ADHD and Anxiety: Why They So Often Co-Exist
ADHD and anxiety frequently occur together in children and adolescents, and this is not by chance. Research indicates that between 50–60% of children with ADHD also meet criteria for an anxiety disorder at some point (American Psychiatric Association, 2022). Understanding why these conditions so often co-exist helps parents, educators, and clinicians respond with greater clarity and compassion.
The ADHD Brain and Stress Response
ADHD is a neurodevelopmental condition involving differences in brain networks responsible for attention, emotional regulation, executive functioning, and impulse control. These same networks are closely connected to the brain’s stress and threat systems.
Children with ADHD often have:
A more reactive nervous system
Differences in the regulation of dopamine and norepinephrine
Reduced efficiency in the prefrontal cortex, which supports emotional control, working memory, and decision-making
When these systems are under strain, the brain is more likely to shift into a heightened state of alert. Over time, this increased physiological arousal can raise vulnerability to anxiety.
Emotional Regulation and Anxiety
Emotional regulation challenges are a core feature of ADHD, though they are not always recognised as such. Many children with ADHD experience emotions more intensely and find it harder to return to baseline once upset. This can lead to worry about losing control of emotions, fear of negative reactions from adults or peers, and/or anticipatory anxiety about situations that feel unpredictable or overwhelming Repeated emotional overload can condition the brain to expect threat, reinforcing anxiety responses.
Executive Functioning and Cognitive Overload
Executive functioning skills, such as planning, organisation, initiation, and cognitive flexibility, are commonly impacted in ADHD. In high-demand environments like school, this can create ongoing cognitive overload. This may result in chronic stress from feeling “behind” or unable to keep up, anxiety around performance, deadlines, and transitions, and/or avoidance behaviours that are often misunderstood as defiance or disengagement. In these cases, anxiety is often a secondary response to repeated experiences of overwhelm or perceived failure.
Masking, Perfectionism, and Anxiety
Some children with ADHD, particularly girls and adolescents, develop compensatory strategies to mask their difficulties. While this may help them cope externally, it often comes at a significant internal cost. These patterns may include perfectionism, excessive self-monitoring, and/or heightened fear of making mistakes. Masking increases cognitive and emotional load, which can significantly elevate anxiety levels. Anxiety can sometimes obscure ADHD symptoms, particularly when inattention is driven by worry rather than distractibility. Conversely, untreated ADHD can contribute to chronic stress and anxiety over time. This overlap highlights the importance of comprehensive, developmentally informed assessment rather than focusing on symptoms in isolation.
Supporting Children with ADHD and Anxiety
Support is most effective when it addresses both neurological differences and environmental demands. This may include:
Therapy focused on emotional regulation, coping strategies, and self-understanding
Parent support to reduce stress and create predictable, supportive environments
School adjustments to reduce executive functioning load and increase clarity
Medical input where appropriate and carefully considered
Addressing ADHD-related needs can support anxiety as the child feels more capable and supported.
A Neuro-Affirming Perspective
From a neuro-affirming lens, anxiety is understood as a nervous system response rather than a personal failing. When environments, expectations, and supports align with a child’s neurological profile, both ADHD-related challenges and anxiety can become more manageable. If you are concerned about attention, emotional regulation, or anxiety, a comprehensive assessment and collaborative support approach can provide clarity and guide meaningful intervention.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). APA Publishing.
Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: An evidence-based guide to select optimal treatment. Molecular Psychiatry, 24 (3), 390–408.
Nigg, J. T. (2017). Annual Research Review: On the relations among self‐regulation, self‐control, executive functioning, effortful control, cognitive control, impulsivity, risk‐taking, and inhibition for developmental psychopathology. Journal of Child Psychology and Psychiatry, 58 (4), 361–383.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171 (3), 276–293.
Snyder, H. R., Miyake, A., & Hankin, B. L. (2015). Advancing understanding of executive function impairments and psychopathology: Bridging the gap between clinical and cognitive approaches. Frontiers in Psychology, 6, 328.