Schools morning shouldn't feel like a battle every day. Yet for thousands of families across the country, that's exactly what it is—tears, tantrums, physical complaints, and overwhelming dread, all centered around the simple act of going to school.
ADHD and Anxiety in Children
Many families face a confusing reality: their child shows signs of ADHD, but anxiety seems to be at play too. Understanding how these conditions overlap can help you find the right support for your child.
What we'll cover in this article:
The Reality of Co-Occurring ADHD and Anxiety
Between 25% and 50% of children with ADHD also experience anxiety disorders [1]. This overlap isn't coincidental, research shows that ADHD symptoms can actually contribute to the development of anxiety over time [2]. When a child struggles with inattention, impulsivity, or hyperactivity, they often face repeated negative feedback from teachers, peers, and even well-meaning family members. This pattern can create genuine worry about performance, social situations, and daily expectations.
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| Co-occurrence rate | 25-50% of children with ADHD have an anxiety disorder |
| Age of onset | ADHD symptoms typically emerge first, followed by anxiety |
| Impact on function | Children with both conditions face greater challenges than those with either alone |
| Goals | Entertainment, learning |
| Gender differences | Co-occurrence rates are similar for boys and girls |
At Blackbird Health, we see this pattern regularly. Nearly nine out of 10 children who need support have more than one condition affecting them. That's why we look at how the brain, body, and behavior interact—to catch the connections that are often missed when these areas are assessed separately.
Recognizing the Signs: Is It ADHD, Anxiety, or Both?
Distinguishing between ADHD and anxiety can be challenging because some symptoms appear similar on the surface. However, understanding the underlying causes helps clarify what's happening for your child.
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Feature |
ADHD |
Anxiety |
Co-Occurring |
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| Difficulty concentrating | Due to distractibility | Due to worry | Both factors present | ||
| Restlessness | Physical need to move | Nervous energy from fear | Combination of both | ||
| Avoidance behaviors | Rarely primary | Common strategy | Present with dual causes | ||
| Sleep problems | Difficulty settling downe | Worry prevents sleep | Multiple sleep challenges | ||
| Social challenges | From impulsivity | From social fears | Compounded difficulties | ||
ADHD Symptoms in Children
Children with ADHD typically show:
- Difficulty sustaining attention on tasks
- Trouble following through on instructions
- Frequently losing items needed for activities
- Physical restlessness or fidgeting
- Acting without thinking about consequences
- Interrupting others or difficulty waiting their turn
Anxiety Symptoms in Children
Children with anxiety often experience:
- Excessive worry about everyday situations
- Physical symptoms like stomachaches or headaches
- Avoidance of anxiety-triggering situations
- Difficulty sleeping due to worry
- Seeking constant reassurance from adults
- Restlessness stemming from internal worry rather than hyperactivity
When Both Conditions Are Present
A child with ADHD and anxiety presents a more complex picture. They might:
- Struggle to focus because worry occupies their thoughts
- Avoid schoolwork not just because it's hard to concentrate, but because they fear failure
- Show physical restlessness driven by both ADHD hyperactivity and anxious energy
- Experience social difficulties from impulsive ADHD behaviors that then trigger anxiety about peer relationships
Why ADHD and Anxiety Often Occur Together
Research reveals an important directional relationship: ADHD symptoms tend to develop first and contribute to anxiety symptoms over time [3]. This makes developmental sense when we consider how a child with ADHD experiences their world.
Children with ADHD face challenges with impulse control, attention, and sometimes hyperactivity. These difficulties often lead to frequent corrections from teachers and parents, struggles with peer interactions, and difficulty completing age-appropriate tasks. Over time, children begin to internalize these patterns: "I always get in trouble," "Other kids don't like me," or "Nothing I do is good enough." These accumulated experiences create genuine anxiety about performance in school, social situations, and meeting expectations.
Executive Function and Emotional Regulation
ADHD involves differences in executive function—the brain's ability to plan, organize, and regulate emotions [4]. These same executive function challenges make it harder for children to manage anxious feelings when they arise. The combination creates a cycle where ADHD makes anxiety harder to control, and anxiety makes ADHD symptoms more disruptive.
The Importance of Accurate Diagnosis
Getting the right diagnosis matters tremendously for treatment effectiveness. A child treated only for ADHD when anxiety is also present may show limited improvement. Similarly, treating anxiety alone won't address underlying ADHD challenges.
What Comprehensive Evaluation Includes
A thorough assessment for co-occurring ADHD and anxiety examines developmental history, current functioning across settings (school, home, social), symptom patterns and triggers, and related factors like learning differences or sensory processing patterns.
At Blackbird Health, our up-to-90-minute New Patient Evaluation (NPE) allows time to truly understand what's causing your child's challenges. This structured, whole-child assessment is led by a psychiatric mental health nurse practitioner (PMHNP). It integrates history, standardized tools, clinical observation, and diagnostic expertise to create a precise understanding of what’s driving a child’s challenges—and how to best support them. We listen to your concerns, observe your child, and create a clear plan for moving forward—often beginning treatment after the first visit.
Treating ADHD and Anxiety Together
The most effective approach treats both conditions simultaneously rather than addressing them separately. Research confirms that integrated treatment produces better outcomes than sequential treatment [5].
Behavioral Interventions
The most effective strategies address both conditions.
Strategies for addressing ADHD:
- Parent training in behavior management strategies
- School accommodations and support plans
- Organizational skills coaching and routine development
Strategies for addressing anxiety:
- Cognitive behavioral therapy (CBT) to address worry patterns
- Gradual exposure to anxiety-triggering situations
- Relaxation and coping skills training
Strategies for addressing both:
- Emotion regulation skills
- Problem-solving strategies
- Building frustration tolerance
- Improving social skills
Medication Considerations
When behavioral interventions need additional support, medication can be effective for treating ADHD and anxiety together:
Stimulant medications: Contrary to common concerns, stimulant medications for ADHD typically don't worsen anxiety and can actually help reduce anxious symptoms by improving a child's ability to succeed academically and socially [6].
Non-stimulant options: Certain non-stimulant medications have demonstrated effectiveness for both ADHD and anxiety symptoms in children, making them a possible option when both conditions are present [7].
Anxiety-specific medications: When anxiety symptoms remain significant despite ADHD treatment, additional medications specifically targeting anxiety may be considered as adjunctive treatment [8].
The Whole-Child Approach
At Blackbird Health, we match your child with the right specialists based on how their brain and body work. This might include therapy to develop coping skills, play therapy for younger children, medication management when appropriate, and parent support throughout the process.
Treatment begins quickly because we understand that every week matters when your child is struggling. We offer both in-person and virtual appointments across Southeast Pennsylvania, Northern Virginia, and Southern New Jersey, so care starts sooner rather than later.
When to Seek Professional Help
Consider reaching out for evaluation if your child experiences:
ADHD-Related Concerns:
- Persistent difficulty completing homework or schoolwork
- Frequent behavioral issues at school
- Significant disorganization affecting daily life
- Impulsive behaviors causing safety concerns
Anxiety-Related Concerns:
- Excessive worry that interferes with activities
- Physical symptoms without medical cause
- Avoidance of school or social situations
- Sleep disruption due to worry
Combined Indicators:
- Academic performance declining
- Withdrawal from activities they once enjoyed
- Strained family relationships
- Physical complaints increasing in frequency
The whole family is affected when a child struggles with ADHD and anxiety. If your family's daily life feels consistently stressful, or you've tried multiple strategies without seeing improvement, professional evaluation can provide clarity and direction.
Moving Forward: Hope and Effective Treatment
Understanding that your child has both ADHD and anxiety helps explain struggles that may have felt confusing or overwhelming. More importantly, this understanding leads to better treatment outcomes. With the right support, children with co-occurring ADHD and anxiety develop skills to manage both conditions and thrive.
Families often tell us our New Patient Evaluation is the first time someone has taken the time to truly understand their child. If you're concerned about ADHD and anxiety affecting your child, we're here to help you find answers and create a path forward.
Frequently Asked Questions
Q: Can anxiety cause ADHD symptoms? A: While anxiety can mimic some ADHD symptoms like difficulty concentrating, research shows anxiety typically doesn't cause ADHD. More commonly, ADHD symptoms develop first and contribute to anxiety over time. A comprehensive evaluation helps distinguish between the two conditions.
Q: Will treating my child's ADHD make their anxiety worse? A: Research shows that appropriate ADHD treatment, including stimulant medications, typically doesn't worsen anxiety and may actually help reduce it. When ADHD symptoms improve, children often experience less stress and fewer situations that trigger anxiety.
Q: How long does treatment take when both conditions are present? A: Treatment timelines vary by child, but integrated approaches addressing both ADHD and anxiety together typically show improvement within weeks to months. At Blackbird Health, we begin treatment after your first visit, so your child gets help quickly.
Q: Should both conditions be treated at the same time? A: Yes, research supports treating co-occurring ADHD and anxiety simultaneously rather than addressing one condition first. This integrated approach produces better outcomes because the conditions influence each other.
Q: What's the difference between normal worry and anxiety that needs treatment? A: Normal worry is proportional to situations and doesn't significantly interfere with daily activities. Anxiety requiring treatment is excessive, persistent, and prevents a child from participating in school, friendships, or family activities they would otherwise enjoy.
Sources
- Centers for Disease Control and Prevention. "Other Concerns and Conditions with ADHD." CDC, October 2024.
- Gair, Shannon L., et al. "Early Development of Comorbidity Between Symptoms of ADHD and Anxiety." Research on Child and Adolescent Psychopathology, vol. 49, no. 3, 2021, pp. 311-323.
- Gair et al., 2021.
- Nigg, J.T., et al. "Temperament and Attention Deficit Hyperactivity Disorder: The Development of a Multiple Pathway Model." Journal of Clinical Child and Adolescent Psychology, vol. 33, no. 1, 2004, pp. 42-53.
- March, John S., et al. "A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder." Archives of General Psychiatry, 2000.
- Coughlin, Casey G., et al. "Treating ADHD and Comorbid Anxiety in Children: A Guide for Clinical Practice." Clinical Pediatrics, 2022.
- Geller, D., et al. "Atomoxetine Treatment for Pediatric Patients with Attention-Deficit/Hyperactivity Disorder with Comorbid Anxiety Disorder." Journal of the American Academy of Child & Adolescent Psychiatry, vol. 46, no. 9, 2007, pp. 1119-1127.
- Coughlin et al., 2022.
Nicole Garber, MD, Chief Medical Officer
Dr. Nicole Garber is triple board-certified in general psychiatry, child and adolescent psychiatry, and obesity medicine, bringing over 11 years of experience in pediatric mental health care.
To learn more about child therapy and psychiatry services, medication management, or to schedule a New Patient Evaluation at Blackbird Health, call (484) 202-0751 or email us at info@blackbirdhealth.com.
