Do I Have ADHD or Anxiety? Here’s How to Tell

Do I have Anxiety or ADHD? Forget ‘To be, or not to be?’ This is the real question and it can be a surprisingly tough one to answer (especially when they occur together, but we’ll get to that). If you’ve been around Little Miss Lionheart for long, you probably know that I’m a mental health clinician who went 28 years thinking I had anxiety, only to discover most of it was undiagnosed ADHD. 

It’s the same story I hear from many, many women. But why?

Anxiety and ADHD share a complicated relationship. They often look similar, which makes it hard to tease them apart and, as if that isn’t hard enough, research shows up to 50% of people with ADHD, especially those with the Inattentive type, have a co-occurring anxiety disorder. 

Despite increased awareness of ADHD in women, chances are if a woman walks into her primary care doctor’s office and says, “Doc, I think I have ADHD,” she’s leaving with an anxiety diagnosis and an SSRI prescription. There are a few reasons for this, but one of them is the strong overlap in symptoms and the fact that many doctors are more knowledgeable about anxiety than ADHD. Thankfully, I think that is slowly changing. I’ve met a few doctors ‘in the wild’ lately with a more in-depth understanding of ADHD and it feels like a dream come true.

Unfortunately, most of us still wondering if our anxiety could be ADHD in disguise end up trying to figure it out ourselves. So if you’ve been wondering, let’s dig into the answer.

Related: 6 Inaccurate Labels that Disguise ADHD

ADHD Overview

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder that begins in childhood and has a strong genetic link. Because of the way our brains develop, people with ADHD struggle to regulate attention, emotion, focus, motivation, and a host of other adulting things. Used to, we had separate diagnoses for ADHD and ADD. Now, the DSM labels them both “ADHD” but offers an ‘Inattentive’ subtype for what used to be ADD.

Keep in mind, for it to be ADHD, these symptoms need to be a frequent problem for you that can’t be explained by things like poor sleep, substance use, or another diagnosis. The symptoms have to cause problems in your daily life, and we should see at least signs of them in childhood.

Here is a brief overview of the types and symptoms. It’s not comprehensive, but it covers the basics.

ADHD Inattentive Type Symptoms

• Zoning out or daydreaming when you need to be paying attention like in meetings or conversations
• Being easily distracted when you need to focus; there’s a reason for the ADHD squirrel cliches
• Unable to stay focused for long when doing a task you don’t enjoy or prefer; the opposite may be true when you engage in things you are highly interested in
• Difficulty following through on things or finishing tasks without supervision
• Forgetfulness, especially with things like appointments, where you put your phone, or the second step in a short list of directions you need to follow, moving the laundry from the washer to the dryer, etc…

ADHD Hyperactive Type Symptoms

• Being impulsive; that can look like spending too much, driving too fast, talking when you’re supposed to be quiet, hopping from job to job without thinking it through, etc…
• Restlessness; unable to sit still, getting up in situations where you’re expected to stay seated, fidgeting, bouncing, biting fingernails, etc…
• Impatience; struggling to wait your turn, interrupting people, finishing other people’s sentences, road rage, etc…

ADHD Combined Type Symptoms

There are 9 symptoms of Inattentive ADHD and 9 symptoms of Hyperactive ADHD. If a person has at least 6 in each category and meets the other requirements for the disorder, they have ADHD combined type.

Since ADHD is a developmental disorder, these symptoms are always present, though they may not always be present in the same degree. If we are in a structured environment with plenty of support doing things that we are very interested in, symptoms may wane considerably, but they are still there. Conversely, if we’re lacking structure, our tasks revolve around executive functioning skills we lack, the environment isn’t terribly supportive, or we find the task very boring, symptoms may be debilitating.

Either way, ADHD symptoms are always present to some degree.

Anxiety Overview

Anxiety is a broad category rather than a single diagnosis. It encompasses everything from Panic Disorder and Social Anxiety to Specific Phobias and Selective Mutism. Most of the time, when ADHD is misdiagnosed for anxiety, though, it’s misdiagnosed as Generalized Anxiety Disorder (GAD).

GAD is characterized by excessive, ongoing worry (duration of at least 6 months) that is hard to control, and is focused on several/many different things, or generalized. That worry interferes with a person’s daily life and makes it hard to get through the day. 

Generalized Anxiety Symptoms:

• Feeling restless, keyed up, or on edge; you might pace a lot, fidget, be constantly on the move or bouncing
• Difficulty concentrating; your mind may be so preoccupied with concerns, you struggle to pay attention, listen, or focus. This can also lead to forgetfulness and make you feel scattered.
• Irritability; you may feel it, or others may point it out
• Tiredness and fatigue
• Muscle tension
• Sleep issues; difficulty falling or staying asleep, waking up too early, or restless or unsatisfying sleep

People with GAD have at least three of these symptoms that they struggle with more days than not and can result in poor work, missed deadlines, and other things that look a lot like ADHD on the surface.

ADHD Vs. Anxiety

Now that we’ve outlined the symptoms of each, let’s delve into their similarities and differences. Then we’ll get to how we tease them apart.

The Overlap between Anxiety and ADHD

If we put the symptoms of anxiety and ADHD side by side, the similarities are stark. Both share the tendency toward being restless, the struggle to focus, difficulty getting things done, impatience and irritability, and even the tendency to be forgetful.

When we go beyond the basic criteria for each disorder and lean more into the research, we find even more similarities. People with both disorders, for instance, tend to struggle with poor sleep and insomnia. Tiredness isn’t just common in anxiety, but also in those with Inattentive ADHD. A mind preoccupied with worry will struggle to be productive, procrastinate, and be forgetful, which looks a heck of a lot like ADHD, doesn’t it? People with both disorders struggle with feeling scattered and overwhelmed.

Even the symptoms that appear to set these disorders apart can instead look similar. Take muscle tension, for instance. On the surface, muscle tension points to anxiety, right? But the restlessness of ADHD and the *secondary anxiety that comes inherent to the mental chaos, not to mention the long list of common co-occurring disorders, means many people with ADHD have muscle tension, too.

A Note on Secondary Anxiety

Worry appears specific to anxiety, but most people with ADHD have secondary anxiety. Secondary anxiety is anxiety that is caused by another diagnosis, like ADHD. Chronic forgetfulness means we often walk around worrying about what we might be forgetting. Frequent inattentiveness means we miss important details, so we often function while anxiously trying to figure out if we’re missing anything. Losing things can make us worry about finding them again, or being late to work if we don’t find them soon, etc…

*Secondary anxiety is directly caused by the symptoms of another disorder. If you take away the ADHD, the anxiety is gone. Primary anxiety, on the other hand, is independent of another disorder. Take away the ADHD, and you still have anxiety.

The Differences between ADHD and Anxiety

If you’ve been asking, “Do I have ADHD or Anxiety?” the answer may seem as clear as mud right now. On the surface, they look remarkably alike, which is one reason they can be so hard to tell apart.

So how the heck do we know?

ADHD or Anxiety? Here’s How to Tell

The differences are in the details. Here are some things I look at when differentiating between ADHD and anxiety. Keep in mind, this is a basic overview, meant to help you explore this question, but it’s not comprehensive.

Content of the Worry

This is one of the more obvious starting places. With GAD, we see disproportionate worry about many things. If a person walks into my office afraid of going outside because a bird might peck their eyes out, I’ll probably be asking more about anxiety. The likelihood of their worry coming true is low and nothing about the content of the worry appears linked to ADHD related issues.

However, if they tell me they have an upcoming presentation at work and they’re worried they won’t get it finished on time or that they’ve already dropped the ball on it somewhere, my ADHD antennae will be buzzing. Especially if they have a history of not meeting deadlines, barely meeting deadlines, or dropping important balls at work.

Different Experiences of Restlessness

Restlessness is the inability to relax. It may or may not come with specific thoughts and worries. When it does, I assess the content of the worries for a better idea of which issue is causing the restlessness. When it doesn’t, I use the following.

I feel like this needs a warning note. Caution: What comes next isn’t 100% true all the time, but most of the time, it holds up. 

Restlessness from anxiety often comes with a nebulous sense of impending doom. Restlessness from ADHD often feels like a simple case of too much energy or a lingering feeling that you’re missing something. 

Executive Functioning Issues

Anxiety can negatively impact executive functioning skills, but someone who also has ADHD will struggle to plan, prioritize, organize, etc…in a bigger and more pervasive way. If a person comes in with a long history of struggling with these kinds of skills in big ways with big consequences, my ADHD spidey sense is going off.

Onset of Symptoms

ADHD begins in childhood. Most of us can point to signs of it in our younger years. I, for instance, was extraordinarily messy at home and at school; I procrastinated on everything and lost things regularly. Generally, if you can’t find evidence of it in childhood, it’s not ADHD. 

That being said, there is an exception. If you had a lot of structure and support in childhood, and your ADHD is on the mild end of things, it’s possible that the consequences of ADHD didn’t show until adulthood when responsibilities increase and support/structure decreases. When this happens, there are usually still subtle signs of ADHD but we have to dig a little harder to find them.

Anxiety can begin at any time. Sometimes it starts in response to a traumatic or overwhelming event; sometimes it’s the result of genetic factors or the environment in which you were raised; sometimes the cause is unknown. If your symptoms started in your thirties after a significant event, anxiety is more likely the cause.

Duration of Symptoms

Anxiety can come and go. The diagnosis requires that you struggle with symptoms more days than not, but people can go for periods of time when they don’t experience symptoms. In other words, anxiety symptoms fluctuate, appear, and disappear.

ADHD does not come and go. At best, we can have easier days and harder days depending on sleep, food intake, hydration, hormone fluctuations, the number of responsibilities we have going on, our level of interest in what we’re doing, etc…but the symptoms are always present. In a nutshell, ADHD symptoms can fluctuate, and they may even temporarily wane, but they never disappear.

If you go through periods of time where you don’t really struggle with symptoms, anxiety is more likely. Especially if symptoms only started in adulthood and there are no ADHD related reasons your symptoms are lower (structured environment, many ADHD supports, high level of interest, etc..).

Patterns in Symptoms

I’m all about patterns and the functions they serve, especially when assessing ADHD vs Anxiety. I mentioned the difference is in the details, right? Our patterns help identify those details. 

While ADHD and Anxiety symptoms overlap, their patterns often present differently. For example, racing thoughts are common to both disorders. But someone with anxiety will often only have racing thoughts when they are stressed and the content of their racing thoughts are almost exclusively stressful. When anxiety dies down, so do their racing thoughts.

Conversely, a person with ADHD usually feels like their head is a pin pong ball in a bouncy house all day every day, even when they aren’t stressed out. During high stress times, their thoughts will certainly include anxious material, but it will also include all kinds of random stuff, too. And once their stress dies down, the racing thoughts simply move to random things.

The same is generally true about most of the overlapping symptoms. Restlessness, poor concentration, forgetfulness, etc… In the anxious person, those symptoms die down when their anxiety lowers. In the ADHD person, those symptoms are always present to some degree. Some days may be easier or worse than others, but ADHD symptoms never fully disappear.

Related: Readers Share What it’s Really Like Inside the ADHD Mind

The Function of the Symptom

I swear, when I’m doing an assessment, I often feel like a five year old with how many times I ask why. But the why matters. It tells us what function the symptom is serving, and that points us to the symptom’s origin. 

If someone tells me they are worried about an upcoming presentation at work, I ask why. 

They say, I’m afraid of looking like an idiot. I ask why.

They say, I don’t feel prepared enough to do a good job. I ask why.

The why question pushes people to be more specific about what is causing their struggle. Eventually, that specificity helps highlight the true underlying culprit. Someone with anxiety will often explain that they worry about what might go wrong and if they will be able to handle it and if they will be judged. Any bad experiences they’ve had with the same kind of situation in the past usually wasn’t so much about them chronically messing up, but hit them hard enough that they fear it happening again.

The person with ADHD can go one of two ways. One, they tell me they’ve been procrastinating on getting started, they get overwhelmed at all the tiny details involved in getting prepared, they’re already on thin ice and nervous if they mess this up it’ll be the last straw, or they have a pattern of messing up similar projects in the past because of the executive functioning challenges they experience. Or two, they have no idea why they are anxious about it. When we explore, it usually has something to do with executive functioning challenges.

Here’s another example I often see. 

A person comes in saying they can’t leave their house without checking the stove a million times. I ask why.

They say I’m afraid of leaving it on. I almost always ask if they’ve left it on before and if so, has it happened more than once? Someone with OCD checks the stove because they are afraid they might leave it on. A person with ADHD checks the stove because they’ve left it on a few times before and they check repeatedly because of ADHD symptoms: forgetting that they’ve checked, not paying attention when they check, unsure if the memory they have of already checking was something they did a few minutes ago or something they’re remembering from yesterday, etc…

Long story short, when you trace the function of the symptom, anxiety comes back to worry. It ends at worry. ADHD always comes back to executive functioning struggles.

Family History

Both ADHD and anxiety can be hereditary; but ADHD is highly heritable. If I suspect a person has ADHD and they tell me their Dad and two of their siblings are diagnosed with it, chances are they have ADHD. If no one in their family has been diagnosed or shows signs of ADHD, it’s not impossible, but it’s less likely. 

Anxiety, on the other hand, is thought to be the result of both environmental and genetic factors. A family history of anxiety does not automatically mean your symptoms are the result of anxiety and not ADHD, it’s just another piece of data to consider.

Family history plays a role in diagnosis, but it’s not the determining factor. It’s simply another piece of the puzzle that helps give direction to which picture fits a person best.

What if I have ADHD AND Anxiety?

If secondary anxiety already complicates the clinical picture, having a co-occurring primary anxiety makes it even more complex. Unfortunately, because of that, having both means you’re even less likely to be diagnosed with ADHD and you probably struggle harder than people who only have one.

When assessing a person who has both, I’ve found that their answers to the questions above are often less helpful on the surface, which requires us to dig far deeper into the details and patterns to figure it out. 

A person who has both conditions often has racing thoughts that focus a lot on anxieties but also deviate toward unrelated things at random. They have difficulty concentrating because of anxiety, but they also have difficulty concentrating, period. Difficulty sleeping is often because of ruminating on fears, but they also have difficulty turning their brain off when it isn’t fixated on worries. 

People with both conditions often struggle to answer my questions at all, especially the ‘either/or’ questions. When I ask, ‘do your racing thoughts focus primarily on your worries or are they often random and bring a variety of emotion with them?’ They either answer “I don’t know” (usually in a very roundabout way) or simply “Yes. To all of it.”

Often, people don’t discover they have both ADHD and anxiety until they receive treatment for the anxiety, but it only solves part of the problem. Anxiety meds do nothing to improve executive functioning problems that aren’t caused by anxiety. They do nothing to improve focus issues that aren’t caused by anxiety. 

How are ADHD and Anxiety Treated?

Both ADHD and anxiety are often best treated with a combination of medication and therapy. Stimulants are the preferred treatment for ADHD according to research. For those who can’t tolerate stimulants, non-stimulants like Straterra, Quelbree, Intuniv, etc… and certain antidepressants used off-label (usually Wellbutrin or Tricyclic Antidepressants like nortriptyline) are often used. In therapy, people with ADHD often benefit from Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and other mindfulness based therapies to help reframe unhelpful thoughts that make everything harder, learn emotion regulation skills, and work through the ways ADHD has negatively impacted self esteem.

Additionally, people with ADHD often benefit from executive function coaching. It helps us build up the skills we lack or struggle with.

SSRI’s and SNRI’s are often the preferred treatment for anxiety, or at least the starting place. For people who don’t tolerate those medication classes well or they are not effective, their doctor may try Tricyclic antidepressants, benzodiazepines, or off-label mood stabilizers or anti-psychotics. In therapy, a variety of approaches can be useful for anxiety including CBT, DBT, Acceptance and Commitment Therapy (ACT), and many others. 

Related: What it’s Actually Like to Take Medication

Treating ADHD AND Anxiety Together

People who have both anxiety and ADHD are often treated with a stimulant (if they can tolerate it), and an SSRI or other anxiety medication. Some doctors will not treat ADHD if you have anxiety; they say that since stimulants can cause anxiety, the use of it when someone has anxiety is contraindicated. In my experience, this is only common with doctors who are less knowledgeable about ADHD. Many, many of us are treated for both.

Both conditions benefit from regular exercise and a balanced diet. In fact, research indicates exercise is one of the few natural ADHD strategies that is actually proven to help. Most of us wouldn’t be able to forgo treatment entirely, but some can. It has a similar effect on anxiety.

Related: 9 Evidence Based Natural Remedies for ADHD

If I think I have ADHD, what do I do?

I’ve developed a few resources to help people wondering if they might have ADHD to explore it further. 

First, the ADHD Test for Women, walks you through specific symptom experiences common to those of us with ADHD. It is based off of the DSM Criteria for ADHD, but uses everyday examples to help you think about it deeper.

I wrote this article about my experience thinking I had anxiety for 28 years only to discover I had ADHD. Many, many people have told me reading this article is what led them to their ADHD diagnosis. It’s a great place to get a feel for what it’s like to live with it undiagnosed.

I created a diagnostic guide to help further explain the symptoms, help you find a knowledgeable doctor for assessment, and provide talking points for exploring it with your doctor. 

Getting diagnosed isn’t easy, especially for women with ADHD, but the right tools can really help. 

Tia Cantrell Clinical Mental Health Therapist

Tia Cantrell is a Licensed Clinical Mental Health Counselor in NC. At the ripe old age of 28, Tia was diagnosed with ADHD and has been hyperfixated on what that means ever since. She started Little Miss Lionheart to help as many ADHD women as possible to better understand and work with their unique brain. She has a Masters in Clinical Mental Health Counseling and a bajillion hours of formal and informal training in all things ADHD. She also has 2 crazy dogs that she's totally in love with, a husband who's best friend material, and probably 1000 Harry Potter themed knickknacks (she she stopped keeping count a long time ago).

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Clinical Mental Health ADHD