ADHD and anxiety together: how they overlap and what helps

ADHD (attention deficit hyperactivity disorder) is a condition that can affect how you focus. The NHS describes symptoms involving the ability to pay attention (being inattentive), having high energy levels (being hyperactive) and the ability to control impulses (being impulsive). Symptoms usually start before the age of 12.

Anxiety is a feeling of unease, worry or fear. NHS inform explains that generalised anxiety disorder causes you to feel anxious about a wide range of issues, most days, and that the main symptom of GAD is feelings of stress or worry that affect daily life and are difficult to control.

Because worry, restlessness, poor concentration and sleep difficulty appear in both, the two conditions can be mistaken for each other or hide each other.

The NHS notes that ADHD often comes with other conditions, including anxiety, and that people with ADHD may be more likely to have mental health issues such as anxiety or depression. For children, the NHS adds that being tired, anxious or stressed can cause restlessness and distractibility without it being ADHD.

NICE guidance on ADHD says that clinicians should be aware of a higher prevalence of ADHD among children and young people with mood disorders such as anxiety and depression, and among adults with a mental health condition.

The NHS says anxiety and depression can make ADHD symptoms worse, which can create a cycle: poor organisation and missed deadlines raise worry, and worry lowers concentration further.

For adults, the NHS says you should make an appointment with a GP if ADHD symptoms are affecting studies, work or relationships. The GP will ask about your symptoms and how they affect your life, and may consider other conditions that could be causing the symptoms, such as autism, Tourette's or anxiety. The GP may then refer you for an assessment with a mental health professional specialising in ADHD.

The NHS says the assessment will focus on work and education, family and friends and medical history, including any mental health issues, and the specialist may contact someone who knows you well. For children, the assessment is with a paediatrician or child and adolescent psychiatrist and includes contact with the school.

The NHS also notes that waiting times vary and may be several months or years, and that the Right to Choose scheme may allow you to find a clinic with shorter waiting lists in England.

NICE guideline NG87 says to offer the same medication choices to people with ADHD and anxiety disorder, tic disorder or autism as other people with ADHD, and to ensure that dose titration is slower and monitoring more frequent if conditions such as anxiety disorders, depression, PTSD or substance misuse are present.

The NHS says ADHD medicines, such as methylphenidate or lisdexamfetamine for adults, must be started and monitored by an ADHD specialist, and that a GP may take over prescribing under a shared care agreement. Not everyone needs or wants medicine. Talking therapies such as CBT or mindfulness may be recommended for adults with ADHD.

For anxiety, the NHS says that for GAD a GP may offer talking therapies, usually CBT, medicines such as an SSRI, or referral to a community mental health team, and will usually advise trying talking therapies first.

The NHS suggests making time for physical activity you enjoy, getting enough sleep with a regular bedtime and a quiet dark bedroom, avoiding screens, caffeine, sugar and alcohol close to bedtime, and aiming for a healthy balanced diet and regular mealtimes.

At work, the NHS says you can request reasonable adjustments, such as a personalised work space in a quiet area, written as well as spoken instructions and help to plan and structure tasks. For GAD, the NHS also advises not avoiding situations that make you anxious but slowly building up time in them, and limiting caffeine.

The NHS says that if you are worried ADHD may be affecting your child, you can talk to a teacher, who may involve the school SENCO, and then to a GP. At the GP appointment other conditions such as autism, Tourette's or anxiety may be considered. Support at school and at home can include breaking tasks into 15 to 20 minute slots, clear single-step instructions and praise.

Because anxiety in children can look like restlessness or distractibility, an assessment that looks at both is important so that support fits what the child is actually experiencing.

On the NHS, ADHD assessment usually starts with a GP referral, and in England you may ask for an NHS appointment at any clinic, including a private clinic that provides ADHD services for the NHS, under Right to Choose.

Some people pay for a private ADHD assessment to avoid long waits. Medicines started privately may need a shared care agreement before an NHS GP will take over prescribing, which is not guaranteed, so check this before you begin. Make sure any assessment considers anxiety and other mental health conditions.