Dual Diagnosis: Understanding the Differences between ADHD and Anxiety

If you are suspecting that your child may have ADHD, you may begin to also notice signs of anxiety. Anxiety can sometimes look like ADHD, and ADHD can lead to the experience of anxiety. That is, your child may be preoccupied with anxious thoughts in class, which could look like he is being inattentive. An anxious child may need to leave the classroom because she is feeling overwhelmed by the amount of work or what other kids may be thinking about her.  She may need to fidget because her anxiety is high and she needs a place to let go of the negative energy.

Likewise, we have seen many adolescents and young adults with ADHD who become anxious when given a long-term or multi-step assignment. A young woman worries about how she is going to write the 5 page paper that is coming up at the end of the week, so she either does it within the last hour before it’s due, or she doesn’t work on it at all. A young man can’t keep track of all of his school demands and social demands so he ends up not going to class or meeting up with friends.

Let’s break it down…
ADHD
Attention Deficit Hyperactive Disorder is a condition where children, adolescents and adults have difficulty sustaining attention and controlling their impulses (Gargaro et al, 2011). According to the DSM-V, it’s broken down into 3 categories: hyperactive and impulsive, inattentive or combined.

When we break it down, we have our children and adolescents whose attention is wavering all within the same 20 minutes, and/or they have a hard time sitting still and become physically overwhelmed if they are unable to move. This is often seen by the classroom teacher as the child who is falling out of his seat, or calling out or runs across the classroom to sharpen his pencil once he notices that his pencil point is low.

This can make being a member of the class quite difficult because of the need to move, the need to work for small spurts of time, and the struggle to wait one’s turn or raise one’s hand. This can lead to overreacting in situations, having difficulty with organizing and finishing tasks, and having too much energy.

Children with ADHD typically meet all developmental milestones, but many of our kids aren’t picking up on the social cues and non-verbal language between their peers. They miss the cues and either join the situation too late or make statements or comments that are not related to what’s really going on.

Or, if you have a hyperactive child, he may be trying to impress with his athletic skill or is jumpy and touchy, which over time, begins to turn off his peers. Whereas he was once funny, now he’s just annoying.

General Anxiety
Generalized Anxiety is the experience of anxiety over several situations but not limited to one. If your child is preoccupied with his thoughts or is afraid of what others may be thinking, it will be that much more difficult to see or read social cues.  Someone with Autism may not be able to take perspective or think abstractly, while someone with ADHD may not be focused enough to read a social cue.

Garcia-Winner and Crooke (2015) label this world based anxiety. Our social world is constantly changing. Children who have difficulty reading social situations can become easily confused with what is expected with them, what is coming next and what someone’s else intentions are. This can make them worried about new experiences, changes in routine and challenging social situations. Social Stories and Visual Schedules can be quite helpful.

Social Anxiety
Another reason for anxiety is difficulty communicating with others. When children have challenges expressing themselves and relating to others, they can have negative social experiences. This can cause social anxiety, where children may be afraid to interact with a person, feel uncomfortable when they are speaking, and be judging themselves after talking to someone. Social skills training can help children be able to read social cues and give them the confidence to participate in social situations.

Low Self-Esteem 
For children with ADHD can experience changes in their mood. This can give them difficulties socializing with peers and succeeding in the classroom. This can cause them to have negative feelings towards themselves. Inability to focus can also extend to their ability to process emotions. Not being able to track and understand their feelings and triggers can cause them to get stuck. Counseling and mindfulness can help children with ADHD process and express their emotions.

ADHD can cause children to not be able to focus on their emotions and their environment. This can cause them to have negative experiences and experience anxiety. Helping them focus through social skills and mindfulness can give them strategies to reduce anxiety and give them more success academically and socially.

Resources

Garcia-Winner, M., & Crooke, P. (2015, September 18). Updates on the social thinking’s cascade of social attention: A conceptual framework to explore a system’s approach to social communication. Retrieved October 15, 2018, from https://www.socialthinking.com/Articles?

Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: how far have we come in the comorbidity debate?. Neuroscience & Biobehavioral Reviews35(5), 1081-1088.

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