What Is Anxious ADD?

While not a clinical diagnosis, “anxious ADD” refers to someone who meets criteria for the neurodevelopmental disorder ADHD and experiences clinically significant symptoms of anxiety. Symptoms typically interfere with their functioning in multiple areas.

ADD

Attention Deficit Disorder (ADD) is a term previously used for what would now be diagnosed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as attention-deficit/hyperactivity disorder (ADHD): Predominantly Inattentive Presentation.1

ADHD: predominantly inattentive presentation is a neurodevelopmental diagnosis that manifests as problems with attention, including:2

Difficulty focusing on school or work tasks
Difficulty paying attention to detail
Disorganization
Becoming distracted easily
Difficulty completing tasks
Losing things
Forgetfulness
Difficulty listening when spoken to
Avoiding tasks that require sustained focus

Anxiety

Clinically, anxiety is nervousness, worry, or fear that is in excess of what is appropriate or expected for the situation. Everyone experiences feelings of anxiety sometimes, and anxious feelings can alert you to danger when you are unsafe.3

When someone experiences excessive anxiety that causes distress or interferes with their functioning, they might meet the criteria for an anxiety disorder. This can manifest as generalized anxiety disorder, social anxiety disorder, panic disorder, or specific phobias.2

The Link Between ADD and Anxiety

Although anxious ADD is not a clinical diagnosis, many people with ADHD also experience anxiety,4 and the presence of both together impacts symptoms and appropriate treatment recommendations.

Symptoms of Anxious ADD

Approximately 80% of people with ADHD have at least one additional diagnosis, and some research shows that up to 50% of people with ADHD also have an anxiety disorder.5

How People With ADD Experience Anxiety

Individuals with ADHD and an anxiety disorder experience their anxiety differently than those with an anxiety disorder but not ADHD. Specifically, those with ADHD experience more severe anxiety, earlier onset of symptoms, and a higher risk for substance use disorders than those who do not have ADHD.6

Furthermore, co-morbid anxiety symptoms can cause ADHD to be more difficult to accurately diagnose.7

Diagnosing Anxious ADD

Because anxiety symptoms can mask ADHD symptoms, providers who diagnose ADHD must understand this connection and consider the possibility that someone may have both sets of symptoms.

An evaluation for ADHD often includes the following:8

Diagnostic interview: The provider gathers a thorough history of your symptoms and life events.
Self-report scales: These measures provide norm-referenced data about your symptoms and compare them to people with ADHD and those who do not have ADHD.
Observer scales: This is information provided by someone close to you and familiar with your symptoms.
Tests of sustained attention: The evaluator may have you complete a task that measures your ability to focus and pay attention in real-time. Your performance is then compared to people who have ADHD and people who do not have ADHD.

An evaluation for anxiety also includes a diagnostic interview as well as measures that assess your level of anxiety compared to the general population.

Causes of Anxious ADD

Anxiety disorders have a genetic component,9 meaning that those with a family history of anxiety are more likely to display symptoms. However, environmental factors and stressors can also cause someone to develop anxiety.

ADHD is primarily caused by genetic factors.10 As a neurodevelopmental condition, ADHD is something that manifests early in development rather than something they develop as they get older.

If someone has undiagnosed ADHD, they might develop anxiety symptoms in relationship to their difficulty with attention or their impulsive behaviors. Parents and teachers can inadvertently reinforce this anxiety response by praising or rewarding a child who acts out less without realizing that the child’s anxiety is increasing.

Rather than punishing behaviors related to ADHD, caretakers should gently redirect the child to more appropriate choices. They can also learn the child’s unique strengths and encourage behaviors and activities that play to these strengths.

How Is Anxious ADD Treated?

Each person with anxious ADHD can follow a specific treatment plan that meets their unique needs. No one course of treatment is right for everyone, and you can work with your treatment team to determine which options are right for you.

Treatment options for anxious ADHD include:11

ADHD Medication. Attentive, hyperactive, and impulsive symptoms related to ADHD can be treated by stimulant medication (such as Adderall) and non-stimulant medication (including Strattera).
Anxiety Medication. People with anxiety can benefit from Selective Serotonin Reuptake Inhibitors (SSRIs), a class of medication that prevents your brain from reabsorbing serotonin, the neurotransmitter connected to feelings of calm and happiness. SSRIs are taken every day. Some prescribers may also recommend benzodiazepines, medication that can be taken on an as-needed basis for panic attacks or severe anxiety symptoms.
Psychotherapy. Treatment with a therapist can help with symptoms of both ADHD and anxiety.

Coping and Living With Anxious ADD

Through therapy, you can learn healthier skills for coping with your ADHD symptoms and experience reduced anxiety symptoms. Specific treatments that can help both anxiety and ADHD include:

Cognitive-behavioral therapy12
Mindfulness therapy13
Solution-focused therapy14

Social support is also essential for treating anxiety and ADHD. People with both diagnoses benefit from close friends and family who help them when their symptoms create challenges.

Those supporting someone with anxiety and ADHD can help them maintain a consistent routine, remember their tasks and appointments, and helping them keep track of their important items and documents.