As I have learnt, ADHD has high comorbidity rates with many other disorders; depression, ODD (oppositional defiance disorder), OCD (obsessive-compulsive disorder), dyslexia, dyscalculia to name but a few. Anxiety is one of these linked to ADHD, with a 25% comorbidity rate. However, anxiety disorders are difficult to recognise as anxiety is often internalized and unless the level of anxiety causes weight loss, sleeplessness or perhaps the refusal to go to school etc, it can often go unmissed. This can then lead to poor concentration in school or restlessness which can be interpreted as a sign of ADHD. So, is it ADHD and/or anxiety?
WHAT IS ANXIETY?
‘Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview.
Anxiety is considered a problem and termed as General Anxiety Disorder (GAD) when you have chronic anxiety about common, everyday experiences and situations. It is a ‘long term’ condition that causes you to feel anxious about a wide range of situations and issues rather than one specific event. People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue’ (Taken from the NHS website).
I read a great book whilst studying psychology called ‘Why Zebras don’t get ulcers’, (great book, highly recommend, any purchase through this link does give me a teeny bit of commission), in a nutshell, a level of anxiety or stress is needed and acceptable in someone’s life. A zebra for instance needs the flight or fight mode to kick in when a predator approaches to attack and eat him. The part of the brain responsible for this is called the amygdala. When this kicks in it takes over from the pre-frontal lobe in the brain, which is used for planning. No planning required, escape only! It would do him no good if he was totally calm and started to plan what to do. He needs that burst of adrenaline, that physiological response, not a spreadsheet.
However, after the attack is over unless he has been eaten, he goes back to being fine and calm again. This is normal. Its when prolonged stress and anxiety occur that it becomes a problem. No one needs to be in this survival mode daily. This would be so tiring for any individual to constantly be in this physiological state. In many cases, it causes a range of mental and physical disorders.
Lack of sleep, constant anxiety over problems that don’t need that level of stress interfere with someone’s day to day life and this is when a person is deemed to have a problem with anxiety. Now imagine this in a child whose less able to verbalise what they are feeling and experiencing. It can become super tough for them and affect their ability at school, in friendships and in everyday life, and this is why we have to be so observant.
ADHD OR ANXIETY?
The tricky thing is many signs of anxiety can look like ADHD, as stated, the lack of concentration, restlessness. So, if your child has ADHD, you may be putting it all down to symptoms of ADHD.
I found this checklist on the Healthline website which I thought was interesting.
|ADHD symptoms||Anxiety symptoms|
|Difficulty concentrating or paying attention||X||X|
|Trouble completing tasks||X|
|Inability to relax or feelings of restlessness||X||X|
|Difficulty listening to and following instructions||X|
|Inability to focus for long periods of time||X|
|Chronic feelings of worry or nervousness||X|
|Fear without an obvious cause||X|
|Trouble sleeping or insomnia||X|
|Headaches and stomach aches||X|
|Fear of trying new things||X|
These overlaps of ADHD and anxiety can look similar to each other even though the causation is different. For instance, the teacher notices a child in the class is distracted. If this child suffers from anxiety, then perhaps their pre-frontal cortex has closed down, due to the amygdala kicking in and taking over. They are so consumed by their worry and entering the flight of fight mode this could look like restlessness and distractibility. However, they are simply consumed by their worries. In a child with ADHD, their levels of neurotransmitters are likely to be to blame. They may be finding the task at hand just too boring to hold their focus or it could be all the other ‘noise’ for other stimuli is distracting them. Same observable behaviour, totally different reasoning.
WHAT TO LOOK FOR?
So, how can you tell if your child has ADHD or anxiety, especially if there are no outward signs of anxiety such as weight loss? The main signs will be more specific restlessness around more explicit situations. Do they seem overly worried about something that really doesn’t need that level of worry? Are they able to rationalise their worry? Is it affecting their sleep or eating patterns? Also, watch for how often these anxieties appear to occur and how long they have been going on? Generally, something that has worried a child for more than six months is considered a problem.
Of course, if there has been something like a death or a divorce then anxiety is a perfectly normal reaction to the event and will hopefully subside. I have read, however, that severe anxiety can stem from being separated from a parent in early childhood can cause anxiety when the child was unable to understand and process why this had happened.
Children with anxiety alone tend to be less impulsive, only showing this side if they are in their highly anxious state, whereas children with ADHD have no control over this in many situations. With anxiety, children are more likely to talk about being worried than any other emotion even though they may not be able to verbalise exactly what they are worried about? Often with ADHD, the child has real trouble being able to articulate what they are feeling. Another difference is anxiety can cause actual physiological symptoms from clammy hands, racing heart to sickness and dizziness. We’ve all experienced this at some time, often when the school phone number used to pop up on my phone and I knew it was SENCo calling to complain about my child!
ADHD and ANXIETY
ADHD and anxiety can aggravate the other, ADHD can be an extremely stressful disorder for children to have. I have talked about low self-esteem being linked to ADHD before, as is depression. I know my daughter who struggles with dyslexia can get totally stressed out by it. Home-schooling was a nightmare for us both. She needed me there the whole time to talk her through it because she felt like a failure if she didn’t understand something or had no clue what they were asking her to do. Often she was totally capable but her low self-esteem made her assume she was doing it all wrong. Her anxiety levels were raised during this time (as were mine!).
So, trying to imagine what this would be like if she suffered from anxiety also really made me think because her anxiety levels intensified her ADHD behaviour, angrier, more irritable, more impulsive, more depressed! She struggled to finish her tasks, was more distracted and was more disorganised than I have ever seen!
Now, bear in mind that both ADHD and anxiety can cause sleeplessness. I don’t know about you, but when I have a rubbish night’s sleep, I feel awful the next day. I am so forgetful, I feel lousy, very absentminded, and often highly anxious and stressed because I’m living off adrenaline to keep me going. That and coffee. The importance of sleep cannot be stressed enough for anyone, let alone a child suffering from ADHD and anxiety. Sorting out sleep issues is essential. For me, melatonin was the key, but I am not your doctor so please don’t go on my say so, that’s just my personal experience.
HOW CAN YOU HELP?
Well, whilst the symptoms can be the same, the reasons behind the symptoms are different and therefore require different treatment. It is so important to get a correct diagnosis. Make sure the specialist is fully informed of everything you, your family and friends, and the school have observed. You know your child best. Bring up any detail. Keep note of any triggers for the anxiety for example going to school, parties, car journeys, night times.
Sometimes the cause of anxiety can be the frustrations associated with ADHD. If this is the case, then treating ADHD can relieve the symptoms of anxiety. ADHD can often be treated by stimulant medication boosting certain neurochemicals (see ADHD Brain).
However, if ADHD is not the cause of the anxiety, then stimulant medication may intensify the anxiety and a different medication could be prescribed such as an SSRI (selective serotonin reuptake inhibitor) as opposed to the stimulant variety. Or, once the anxiety is addressed and treated then it would be possible to reintroduce the stimulant medication to help with ADHD.
The specialist should focus on the condition that is impacting the child’s life the most before addressing the secondary one. Cognitive Behavioural Therapy (CBT) is thought to be a great technique for children with anxiety. Basically put, CBT enables a child to ‘restructure’ their negative thought patterns and turn them into positive ones through role play and other methods.
Until I started researching this I never realised how close the two symptoms could be, but now it actually makes perfect sense. Above all, make sure the child knows it is not their fault. Give them love and understanding. As frustrating as it can sometimes be, it’s worse for them. They need to know that you ‘get it’.
I hope this has helped, as usual, I do love any feedback as I’m on this journey too. Always love advice or good books that you may have come across so please do get in touch. We’re on this journey together.
I have started a private support group on Facebook for parents and carers who need support with their child with ADHD. It’s a friendly place to chat with others. Please do click this link ADHDinchildren to join. And for anyone on Instagram, I’m there too ADHD Mum.