Medication and psychotherapy can help treat ADHD and anxiety
Life for a child with ADHD can be made more challenging when the condition is paired with an anxiety disorder. The match-up, while not a given, is fairly common. An estimated 20% to 40% of children and teens with ADHD will also show symptoms of anxiety disorder.
Generalized anxiety disorder is one form of anxiety in youth with ADHD; social anxiety disorder, obsessive compulsive disorder, and separation anxiety are also seen.
What's the Connection?
A 2008 study found no evidence that ADHD causes anxiety, or vice-versa. However, some researchers believe that the challenges and realities that sometimes arise from a life with ADHD—such as rejection from other children, discipline from parents or in school, or poor academic or athletic performance—can foster anxiety.
Symptoms of ADHD and Anxiety Disorders
Children and teens with ADHD and anxiety look and act somewhat differently than those with ADHD alone or with another co-occurring condition. When ADHD occurs with anxiety disorder, children and teenagers are more likely to show symptoms of inattention rather than hyperactivity and impulsive behavior.
Because of this somewhat different symptom profile, ADHD and anxiety are often overlooked or misdiagnosed in children and teens. Symptoms vary from one type of anxiety to another, but some of the more common signs include:
- frequent worries or fears about ordinary events
- difficulty concentrating or focusing on one task
- avoiding school or social activities
- difficulty falling or staying asleep; restlessness
- fear of sleeping alone
- frequent headaches, stomachaches or other complaints
- irritability, tension or feeling "on edge"
- fear of other people, especially strangers
- blushing, sweating, trembling or rapid pulse
Treatment of ADHD and Anxiety Disorders
When treating children or teenagers with ADHD and anxiety disorders, doctors address the most troubling symptoms first. If ADHD symptoms are impairing functioning the most, the doctor may decide to treat the ADHD with a stimulant medication or atomoxetine. In some cases, anxiety subsides once the ADHD is under control. However, if symptoms of anxiety continue, doctors may recommend psychotherapy and/or medication to manage the anxiety.
When the symptoms of anxiety are more severe, anxiety may be treated first, using anti-anxiety medications like benzodiazepines or antidepressants combined with psychotherapy. ADHD may then be treated with a stimulant or atomoxetine.
A 2008 study from the New England Journal of Medicine found that the antidepressant sertraline (Zoloft), combined with cognitive-behavioral therapy, was the most effective way to help children with anxiety; some of the children in the study (aged seven to 17) also had ADHD.
If your child or teen is showing signs of anxiety and/or ADHD, a mental health professional can conduct an assessment to determine what condition (or conditions) may be in fact be at play—then determine how best to treat it. Oftentimes, treatment helps curb symptoms and prompt children to resume their engagement in school activities and social events.
American Academy of Pediatrics
Baldwin, Jennifer S. et al. "Examining Alternative Explanations of the Covariation of ADHD and Anxiety Symptoms in Children: A Community Study." Journal of Abnormal Child Psychology. 2008. Volume 36, Number 1, 67-79.
National Alliance on Mental Illness (NAMI)
National Institute of Mental Health (NIMH) Interview: Joel Sherill on Anxiety Disorders in Children. April 27, 2010.
"Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder." Journal of the American Academy of Child & Adolescent Psychiatry. 2007;46(7):894Y921.
Walkup, John T. et al. "Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety." New England Journal of Medicine 2008; 359:2753-2766.