I recently worked with a student whose parents expressed concern with their daughter’s attention and overall performance in school. They watched their daughter struggle academically, as she tended to procrastinate on assignments, need constant reminders to finish schoolwork, and appear restless or fidgety when working on homework at home. In their initial conversation with me, they wondered if she was experiencing ADHD.
Once I actually met with her, it was evident that there may be another variable at play. The student expressed worry about making mistakes in her schoolwork, particularly on tests. She stated that she often becomes overwhelmed during tests, which causes her to “blank out.” And she added that she often overthinks on tests, which causes her to change her answers, often incorrectly. I began to wonder: could this actually be anxiety rather than inattention?
Anxiety and ADHD can look remarkably similar, particularly in a school and/or performance-based setting. Understanding what each condition is and how it presents is an important part of identifying the right support.
Why Do ADHD and Anxiety Look Similar?
ADHD is a neurodevelopmental disorder involving difficulties with attention, hyperactivity, and/or impulsivity. Anxiety disorders involve excessive fear or worry and related symptoms that interfere with daily functioning.
Although these are separate and distinct diagnosable conditions, both can affect concentration and task completion. In a 2022 study examining comorbidity of anxiety and ADHD, the researchers describe how overlapping symptoms can complicate diagnosis and treatment.
In their research, they identified common characteristics of anxiety and ADHD:
Difficulty concentrating: following a lesson or conversation can be challenging.
Restlessness: someone may fidget or have trouble settling down.
Procrastination: starting assignments or responsibilities may feel difficult.
Sleep difficulties: poor sleep can further interfere with attention.
Feeling overwhelmed: everyday demands may become harder to manage.
As you can see, there are several commonalities, which can make diagnosing difficult.
What Might Suggest ADHD?
When considering ADHD, clinicians look for a longstanding pattern dating to childhood. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnosis of ADHD requires that several symptoms must have been present before age 12, even if the person was not diagnosed until adulthood. Additionally, symptoms must occur in and interfere with an individual’s functioning in more than one setting.
Common characteristics of ADHD behavior include:
Losing track of responsibilities: assignments, appointments, or belongings are frequently forgotten.
Difficulty organizing tasks: managing time and following through are persistent challenges.
Distraction beyond worry: attention drifts even when the person is not preoccupied with fears.
Impulsive behavior: interrupting or acting without considering consequences may occur.
Someone with ADHD can often times focus well on an engaging activity such as video games but struggle with routine or mundane tasks.
What Might Suggest Anxiety?
With anxiety, attention may diverted by worrying or perceived threats. The person may appear distracted because they are preoccupied with negative thoughts.
For example, a student may miss instructions in class while worrying about being called on. An adult may delay sending an email to her boss because she fears saying something embarrassing.
Common characteristics of anxiety include:
Persistent worry: thoughts repeatedly return to mistakes, safety, performance, or others’ opinions.
Avoidance: tasks or situations are postponed because they feel threatening.
Physical discomfort (i.e., somatization): muscle tension, stomachaches, sweaty palms, or a racing heart may accompany worry.
Repeated reassurance: the person frequently asks whether things will be okay.
It is important to note that not everyone with anxiety can articulate their feelings clearly, particularly younger children. Consequently, to an outsiders perspective, anxiety can often be overlooked.
Why Is Someone Putting Off a Task?
This question brings us back to the student I mentioned at the beginning of this post. Procrastination is a good example of why behavior alone can be misleading. Two students may avoid the same assignment for different reasons.
Consider these possibilities:
ADHD-related difficulty: the student struggles to organize the steps, loses track of time, or becomes distracted by external stimuli.
Anxiety-related difficulty: the student fears doing poorly, repeatedly delays starting the activity, or experiences “paralysis by analysis.”
Combination of ADHD/anxiety: organizational difficulties lead to missed deadlines, which increase worry and make starting even harder.
Adults may experience similar patterns with paperwork, bills, or work projects.
When considering whether it is ADHD or anxiety, the useful question to ask is:
“What is keeping me from starting?”
Can You Have Both ADHD and Anxiety?
The short answer is Yes.
Choi and colleagues (2022) reviewed research on psychiatric conditions occurring alongside adult ADHD. Not surprisingly, anxiety disorders were among the most commonly reported co-occurring conditions. These findings are consistent with my work over the last 15 years, in which ADHD and anxiety are frequently co-diagnosed.
However, feeling anxious about ADHD-related problems does not automatically mean someone has a separate anxiety disorder. A clinician must consider the nature, severity, and impact of those symptoms.
How Can an Evaluation Help?
An evaluation examines the broader pattern rather than relying on a few familiar symptoms. When considering diagnoses of ADHD and/or anxiety, no single test can definitively confirm or rule out either condition. Rather, clinicians should consider multiple data points in order to establish a longstanding pattern of behavior.
A thorough assessment for ADHD and anxiety should consider:
Developmental history: when did symptoms begin?
Daily functioning: how are school, work, home, and relationships affected?
Different perspectives: what do parents, teachers, or partners observe?
Other explanations: could sleep problems, depression, learning difficulties, or medical concerns contribute?
The clinician can then put the puzzle pieces together to figure out what variables are at play.
What Happens After Diagnosis?
Treatment recommendations should reflect the person’s actual difficulties and goals. Someone with anxiety-related avoidance may need a different approach from someone primarily struggling with organization.
Depending on the findings, recommendations may include:
For ADHD: medication when appropriate, behavioral strategies, organizational/executive function support, and academic or workplace accommodations.
For anxiety: therapy, including Cognitive-Behavioral Therapy, medication when appropriate, and lifestyle changes.
For both: coordinated care that monitors how each condition responds.
Every individual is unique and so are treatment plans. Treatment priorities depend on severity of the condition, the level of impairment, client preferences, and clinical judgment. Medication is not always the first line of treatment.
What Should You Do Next?
If attention problems or excessive worry are affecting you or your child’s life, you may consider a full evaluation. Identifying the source of the difficulty is the first step to managing it.
Before an appointment:
Write down examples: describe specific difficulties rather than only naming symptoms.
Consider the timeline: note whether problems began recently or were present in childhood.
Gather relevant information: school records and previous evaluations may help.
While ADHD and anxiety are both life-impacting conditions, the right treatment plan can make a tremendous difference.