My Child Can’t Focus: Is it ADHD or Anxiety?

While it can be challenging to differentiate between ADHD vs. anxiety, it’s true that both conditions often go hand-in-hand. Understanding the nuances can be the key to providing your child with the tailored care they need to be less distracted, more focused, and confident.

This article will help you identify where one condition ends and the other begins, or what they look like together. We’ll discuss how these conditions affect a child’s attention, behavior, school performance, and emotional regulation, then provide helpful information for seeking the right kind of help.

Understanding ADHD and Anxiety

Attention-deficit hyperactivity disorder (ADHD) in children is a neurodevelopmental disorder marked by hyperactivity, impulsivity, and difficulties with attention span. ADHD is prevalent in about 7.2% of children worldwide [*].

Many symptoms of ADHD are noticeable in early childhood and can be influenced by several factors, including brain anatomy, genes, prenatal exposures, prematurity, and significant head injuries.

Anxiety is a mood disorder marked by excessive worrying, fear, or avoidance that impairs a child’s normal functioning. Between 15% and 20% of children meet the criteria for anxiety disorders, with a prevalence of up to 31.9% in adolescents between 13 and 18 [*].

Some children are naturally sensitive, though children in families with a tendency for anxiety are more likely to develop it. Anxiety may also be the result of adverse childhood experiences (ACEs) or traumatic events, such as a death in the family or separation.

Children with ADHD can also have anxiety, and vice versa. There is about a 25% comorbidity for both conditions, with some studies reporting up to 50% [*].

What ADHD Usually Looks Like in Children

ADHD in children will typically manifest as difficulties paying attention and being hyperactive or impulsive. We can break symptoms up into two primary types:

• Inattentive symptoms: inability to pay close attention to details, struggling to stay organized, having difficulties with listening or following instructions, losing items frequently, being easily distracted, forgetting tasks, or avoiding ones that require significant effort
• Hyperactive and impulsive symptoms: talking too much, interrupting others, struggling to wait for their turn, inability to play or do things quietly, running and climbing during inappropriate times, constant fidgeting, restlessness, being constantly in motion

What Anxiety Usually Looks Like in Children

Sometimes, children will verbalize their fears and worries, but that isn’t always the case. If your child doesn’t yet have the vocabulary to express themselves, they might demonstrate anxiety in these ways:

• High irritability or prone to anger
• Finding it difficult to relax or stay calm
• Sleep problems
• Shaking and tremors
• Crying frequently
• Using the bathroom frequently
• Somatic symptoms, such as headaches and stomachaches

Why ADHD and Anxiety Can Look Similar

Symptoms of ADHD and anxiety can overlap, which is why they often look so similar. Both conditions can make a child inattentive and restless. They also affect a child’s executive functioning in that they might struggle to emotionally regulate, stay organized, or exercise self-control.

The emotional experience is also very similar. Both conditions can cause children to feel overwhelmed and overstimulated. Often, a child with either condition may experience difficulties with sleep and have low frustration tolerance.

Both ADHD and anxiety have a similar effect on a child’s school performance. If they are highly distractible or often worried, it can be challenging for them to complete long-term projects or spend a lot of time studying.

A child with anxiety may also develop avoidance and refuse to go to school. Together, both conditions result in lower academic output, working memory overload, and burnout.

Is It ADHD or Anxiety?

Differentiating between ADHD and anxiety involves looking at the source of the discomfort, the direction of the thoughts, and the timing of the symptoms. Below, we outline how both conditions differ.

The key to determining whether your child has ADHD or anxiety (or both) is to observe patterns. For example, if your child struggles to focus all the time, that could indicate ADHD. However, if they only struggle to focus during stressful times, that could indicate anxiety.

If you’ve already introduced relaxation techniques, observe whether these help or not. If calming exercises like deep breathing or mindful meditation are helpful, your child might be struggling with anxiety. If the symptoms don’t subside, it could point to ADHD.

Can My Child Have Both Anxiety and ADHD?

It is possible for a child to have both anxiety and ADHD. Both conditions have a genetic component. For ADHD, there is 74% heritability, whereas 31.6% of the likelihood of anxiety disorders is linked to genetics [*]. If there is a family history of both, it’s possible that the child will inherit both conditions.

Environmental factors can also influence the probability that a child develops both conditions. This is likely to happen if the child doesn’t receive familial or professional support, or if the child is in poor physical health.

One condition can also possibly affect the other. Because children with ADHD often struggle with executive functioning, they are more likely to become frustrated when they can’t achieve something they set out to do. This low tolerance can cause more stress and anxiety in the child.

In the same thread, anxiety symptoms can interfere with a child’s ability to pay attention, which can intensify other symptoms of ADHD.

Treatment for ADHD and Anxiety

The best form of treatment for a child with ADHD and anxiety is a combination of therapies and medication.

Psychotherapies are most effective for targeting anxiety. Treatments like cognitive-behavioral therapy (CBT) to address negative thinking can ease anxiety during stressful times, while relaxation training can help your child implement calming techniques when they encounter triggers. In more severe cases, your child’s doctor may prescribe antidepressants to provide more relief for anxiety.

Specialists may also prescribe stimulant medication to address ADHD symptoms. The most common medication is methylphenidate (Ritalin 10, Ritalin LA, and Concerta). Methylphenidate works by increasing the production of neurotransmitters in the brain [*]. When dopamine and norepinephrine increase, the child experiences an increased attention span, reduced hyperactivity, more controlled behaviors, and better executive functioning.

However, medication does not work the same way for every child. It’s common for specialists to prescribe different medications before finding one that works well for your child. If stimulants aren’t effective, your child’s doctor might prescribe a non-stimulant medication, which may take longer to work but can be helpful for some children.

The Bottom Line

Because the symptoms of ADHD and anxiety often mimic each other, it can be difficult to tell the two conditions apart. Recognizing how these two conditions interact with each other is a good first step towards giving your child the support they need.

Help make your child’s day-to-day more manageable with exercises from our ADHD worksheets collection.

Sources

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2. Chiu A, Falk A, Walkup JT. “Anxiety Disorders Among Children and Adolescents.” Focus, 2016.
3. D’Agati E, Curatolo P, Mazzone L. “Comorbidity between ADHD and anxiety disorders across the lifespan.” International Journal of Psychiatry in Clinical Practice, 2019.
4. Faraone SV, Larsson H. “Genetics of attention deficit hyperactivity disorder.” Molecular Psychiatry, 2018.
5. Jaeschke RR, Sujkowska E, Sowa-Kućma M. “Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review.” Psychopharmacology, 2021.