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

Dragons, Mountains, and Math: Why Kids Need Challenges

A dragon flying through the forest

It’s often said that, on a hero’s journey, there will be dragons. This means that, if you’re doing meaningful work, you’re going to encounter extremely difficult problems. These problems will often be scary, but since you’re committed to your goal, you face them head-on. That’s what heroes do.

And in one way or another, we’re all on a hero’s journey – or at least, we should be. And that means we all need to be able to face down whatever dragons are on our path.

Of course, no one goes from zero to hero overnight. To be able to face serious challenges as adults, kids need to learn how to face lesser challenges as they grow up. They need opportunities to practice, starting with small challenges and building up gradually. They need direct instruction and encouragement. And they need adults to show them the way.

Mountains and Math Problems

Growing up, mountains were the main arena in which I practiced challenges. The first hike I remember doing was Little Si in North Bend, WA. It’s a tiny little nub of a mountain nestled up against the much larger Mt. Si. When we were on the top, my dad pointed to the big mountain and said, “People are climbing that right now. One day, you will too.” All I could do was stare up at it in disbelief. It seemed impossible to my six-year-old brain to climb something that large.

But as the years went by, the hikes got longer and steeper, and I got tougher. Eventually, peaks like Mt. Si were easy to climb, so I pursued the next level of challenges: backpacking and mountaineering. I climbed Mt. Rainier when I was 15, which was by far the most difficult thing I had ever done. The memory of that experience has forever inspired me to be resilient when I’ve faced other challenges.

Mt. Rainier

School provides a similar progression of ever-increasing challenges, and, done right, it offers them up at an appropriate pace. When my students express frustration that the math they’re doing is difficult, I kindly remind them that it’s supposed to be hard. After all, your brain muscles don’t grow unless you put them to work.

Direct Instruction

Overcoming challenges is not merely a matter of willpower and mental toughness; it’s also a matter of strategy. Children should not be expected to reinvent the wheel. They should be given direct instruction about how to manage the challenges they’re facing from their parents, teachers, and coaches. The methods for solving hard problems in life must be passed down from generation to generation.

“Children who have not been taught to confront challenges will try to avoid all challenges.” –Alfred Adler1

This extends beyond concrete problem-solving to teaching about resilience itself. Children need to be encouraged to try hard things and persist in the face of difficulty. They need you to express confidence in them – not necessarily confidence that they can do it right now, but a certainty that they can figure it out eventually. And they need to understand what it means when something is hard. It doesn’t mean there’s something wrong with them, and it doesn’t mean they should give up. It means they should seek out strategies and resources; it means they should keep trying.

Leading By Example

Kids learn how to deal with challenges in large part by observing their parents, so modeling the right behaviors is essential.

“Model healthy and appropriate ways to manage stress. It’s OK to share your mistakes … with children when it is appropriate. Tell them how you are going to manage that stress, ‘I am going to go for a short walk and then come back and talk about this,’ or ‘I am going to take a few deep breaths before I try to solve this problem.’”2

In addition to practicing good stress-management tactics, you can also apply Stoic principles and practices in your daily life. The resilience you model will naturally rub off on your children.

A boy standing on a rooftop while his dad fixes the roof

Let Them Fight Their Own Dragons

The problems that are extremely challenging for your child might be much easier for you because you’re an adult, so it will be tempting to just take care of things yourself. Don’t. You can provide love and support, but your child needs to be the one to do the work. In the end, your children will need to fight their own dragons and climb their own mountains.

Don’t manage their school life for them. Don’t shield them from difficulty. Don’t rescue them from failure. Give them the chance to experience life fully and encourage them to seek out challenges. The struggles they will inevitably experience might be painful, but it is only through these struggles that they grow stronger.

1 Kishimi, Ichiro, and Fumitake Koga. The Courage to Be Disliked: The Japanese Phenomenon That Shows You How to Change Your Life and Achieve Real Happiness. Atria Books, 2018.

2 Rymanowicz, Kylie. “The importance of taking on challenges for young children.” Michigan State University Extension. May 4, 2016.

How to Support Your Child Without Doing Everything For Them

One of the timeless struggles parents face is deciding just how much support to give their children as they grow up.

When your children are very young, you have to do everything for them. And, hopefully, by the time they’re adults, they’ll be able to take care of themselves. In between, well, that’s where it gets tricky. You have to gradually pull back your support, doing less and less for them. But how much should you pull back? And how quickly?

Product vs. Production Capacity

In The 7 Habits of Highly Effective People, Stephen Covey explains the challenge parents face in terms of balancing “product” – the results we want – with “production capacity” – the ability of the child to produce those results on their own. And it’s not about choosing one or the other. As he says, “effectiveness lies in the balance … the P/PC Balance.”1

Most of the time, parents err on the side of doing too much for their children – focusing too much on the product. They’re not good at making their bed, so we do it for them. They’re not skilled at washing the dishes, so we don’t let them help. They’re not wise enough to make smart choices, so we decide everything for them. As Covey explains, it’s tempting to slip into authoritarian parenting:

When children are little, they are very dependent, very vulnerable. It becomes so easy to neglect the PC work – the training, the communicating, the relating, the listening. It’s easy to take advantage, to manipulate, to get what you want the way you want it – right now! You’re bigger, you’re smarter, and you’re right! So why not just tell them what to do? If necessary, yell at them, intimidate them, insist on your way.”1

But what about the other extreme? Would permissive parenting be better?

“Or you can indulge them. You can go for … popularity … giving them their way all the time. Then they grow up without any internal sense of standards or expectations, without a personal commitment to being disciplined or responsible.”1

Either way, you have a product mentality; you’re focused exclusively on getting good results now at the expense of future production capacity. You’re grabbing short-term benefits at the expense of long-term growth.

Authoritative Parenting

In between the extremes of authoritarian parenting and permissive parenting lies a better, more balanced approach: authoritative parenting.

This means holding your children to realistically high standards, rather than astronomically high standards or no standards at all. It means providing support and guidance without doing everything for them. And it means patiently cultivating production capacity, even if that means getting a poorer outcome today.

Scaffolding

In the realm of executive function, this is often referred to as “scaffolding.” When a building is under construction, the builders put up scaffolding – a temporary structure that supports the construction process. Scaffolding never attempts to take the place of the building itself or perform the building’s functions for it; it just helps. And as the building becomes closer and closer to completion, the scaffolding is steadily removed.

The Discomfort of Letting Go

If you’re doing scaffolding right, you’ll probably feel uncomfortable. Most of the time, we have to stop doing things for our children before they’re ready to do them on their own. The training wheels come off before they really learn how to ride, not after. Letting go in this way is very uncomfortable because we can see that they’re not ready, and that they’re probably going to fail.

But if we’re wise, we can remember that they will learn from these failures, and they’ll get stronger through the act of struggling to do things on their own. And it is precisely this learning and this strength-building that sets them up to succeed later in life.

So listen to this discomfort. It doesn’t mean you’re making a mistake; it means that you’re going in the right direction. Like most forms of psychological resistance, it is a compass, not a warning.

1 Covey, Stephen R. The 7 Habits of Highly Effective People: Powerful Lessons in Personal ChangeFireside, 1990.