ADHD and Anxiety: Why They So Often Occur Together
Reviewed byElizabeth Lokenauth, PA-C
SiggyMD Clinical Team · Last updated July 1, 2026
Key Takeaways
- Nearly half of adults diagnosed with ADHD also have at least one anxiety disorder, making this the most common ADHD comorbidity. The co-occurrence is not coincidental — it is rooted in shared neurobiology.
- Anxiety that develops in someone with untreated ADHD often looks like a secondary response to ADHD impairment: failing to meet deadlines, losing things, social consequences of impulsivity. Treating ADHD can reduce that anxiety.
- Not all anxiety in ADHD is secondary. Primary anxiety disorders (GAD, social anxiety, panic disorder) can genuinely co-occur with ADHD and may require direct treatment alongside ADHD.
- Stimulant medications — the first-line treatment for ADHD — can worsen anxiety in some people. A clinician experienced with this comorbidity knows how to navigate medication sequencing carefully.
- When both conditions are present, the clinical presentation is more severe, with greater impairment in executive function, emotional regulation, and daily functioning than either condition alone.
If you’ve been told you have ADHD and wonder why you’re also anxious all the time, or been told you have anxiety and wonder why you can’t focus, there’s a reason. These two conditions overlap more than most people, and many clinicians, realize.
This isn’t a rare edge case. Nearly half of adults with ADHD have at least one anxiety disorder, making anxiety the most prevalent comorbidity in adult ADHD. Understanding why they occur together, how they interact, and what treatment actually needs to account for when both are present can change the entire experience of getting care.
What This Page Covers
- Why ADHD and anxiety disorders co-occur so frequently
- The shared neurobiology driving both conditions
- How to tell them apart, and why that’s harder than it sounds
- What anxiety in ADHD looks like (secondary vs. primary)
- How treatment is different when both are present
- What to expect from medication when you have both
How Common Is This?
The numbers are striking. In the National Comorbidity Survey Replication, 47% of adults with ADHD had a co-occurring anxiety disorder. More than half of adults with ADHD have at least one lifetime anxiety disorder, with generalized anxiety disorder (GAD) being the most frequent.
This is not a coincidence. The co-occurrence is structural. The same systems that don’t work the same way in ADHD also play a central role in anxiety.
The Shared Neurobiology
Both ADHD and anxiety disorders involve deficits in dopamine and norepinephrine signaling in fronto-striatal circuits, the networks connecting the prefrontal cortex to the striatum and limbic system. These circuits govern attention regulation, executive function, emotional processing, and the ability to inhibit reflexive responses.
Anxiety and ADHD are both affected by deficits in reward processing in the ventral striatum with altered monoamine signaling. When these systems are dysregulated, the result can look like inattention, impulsivity, and difficulty managing responses to perceived threat, all at once.
When anxiety is comorbid with ADHD, it tends to be more severe and emerge earlier than anxiety in the general population. The interaction is bidirectional: untreated ADHD creates conditions for anxiety to develop and worsen, and untreated anxiety impairs the executive function that ADHD already compromises. Each makes the other worse.
Why ADHD Causes Anxiety (The Secondary Pathway)
The most common explanation for why ADHD and anxiety co-occur is also the most intuitive: living with ADHD is reliably anxiogenic.
Think about what ADHD actually feels like day to day. You miss deadlines. You lose things. You interrupt people and watch their faces change. You start tasks and abandon them. You arrive late. You forget commitments. You underperform relative to how hard you’re working, and you often can’t explain why.
Research suggests that stress, depression, and anxiety may result from undiagnosed and untreated ADHD. The anxiety isn’t imagined. It’s a rational response to conditions the ADHD is creating. Over time, anticipating failure becomes its own source of dread.
ADHD symptoms such as impulsivity resulting from pathway dysfunction may increase behavioral and social problems that further contribute to anxiety. When someone with ADHD has consistently gotten feedback that they are disruptive, unreliable, or scattered, anxiety about social interactions is a predictable outcome.
This matters clinically because anxiety that is secondary to ADHD often improves substantially when ADHD is treated. Addressing the root cause changes the picture.
Primary Anxiety in ADHD: Not All Anxiety Is Secondary
Not all anxiety in people with ADHD is a downstream consequence of ADHD impairment. Primary anxiety disorders, including GAD, social anxiety disorder, and panic disorder, can co-occur with ADHD as genuinely independent conditions.
In childhood, GAD may actually prevent the typical inhibitory dysfunction present in ADHD; in adolescence it may increase working memory deficits; in adulthood it enhances sleep problems. These interactions change across the lifespan, which is why a developmental history is important in evaluation.
For primary anxiety disorders, treating ADHD alone is unlikely to resolve the anxiety. Both conditions need clinical attention, and the sequencing matters.
The Diagnostic Challenge
ADHD and anxiety share surface-level symptoms that can mask each other or mimic the other condition.
Both involve:
- Difficulty concentrating
- Restlessness
- Emotional dysregulation
- Sleep problems
- Avoidance behaviors
The distinctions are real but subtle:
In ADHD, inattention occurs across tasks regardless of content. The person struggles to sustain focus on low-interest tasks even when calm. Impulsivity shows up in decisions and interruptions, not just worry. Hyperactivity is physical and mental restlessness that isn’t rooted in apprehension.
In anxiety, difficulty concentrating is driven by intrusive worry occupying cognitive resources. The person may be able to focus when they’re not anxious. Avoidance is specifically about feared outcomes. Physical symptoms like racing heart and shortness of breath are tied to perceived threat.
A clinician who doesn’t ask about childhood symptom history may diagnose anxiety in someone whose core condition is ADHD. A clinician who assumes all anxiety in a person with ADHD is secondary to it may miss a primary anxiety disorder that needs direct treatment.
What Treatment Looks Like When Both Are Present
For patients with comorbidities, the current treatment consensus is to prioritize the most severe, functionally impairing, and unstable condition. There is no universal protocol. The right sequence depends on which condition is more disabling, what type of anxiety is present, and how the person responds.
Medication Considerations
Stimulant medications are first-line for ADHD. They work. But in people with significant anxiety, they can worsen it, particularly at higher doses or in people with panic disorder or social anxiety. There is a complex relationship between the conditions: untreated ADHD worsens anxiety, treatment of ADHD with stimulants can worsen anxiety in some individuals, and untreated anxiety can worsen ADHD symptoms.
Non-stimulant ADHD medications, including atomoxetine (Strattera), viloxazine (Qelbree), and guanfacine, carry lower anxiety risk and are often preferable when anxiety is prominent. SSRIs address anxiety directly and are compatible with most ADHD medications.
A 10-year longitudinal study found that ADHD patients treated with stimulants had a lower incidence of secondary anxiety and depression versus untreated peers. This supports the idea that treating ADHD does reduce secondary anxiety in the long run, even if stimulants require careful management in the short term.
Psychotherapy
CBT has demonstrated moderate-to-large effects on symptom reduction and comorbid anxiety and depression in adult ADHD. For ADHD specifically, CBT targets executive function deficits, self-management, and maladaptive cognitions. For anxiety, it addresses avoidance and worry cycles.
Individuals with comorbid ADHD and anxiety disorders are less likely to benefit from CBT alone and often need adjunctive pharmacological treatments. The most effective approach typically combines behavioral intervention with medication management under continuous clinical oversight.
Continuous Monitoring
The distinguishing factor in long-term outcomes for both ADHD and anxiety is not the initial medication choice. It’s what happens after. Does the prescriber know whether the medication is helping? Do they know when anxiety spikes? Can they adjust when something’s not working?
“What I see with ADHD and anxiety together is that the standard approach of a quarterly check-in doesn’t catch the patterns,” says Elizabeth Lokenauth, PA-C, of the SiggyMD clinical team. “Someone with both conditions needs their prescriber to know what’s actually happening week to week. The anxiety might flare when the ADHD medication dose is too high, or it might improve as the ADHD gets better treated. You can’t see that without continuous data.”
About SiggyMD
SiggyMD provides clinician-supervised care for anxiety and depression, with daily check-ins that build a longitudinal record of what’s actually happening, not a reconstructed version of the past three months. If anxiety is a significant part of your picture, whether or not ADHD is also in the frame, the intake is free, anonymous, and begins without an account, name, or email.
Every treatment plan is reviewed by a licensed prescriber before anything is prescribed.
For related reading, see our guide on generalized anxiety disorder.
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What Members Are Saying
JS
J.S., 34
ADHD and Generalized Anxiety Disorder
“I spent years treating the anxiety and not the ADHD. Every CBT program would help for a while and then I’d slide back. When I finally got the ADHD diagnosed and treated, the anxiety dropped significantly. Not completely, but enough that I could actually use the skills I’d learned. No one had ever told me the ADHD was driving a lot of it.”
T.O., 29
Late-Diagnosed ADHD, Social Anxiety
“My social anxiety turned out to be mostly about ADHD. I was anxious in social situations because I interrupted people constantly, forgot names, and said impulsive things I regretted. Once I got the ADHD under control, I wasn’t as anxious because the thing I was anxious about stopped happening as often.”
Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. You can begin anonymous intake without an account, name, email, or payment.
If you are in crisis or experiencing thoughts of self-harm, call or text 988. If you are in immediate danger, call 911.
Sources
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Fu et al. Adult ADHD and comorbid anxiety and depressive disorders: a review of etiology and treatment. Frontiers in Psychiatry. 2025;16:1597559.
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D’Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan. International Journal of Psychiatry in Clinical Practice. 2019;23(4):238-244.
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Nicastro N et al. Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems. Psychiatry Research. 2022.
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Leon-Barriera R, Ortegon RS, Chaplin MM, Modesto-Lowe V. Treating ADHD and Comorbid Anxiety in Children: A Guide for Clinical Practice. Clinical Pediatrics (Philadelphia). 2023;62(1):39-46.
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National Institute of Mental Health. Attention-Deficit/Hyperactivity Disorder (ADHD). NIMH. Reviewed 2023.
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Kessler RC, et al. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry. 2006;163(4):716-723.
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Gomez-Bernal F, et al. ADHD in adulthood: clinical presentation, comorbidities, and treatment perspectives. International Journal of Molecular Sciences. 2025.
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). APA Publishing, 2022.
Frequently Asked Questions
Can ADHD cause anxiety?
Yes, though the relationship is more nuanced than direct causation. Living with untreated ADHD creates consistent conditions for anxiety to develop: chronic underperformance relative to effort, social friction from impulsivity, missed deadlines, and the sense that you are perpetually behind. This accumulated stress frequently produces anxiety that is secondary to ADHD. When ADHD is treated effectively, this type of anxiety often improves as well. However, primary anxiety disorders can also co-occur with ADHD independently of this mechanism.
How do you tell ADHD and anxiety apart?
Both conditions cause difficulty concentrating and restlessness, which is why they're frequently confused. The key distinction: in ADHD, inattention occurs across many types of tasks and especially those with low intrinsic interest. In anxiety, difficulty concentrating is driven by intrusive worry — the person can't focus because their mind is occupied. ADHD also includes impulsivity and hyperactivity not seen in anxiety. Anxiety involves anticipatory dread, physical arousal, and avoidance behaviors not typical of ADHD. A structured clinical evaluation, including a developmental history, is needed to distinguish them accurately — and both can be present simultaneously.
Does treating ADHD help with anxiety?
Often yes, particularly for anxiety that has developed as a secondary response to ADHD impairment. Treating ADHD can reduce the chaos, underperformance, and social friction that fuel that anxiety. For primary anxiety disorders co-occurring with ADHD, the relationship is less automatic. Stimulants can sometimes worsen anxiety, requiring careful medication management. Non-stimulant ADHD medications may be preferable when anxiety is a significant concern. In many cases, combining ADHD medication with CBT addresses both conditions more completely than medication alone.
What is the best medication for ADHD with anxiety?
There is no single best answer because it depends on which condition is more severe, what type of anxiety is present, and individual response. Stimulants are first-line for ADHD but may worsen anxiety in some people. Non-stimulant options like atomoxetine (Strattera), guanfacine, or viloxazine don't carry the same anxiety risk and may be preferred when anxiety is prominent. SSRIs address anxiety directly and can be added to ADHD medication. The decision should involve a clinician who can assess and track both conditions over time — not a one-time prescription visit.
Can you have ADHD and generalized anxiety disorder at the same time?
Yes. Generalized anxiety disorder (GAD) is the most common anxiety disorder in ADHD, and the two can genuinely co-occur as distinct conditions. GAD in someone with ADHD tends to be more severe and emerge earlier than GAD in the general population. The comorbidity also changes the treatment picture: people with ADHD and GAD are less likely to benefit from CBT alone and often need combined pharmacological and psychological approaches.
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