ADHD & Anxiety in Children
It’s common for children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) to struggle with anxiety, whether it’s a few symptoms or a full-blown disorder. According to the National Survey of Children's Health (NSCH), most recently conducted in 2016, three in 10 children with ADHD also have an anxiety disorder, and the most current research also shows comorbidity between ADHD and anxiety reaching 32.7% in many samples.
Some of the symptoms of ADHD, such as frequent interrupting, blurting out, fidgeting, and forgetfulness, can be very intrusive and increase stress levels for children. If children are consistently reprimanded for talking out of turn in school, for example, they are likely to experience higher stress and low self-esteem.
ADHD OR ANXIETY?
ADHD or Anxiety? Understanding the Connection
Many children diagnosed with ADHD struggle with working memory, time-management skills, and organizational skills. This can make it difficult to follow daily routines and complete both short and long-term tasks. It can also result in chronic stress.
Emotional regulation is another challenge for children with ADHD. ADHD has a tendency to flood kids with emotions—positive or negative—which can be difficult to manage in the moment. If a child is flooded with feelings of anxiety and starts to ruminate with worry, for example, that child might struggle to make sense of his thoughts and become caught in a cycle of negative and anxious thinking.
Anxiety Symptoms in Your ADHD Child
Difficulty regulating emotions and coping with anxious thoughts can manifest in different ways for different kids. While some kids might completely check out and turn their anxious thoughts inward, others are likely to act out with negative behaviors. Tuning into your child’s baseline behaviors will help you assess for co-existing anxiety when notice a shift in behaviors.
Symptoms of anxiety in children include:
- Sleep disturbance (difficulty falling or staying asleep)
- Increased irritability
- Being argumentative
- Withdrawing from peers
- School refusal
- Being disruptive or clowning around in school
- Hair twirling, skin picking, or other anxious behaviors
Misdiagnosis can and does occur when it comes to children with ADHD and/or anxiety. The best course of action to ensure an accurate diagnosis is a thorough evaluation by a neuropsychologist. (Your pediatrician or school counselor should be able to refer you to a specialist.)
Anxiety looks a lot like ADHD for many children, so it’s important to have your child evaluated by someone who is familiar with the nuances of ADHD in order to determine the best course of treatment. Be aware that classroom teachers may be more familiar with symptoms of ADHD than they are with anxiety so it's not uncommon for confusion to arise at school.
The following are just a few of the many ways in which symptoms of ADHD and anxiety overlap:
Inattention. An anxious child might check out and tune into his worries. To the teacher or parent, this looks like inattention. For an ADHD child, inattention is a symptom of the disorder.
Poor peer relationships. A child with social anxiety will struggle to make and maintain friendships due to fears about rejection or difficulty regulating emotional thoughts while engaged with peers. A child with ADHD is likely to have low impulse control and poor social skills, which makes it difficult to sustain friendships.
Slow work habits. Anxious children can struggle with perfectionism, making it difficult to complete in-class and homework assignments. An ADHD child struggles with the workload due to poor organizational skills and reduced attention span.
Constant movement. Anxious children tend to move around a lot (foot tapping, tipping chair) and ask constant questions in an attempt to manage anxious energy. ADHD kids fidget because of low impulse control.
While there are symptoms that overlap, it’s important to note that anxious children display more perfectionist behaviors and worry about socializing with others, while ADHD kids struggle with impulse control and organization.
A complete neuropsychological evaluation, including at least one classroom evaluation, will help determine whether a child’s behaviors are rooted in ADHD, anxiety, or some combination of the two. School accommodations may also be helpful.
HOW TO HELP YOUR ADHD CHILD COPE
How to Help Your ADHD Child Cope with Anxiety
Both ADHD and anxiety are hard on children. As a parent, it's your job to look out for your child's self-esteem. Let your child know that it's not their fault and that many other children struggle similarly. In the meantime, here are some strategies for helping your child work through anxious moments.
Keep a Trigger Tracker
Understanding what particular stressors cause the most anxiety for your child helps your child learn to predict anxiety-inducing situations and manage symptoms as they arise. If test anxiety triggers distorted thinking, for example, your child can meet with the classroom teacher to determine test-taking strategies that might help in the moment.
Your child can keep a “worry thermometer” in his backpack or desk to jot times when he felt “hot” with anxiety during the school day. He can color in the thermometer to the appropriate level and write down the time of day. This will help the classroom teacher understand his anxiety hot s pots. Kids can also use the worry thermometer at home, or use a worry journal to keep a list of anxious and intrusive thoughts.
Teach Thought Stopping
Anxious kids struggle with flooding. Anxious thoughts tend to overwhelm kids all at once, and it can be difficult to recover once the brain shifts into a pattern of anxious thinking.
Teach your child to practice thought-stopping at home. In a calm moment, have your child practice saying, “No. Stop telling me that, worry brain. I can do this.” When kids “talk back” to their worry brains and replace anxious thoughts with positive ones, they can interrupt the worry cycle and reset themselves.
Teach Deep Breathing
Deep breathing is a great strategy for young children. Deep breathing slows down the heart rate and relieves muscle tension. Encourage your child to visualize blowing up a balloon while taking a very deep breath. Your child should inhale for a count of four, hold for four, and exhale for four.
The Stop, Think, Breathe app is an excellent resource for children with anxiety and ADHD. Through guided meditations and mindful breathing, kids learn to manage their anxious thoughts and replace negative/anxious thinking with calm/peaceful thinking.
If your child’s anxiety impacts his daily living (school, home, outside activities) and interferes with his ability to access the curriculum at school and enjoy his life, it’s time to seek a licensed mental health professional. Through psychotherapy, kids can learn to manage their emotions and work through their triggers of stress and anxiety. Seek a referral for a child psychotherapist who specializes in anxiety for best results.
Anxiety and Depression in Children by Centers for Disease Control and Prevention
Metacognitive teaching strategies that empower young children by Michael Hilkemeijer
The Role of Make-Believe Play in Development of Self-Regulation by Laura E. Berk, PhD
What is sensory processing disorder? by familydoctor.org
How to Change Negative Thinking Patterns by Juliann Garey
How to Help Kids Deal With Cyberbullying by childmind.org
How Can We Help Kids With Non-Verbal Learning Disorder? by Caroline Miller
Dyslexia and ADHD: Which Is It or Is It Both? by Timothy J. Legg, Ph.D., CRNP — Written by Rebecca Joy Stanborough
Occupational Therapists: What Do They Do? by Beth Arky
Sensory Processing FAQ by Child Mind Institute
Autism Plus Wandering by Beth Arky