The Link Between High Functioning Anxiety and ADHD
written by Dr. Liz Nissim, published on Psychology Today
When they imagine attention-deficit hyperactivity disorder (ADHD), many parents envision a child who can’t sit still, forgets homework, or gets in trouble for talking too much. But there’s another group of children we don’t talk about enough.
These children often get good grades, follow the rules, and seem responsible or even mature. Yet inside their internal world, they may be worried, tense, and afraid of falling apart.
In a child who has ADHD, this can be understood as a kind of high-functioning anxiety. This subset of children may look like they’re coping well, but behind the scenes, they’re running on stress. They’re getting it all done, but their internal world can sometimes feel like a pressure cooker.
How Does ADHD Turn Into Perfectionism?
Children with ADHD often hear subtle (or not-so-subtle) messages, such as:
- “Why can’t you just focus?”
- “You’re so smart, but you’re not applying yourself.”
- “You forgot again?”
Often, over time, kids with ADHD begin to internalize these messages—and some dramatically shift their behavior as a result. Instead of appearing careless, they become hyper-careful. They may double-check the most minor details, spend hours on assignments that should take 30 minutes, or panic over small mistakes.
The natural place to attribute blame or understanding for the perfectionismis a parent with high expectations. On the contrary, many of these children’s parents make a real effort to demonstrate that it’s OK to make mistakes, forget something, or get a B. Yet the child, in trying to compensate for their attentional weaknesses, internalizes much stricter standards to bolster their self-worth.
Perfectionism then turns into trying harder, being more organized, and more prepared, in the hopes that no one will be disappointed or let down. From the outside, this looks like a strong sense of responsibility or work ethic. Yet on the inside, it feels like constant pressure. Parents may even feel proud of their child’s work ethic, not realizing that it’s being fueled by anxiety rather than confidence.
Big Emotions in a Small Body
ADHD affects more than attention. It also impacts emotional regulation. This means your child may feel emotions faster, stronger, and longer than other kids. Add anxiety to that mix, and their nervous system can stay on high alert for long periods of time.
What does emotional dysregulation look like? Possible manifestations include:
- Meltdowns over small changes in plans
- Tears after a minor correction
- Not wanting to try new activities for fear of failure or not being good enough
- Stomachaches in the morning
- Struggles with settling down at night in anticipation of the next day’s demands