to treat ADHD sometimes exacerbate anxiety symptoms.1

Treatment for Anxiety

As with ADHD, anxiety can be treated with medication, which is sometimes appropriate. However, there are also non-medication treatment options that can be very effective on their own or in addition to a medication plan. And since these are all good things to do even if you don’t have anxiety, they’re a great place to start while you’re sorting out diagnoses and professional treatment options.

Here are some helpful, non-medication interventions for anxiety:

However, starting and sticking with these kinds of healthy habits is challenging, especially if you have ADHD. But you don’t have to use brute-force willpower, and you don’t have to go it alone. I offer strategic habit coaching for adults and older students, and I would love to help you install some of these behaviors to run on autopilot. (For parents of younger students, the best place to start might be adopting these habits yourself and modeling them for your children.)

Treating Both

All of the anxiety-reducing strategies listed above also help reduce ADHD symptoms, so if you’re struggling with both anxiety and ADHD, you stand to benefit greatly from using these techniques.

Just as worsening anxiety leads to worsening ADHD in a downward spiral, treating one often improves the other, leading to a virtuous cycle of improvement on both fronts.

A feedback loop showing that reduced ADHD leads to reduced anxiety, which leads to reduced ADHD

So if you or your child has both of these conditions, there is a good reason to be optimistic. True, ADHD with comorbid anxiety can spiral out of control if left untreated. But if you address them both using a combination of professional help and at-home treatments, you can turn things around and create a great deal of positive momentum.

1 Written by Jayne Leonard. Medically reviewed by Timothy J. Legg, Ph.D., CRNP. What is the link between anxiety and ADHD? Medical News Today. May 15, 2017

2 Tiago Figueiredo, Gabriel Lima, Pilar Erthal, Rafael Martins, Priscila Corção, Marcelo Leonel, Vanessa Ayrão, Dídia Fortes, Paulo Mattos. Mind-wandering, depression, anxiety and ADHD: Disentangling the relationship. Psychiatry Research. Volume 285, 2020, 112798, ISSN 0165-1781,

3 Pliszka, Steven R., M.D. Effect of Anxiety on Cognition, Behavior, and Stimulant Response in ADHD. From the Department of Psychiatry, The University of Texas Health Science Center at San Antonio. Accepted 31 May 1989, Available online 4 January 2010.

4 John J. Ratey, MD. Can exercise help treat anxiety? Harvard Health Publishing. October 24, 2019

5 Uma Naidoo, MD, Nutritional strategies to ease anxiety. Harvard Health Publishing. August 28, 2019

6 Tips for beating anxiety to get a better night’s sleep. Harvard Health Publishing. October 13, 2020

7 Kaczkurkin, Antonia N, and Edna B Foa. “Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.” Dialogues in clinical neuroscience vol. 17,3 (2015): 337-46.

8 Julie Corliss. Mindfulness meditation may ease anxiety, mental stress. Harvard Health Publishing. January 08, 2014

The Downside of Neuroplasticity

Think about your best kitchen knife. The more you use it, the duller it gets. Eventually, you have to sharpen it. But if you don’t use it, and you just leave it in a drawer for six months, it’ll be just as sharp as the day you put it away.

Now think about your brain. Your brain and that knife have nothing in common.

I often talk about how great it is that our brains can grow and rewire in response to challenges, much in the same way that muscles grow when you exercise. And don’t get me wrong – this is a good thing. It means we’re not stuck the way we are. We can learn, grow, and improve. We can become more skilled, more intelligent, and more creative. But there is a downside that’s rarely discussed.

I’ve hinted at it before. I did mention in my post about brain muscles that cognitive skills, just like the muscles in your arms and legs, can atrophy with disuse. I have highlighted the “use it or lose it” principle of neuroplasticity. And I’ve warned students that the mastery path is a muddy slope. But it’s time to really get clear about this.

You can improve, yes, but you can also get worse. Think about your physical fitness. What would happen if you just stopped exercising? How fit would you be a year from now? Five years from now? Well, your brain works the same way. If you don’t challenge your brain with mental workouts – learning new things, practicing old skills, and solving difficult puzzles – you won’t just stagnate; you’ll actually lose intelligence.

Trust me, I’ve been there. Between the ages of 23 and 27, that’s exactly what happened to me. I didn’t challenge myself intellectually, and my mind got weaker as a result.

This also applies on the micro-level of learning new skills. You can get better, but you won’t stay better unless you keep at it. On the fixed-mindset – growth-mindset continuum, there are people who are growth-minded enough to know that they have to work hard to get good at something, but then they mistakenly believe they no longer need to practice. And then a week or a month or a year later, that hard-earned skill is gone.

So having a growth mindset, isn’t just about believing that you can improve; it’s also about remembering that you can regress.

This is part of the reason I encourage kids to make good use of summer. And it’s a major reason that I personally practice relentless learning. Unlike a kitchen knife left in a drawer, my brain won’t stay sharp automatically. I have to use it to keep it sharp.

Brain Food

Disclaimer: This is about how food affects the brain. It is not health advice. Please consult your doctor before making any changes to your diet or taking any supplements.

Long-time readers will know that brain health is one of my favorite topics. All other things being equal, students with healthier brains will be happier and more academically successful. They’ll find it easier to focus and have better executive function. They’ll have an easier time solving tough problems and remembering what they’re learning, leading to better test scores and higher grades. And we’ve already covered the importance of sleep and physical exercise and play, so it’s time to finally tackle what is perhaps the most important element of brain health: nutrition.

Eating a healthy diet is strongly associated with good general brain health and stronger brain function.1 In other words, it’s not complicated: What’s good for your body is, in general, good for your brain. And while there are countless fad diets and conflicting views about what’s healthy to eat, there are a handful of simple principles that almost everyone agrees on. Pretty much no one offering nutritional advice suggests eating more processed foods, and pretty much everyone agrees that eating more vegetables is a good idea. We’ve already covered all the ways sugar is harmful to the brain, and you’d be hard-pressed to find a diet book or a nutritionist suggesting that we eat more sugar.

Those simple guidelines are a good start, but there are some details worth looking at, so I’ll now take you on a quick tour beyond the basics. I hope you’re hungry for knowledge because you’re about to learn all about brain food.

Protein

Protein from your diet is the source of amino acids, which are the building blocks of cells and, importantly, neurotransmitters – the chemicals used by neurons to communicate with each other.2 However, you do not have to eat meat or chug protein shakes to get the protein you need; there are many different sources of protein to choose from, and, in the western world, it’s not hard to get enough.

Diets very high in animal protein and very low in carbohydrates, such as Atkins or Paleo, are most likely a poor choice for brain health. These diets usually do not include enough complex carbohydrates to keep the brain fueled properly, and there is evidence that such diets impair brain function in mice, suggesting that they might do the same in humans.3 That said, everyone is different, consult your doctor, and run little experiments on yourself to find out what works for you.

Carbohydrates

Unless you’re in ketosis (very hard to do),4 your brain is running on glucose derived from carbohydrates in your diet.1 And since you’re brain doesn’t store glucose for the future, you have to eat regularly to keep it fueled (hence the importance of breakfast).5 The best way to do this is with complex carbohydrates rather than simple ones because, with their fiber, they digest more slowly.5 In other words, whole grains are better than processed grains, fruit is better than juice, and quinoa is better than candy. You can also slow down the digestion of carbohydrates by mixing them with protein and fat.1

Fats

Dietary fat got a bad rap in the latter half of the 20th century, so some people still avoid it like the plague. Now the pendulum is swinging in the other direction, and some people are claiming that dietary fat should make up the bulk of one’s calories. The truth, as usual, is more complicated, so here’s the skinny on fat: We need dietary fat, but not all fats are created equal.

First, eating a diet primarily based on fat – a ketogenic diet – is very difficult to do and should only be attempted under the supervision of a doctor.4 And the other extreme – an extremely low-fat diet – probably isn’t very good either. About 60% of your brain is made of fats,6 and they are an important component of myelin sheaths – the insulation for neural connections that increase signal speed as you develop mastery.7 Furthermore, dietary fats “help carry, absorb, and store the fat-soluble vitamins (A, D, E, and K) in your bloodstream.”6

Second, we need to distinguish between healthy and unhealthy fats. “If your diet is loaded with bad fats, your brain can only make low-quality nerve cell membranes that don’t function well; if your diet provides the essential, good fats, your brain cells can manufacture higher-quality nerve cell membranes and influence positively your nerve cells’ ability to function at their peak capacity.”6 In particular, trans fats, which have been widely shown to cause harm to the body,8 also cause harm to the brain and hinder brain function in a variety of ways.6 Increased consumption of trans fats is correlated with impaired cognitive function.9 How do you know if something has trans fat? One way is to look for the phrase “partially hydrogenated” on the ingredients list.9 If you see that, steer clear. Saturated fats can also be unhealthy and should be consumed in moderation.10 On the other end of the spectrum, we have unsaturated fats, which are generally healthier,10 and the Omega-3’s:

“Omega-3 fatty acids are great for mental clarity, concentration, and focus. They play an essential role throughout your life and should be at the top of your shopping list in terms of positive value for your brain. … Certain foods containing omega-3 fatty acids are especially good for your brain. These include: Certain cold-water fish (bluefish, herring, mackerel, rainbow trout, salmon, sardines, tuna, and whitefish); Olive oil; Flaxseed oil; Peanut oil; Canola oil. Studies have revealed that Omega-3 fatty acids, which are essential for maintaining normal cognitive function, have additional advantages in the brain. For example, DHA and EPA, the Omega-3 fatty acids found in fish, particularly salmon, albacore tuna, sardines, and swordfish, are vital for a sharp mind.”6

Omega-3’s, along with Omega-6’s are “essential” fatty acids because our bodies cannot make them on their own, so they must come from the food we eat. We need both, but our bodies and brains prefer a balance, and the modern American diet makes it really easy to eat way too much Omega-6 and not enough Omega-3.11 Our ancestors likely ate a 1:1 ratio of Omega-3 to Omega-6, and most Americans now eat 1:20 ratio – 20 times more Omega-6 than Omega-3.11 Improving this ratio is as much about eating more Omega-3-rich foods like salmon and flaxseed as it is about eating less Omega-6-rich foods. Fried foods like chips and French fries are usually high in Omega-6, as are corn-fed beef and corn-fed dairy products (grass-fed is better).11 So reducing these foods is an easy way to improve your ratio.

Fruits and Veggies

Eating a large quantity and a wide variety of fruits and vegetables gives your brain the micronutrients it needs to thrive.5 However, we have a tendency to lump these two types of food into a single category “fruitsandvegetables,” as though they are equally valuable.13 Too many people assume they’re getting all the nutrition they need by just eating fruit and skipping the veggies. You need both, and vegetables, it turns out, are more important because they are more nutrient-dense and have less sugar.13

Vitamins and Minerals

The brain, like the body, needs a wide variety of vitamins and minerals to thrive. However, studies have shown that, in most cases, taking vitamin supplements is not an effective way to get the micronutrients your body needs.14 Therefore, you’ll want to get your vitamins and minerals from the foods you eat. Here are some excerpts from a Psychology Today article titled “Have You Fed Your Brain Today?”:

“Research studies have shown that people with higher blood levels of the antioxidants vitamins C and E, in particular, have fared better on memory tests. Nuts (hazelnuts and almonds in particular), sunflower seeds, and vegetable oils are rich in Vitamin E. Citrus fruits, guava, papaya, strawberries, bell peppers, tomatoes and broccoli are all excellent sources of Vitamin C. Blueberries, which are also rich in Vitamin C, heighten brain function and have significant memory-improving properties.”5

“B vitamins also play important roles in cognitive function. An amino acid, known as homocysteine, is associated with clogged arteries, which result in decreased brain blood flow, causing impairment of mental functions. B vitamins, such as folate, Vitamin B6 and B12, seem to assist in lowering homocysteine levels, while B vitamin deficiencies have been linked to high levels of homocysteine. B12 is essential for an astute mind, as a B12 deficiency is associated with cognitive problems such as memory lapses. B6 also bolsters memory. Folate can be found most abundantly in leafy green vegetables, especially spinach, broccoli, beans, orange juice, and avocados. B12 can only naturally be found in animal products, particularly salmon, beef, shrimp, yogurt, milk and cheese, but it is often fortified in foods such as soy milk and cereals. B6 is found primarily in animal sources like poultry, pork, beef and seafood, and in smaller amounts in legumes, such as black beans, leafy green vegetables, nuts, and whole grains.”5

“Vitamin D receptors are found throughout the brain and especially in the hippocampus, and low Vitamin D levels have been linked to poor memory and cognitive function. Vitamin D also aids in the growth of new neurons and neurotransmitter synthesis.”5 Remember that Vitamin D is fat soluble, which means that you cannot absorb it if you don’t eat it with fat. Hence, if you’re “getting” your Vitamin D from fat-free milk or fat-free yogurt, you may not be getting it at all. You don’t, however, need to get all your Vitamin D from food: Your body will produce Vitamin D naturally when your skin is exposed to sunlight.

“Superfoods”

You’ve probably heard about so-called “superfoods” that are especially beneficial for your body or brain. This is a marketing term that simply refers to foods – many already mentioned here – that are nutrient-dense or otherwise very healthy to eat. You don’t need to worry about whether or not the foods you’re eating are “super,” though. You just need to eat well. Are chia seeds, kale, and blueberries healthy? Yeah. Do they have magic powers? Can they make up for an otherwise unhealthy diet? No.

Water

Water matters too because dehydrated brains don’t function as well.15 However, you probably don’t need to drink eight glasses of water a day. That’s a myth. Just drink water when you’re thirsty.16

Can You Eat Your Way to an A?

Eating well is vitally important for brain health and, in turn, academic success, but let’s not see it as a cure-all. This is one of several fundamentals that help prepare a student’s brain for school. And preparation alone does not guarantee success. You still have to play the game of school, engage the content with curiosity, and learn it deeply by doing more than what is asked of you. And you can still get A’s without eating well, but you’d be making school harder than it needs to be.

Your brain is your #1 asset. Feed it well.

1 MacDonald, Matthew. Your Brain: The Missing Manual. O’Reilly Media, 2008.

2 Lawson, Willow. “Brain Power: Why Proteins Are Smart.” Psychology Today. January 3, 2003.

3 Macrae, Fiona. “High protein diets may shrink brain and boost risk of Alzheimer’s.” Daily Mail. October 21, 2009.

4 Ferriss, Tim. Tools of Titans: The Tactics, Routines, and Habits of Billionaires, Icons, and World-Class Performers. Houghton Mifflin Harcourt, 2016.

5 Aubele, Teresa, and Susan Reynolds. “Have You Fed Your Brain Today?” Psychology Today. September 7, 2011.

6 Reynolds, Susan, and Teresa Aubele. “The Skinny on Brain Fats.” Psychology Today. September 22, 2011.

7 Morell, Pierre, and Richard H Quarles. “The Myelin Sheath.” Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Siegel GJ, Agranoff BW, Albers RW, et al., editors. Philadelphia: Lippincott-Raven; 1999.

8 Willet, Walter. “The Scientific Case for Banning Trans Fats.” December 13, 2013.

9 Chan, Amanda L. “Good And Bad Fats Affect Brain Health, Too.” The Huffington Post. May 19, 2012.

10 “The truth about fats: the good, the bad, and the in-between.” Harvard Health Publishing. Harvard Medical School. August 13, 2018.

11 Pollan, Michael. In Defense of Food: An Eater’s Manifesto. Penguin Books, 2009.

12 Simopoulos, Artemis P. “An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity.” Nutrients. March 2nd, 2016.

13 Asprey, Dave. The Bulletproof Diet: Lose up to a Pound a Day, Reclaim Energy and Focus, Upgrade Your Life. Rodale Books, 2014.

14 St. Michael’s Hospital. “Most popular vitamin and mineral supplements provide no health benefit, study finds.” ScienceDaily. May 28, 2018.

15 “Brain Food: Superfoods To Improve Your Cognitive Function.” The Huffington Post. September 19, 2012.

16 “Myth of 8 Glasses of Water a Day.” University of Michigan Health System.