ADHD vs anxiety: how to tell them apart, and what happens when you have both

Attention problems, restlessness, irritability and disturbed sleep are common to both ADHD and anxiety, so it is easy to see why people are unsure which one they have. The NHS lists the symptoms of generalised anxiety disorder as difficulty sleeping, feeling restless, irritable or finding it difficult to concentrate, getting tired easily, feeling tense, stomach problems, palpitations and feeling lightheaded. It lists the signs of ADHD in adults as being easily distracted or forgetful, finding it hard to organise time and finish tasks, losing things often, having a lot of energy or feeling restless, talking a lot, and making quick decisions without thinking.

Look at those lists side by side and there is plenty of overlap, which is why a careful assessment matters. A person who cannot concentrate because of constant worry may look very similar to someone whose attention drifts for neurological reasons, and a person with ADHD who has repeatedly missed deadlines may be anxious precisely because of the consequences. Both can be true at once.

No single symptom separates the two, but a few patterns help clinicians. The first is the course over time. The NHS says ADHD symptoms usually start before the age of 12 and the specialist will ask about the history of your symptoms, particularly if they started in childhood and how they affected you at school. Anxiety can begin at any age, and the NHS says GAD does not usually have an obvious cause, though stressful or traumatic experiences, a long-term painful health condition, or another anxiety disorder can raise the chance of it.

The second is the content of the experience. In GAD the NHS says the main symptom is feelings of stress or worry that affect daily life and are difficult to control. The mind is occupied by worry about many things. In ADHD the central difficulty involves attention, activity and impulse control: the mind wanders, tasks are hard to start or finish, or the person acts quickly without thinking about the consequences.

The third is how the difficulties show up across your life. The NHS says the ADHD assessment looks at several areas, including work and education, family and friends, and medical history, and asks how symptoms affected you at school. A pattern that has been present since childhood and across settings points more towards ADHD, though anxiety can also be long-standing and the two can coexist.

It is very common to have both, and the NHS acknowledges that people with ADHD may be more likely to have mental health issues such as anxiety and depression. Living with undiagnosed ADHD often generates anxiety: constant lateness, forgotten tasks and criticism take their toll. The reverse can also happen, with anxiety draining the concentration that ADHD already makes difficult.

The NHS notes that anxiety and depression can make ADHD symptoms worse, so treating anxiety is often an important part of ADHD care. It also says exercise helps reduce symptoms of anxiety and depression, and that getting enough sleep matters. Which condition is treated first is a decision for the clinicians involved, based on what is causing the most difficulty.

Medicines need a joined-up approach. Because ADHD medicines are started and monitored by a specialist and anxiety medicines are usually prescribed through the GP, tell each prescriber about the other, and do not change or stop medicines independently.

For either condition the first step is the GP. For ADHD, the NHS says the GP will ask about your symptoms and how they affect your life, may consider other conditions that could be causing them, and may refer you for an assessment with a mental health professional specialising in ADHD. The assessment is with an ADHD specialist such as a psychiatrist, who will ask about the history of your symptoms and focus on work and education, family and friends, and medical history including any mental health issues. They may want to contact someone who knows you well.

For anxiety, the NHS says that a GP will ask questions about your worries and physical symptoms and may diagnose GAD if you often worry about a wide range of things, it affects your daily life, you find it hard to control, and you have felt anxious a lot of the time for at least 6 months. If you are 18 or over you can refer yourself directly to an NHS talking therapies service without a GP referral.

The NHS is open about waiting times for ADHD assessments, saying they vary and you may have to wait several months or years. It says you may be able to find a clinic with a shorter waiting list through the Right to Choose scheme in England. NICE has published a guideline on ADHD diagnosis and management (NG87) that covers recognition, diagnosis and treatment in children, young people and adults.

For GAD the NHS says the main treatments are talking therapies, usually cognitive behavioural therapy, medicines that treat anxiety, usually an antidepressant called an SSRI, and referral to a community mental health team. A GP will usually advise you to try talking therapies before prescribing medicine or referring to a specialist.

For ADHD, the NHS says management can include lifestyle changes, changes at work and medicines, and not everyone needs or wants medicine. ADHD medicines must be started and monitored by an ADHD specialist, and the NHS names methylphenidate and lisdexamfetamine as examples. A GP may be able to take over prescribing if there is a shared care agreement. Talking therapies such as CBT or mindfulness may also be recommended, and reasonable adjustments at work or study, such as written as well as spoken instructions, a quiet workspace and help planning tasks, can make a large practical difference.

Both conditions respond to the basics of sleep, regular meals, physical activity and limiting caffeine, sugar and alcohol close to bedtime, as the NHS pages advise. Do not stop prescribed medication suddenly without advice.

See a GP if you think you might have either condition, or if you have been diagnosed and treatment is not helping. The NHS notes that people with ADHD are at higher risk of suicide and that support is available straight away if you are feeling like you want to end your life. If you or someone you know is in crisis, contact NHS 111, ask for an urgent GP appointment, contact Samaritans or call 999 in an emergency.

Charities such as ADHD UK and ADHD Adult UK, which the NHS lists, and Mind, Rethink Mental Illness and Anxiety UK, which the NHS lists for anxiety, offer information and peer support while you wait for assessment.