Anxiety and ADHD: Four Treatments to Support a Combined Diagnosis

Your name’s called. “Sorry?” Startled, you look up to find everyone in the meeting is staring at you. Dammit, what were they saying again? “So what do you think?” your supervisor looks at you. Heart pounding, you try to move your face into a neutral expression. “Uh yep, sounds good,” you say, making a mental note to follow up on whatever you just agreed to later. Ugh, this is why meetings make you so anxious. You never quite manage to get them right.

Anxiety disorders identified in the DSM 5 include social anxiety and generalized anxiety [1]. These anxiety disorders often correlate with ADHD, and in studies examining this comorbidity, it ranges from approximately 15 to close to 50 percent [2]–[4]. Over the years, people have proposed several reasons for this correlation between ADHD and anxiety. Some argue a subtype of ADHD includes anxiety.

In contrast, others theorize that anxiety developed alongside ADHD. Since ADHDers are more likely to receive criticism when compared with neurotypical peers, anxiety could be an unhealthy coping strategy developed to curb impulsiveness and reduce that criticism [4], [5], [6]. There is also evidence anxiety negatively affects other executive functions, such as working memory and attentiveness, both of which can already be struggles for people with ADHD [7].

As ADHD and anxiety occur so often together, many papers have examined how to treat them. Overall, the consensus is that a multipronged approach is needed, taking both the unique elements of anxiety and ADHD into account [4], [8]. Below I have outlined some treatments recommended in the research.

1. Yoga

Studies have found that while regular yoga has been correlated with reported improvements in self-regulation and executive function, it has also been found to decrease anxiety symptoms and support the nervous system [9]. As a result, it’s been identified as possible support for both ADHD and anxiety. If you are new to yoga, you could start with an online option, such as yoga with Adriene. If you find the practice too dull, try turning down the sound and adding your favourite relaxing podcast in to see if this helps with attention.

2. CBT

While there is some evidence that CBT is less effective for combined ADHD and anxiety than for anxiety alone, other research has also found that it can improve both ADHD and anxiety [8], [10], [11]. Ultimately, if you have both anxiety and ADHD, it might be helpful to find an ADHD specialised therapist. They can then help you decide which combination of therapeutic approaches might work best with your diagnoses and provide additional tools as needed.

3. Medication

Please note that I’m not an expert in this area, so I would highly recommend talking to a medical professional before making these decisions. Some studies have found evidence that certain medication types may better support ADHD and anxiety more than others. Friesen and Markowsky [8] and Caye and colleagues [12] both noted that moving to atomoxetine may be preferable to stimulants for ADHD and anxiety.

4. Executive Function Coaching or Training

Along with these other supports, learning how best to build and manage strategies to cope with your ADHD could help you feel less overwhelmed and reduce those executive dysfunctioning experiences contributing to anxiety. Studies examining different forms of ADHD coaching have noted that many have found it helpful in reducing the severity of their executive functioning struggles correlated with ADHD [13]–[15].

Overall, if you’ve been diagnosed with both ADHD and anxiety, you’re not alone. This is a common struggle for many people. Taking this multipronged treatment approach by trying a few different support services can help ensure you start addressing these separate but related difficulties. Let me know if you try anything and what you’ve found supports your ADHD and anxiety.

Talk to you soon.

Skye.

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References

[1] A. P. American Psychiatric Association and A. P. Association, Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American psychiatric association, 2013.

[2] S. R. O’Rourke, A. C. Bray, and A. D. Anastopoulos, ‘Anxiety Symptoms and Disorders in College Students With ADHD’, J. Atten. Disord., vol. 24, no. 12, pp. 1764–1774, Oct. 2020, doi: 10.1177/1087054716685837.

[3] K. Grogan et al., ‘Differential diagnosis and comorbidity of ADHD and anxiety in adults’, Br. J. Clin. Psychol., vol. 57, no. 1, pp. 99–115, 2018, doi: https://doi.org/10.1111/bjc.12156.

[4] S. Pallanti and L. Salerno, ‘Adult ADHD in Anxiety Disorders’, in The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders, S. Pallanti and L. Salerno, Eds. Cham: Springer International Publishing, 2020, pp. 167–181.

[5] D. Menghini et al., ‘The influence of Generalized Anxiety Disorder on Executive Functions in children with ADHD’, Eur. Arch. Psychiatry Clin. Neurosci., vol. 268, no. 4, pp. 349–357, Jun. 2018, doi: 10.1007/s00406-017-0831-9.

[6] D. M. Beaton, F. Sirois, and E. Milne, ‘Self-compassion and Perceived Criticism in Adults with Attention Deficit Hyperactivity Disorder (ADHD)’, Mindfulness, vol. 11, no. 11, pp. 2506–2518, Nov. 2020, doi: 10.1007/s12671-020-01464-w.

[7] D. B. Schatz and A. L. Rostain, ‘ADHD With Comorbid Anxiety: A Review of the Current Literature’, J. Atten. Disord., vol. 10, no. 2, pp. 141–149, Nov. 2006, doi: 10.1177/1087054706286698.

[8] K. Friesen and A. Markowsky, ‘The Diagnosis and Management of Anxiety in Adolescents With Comorbid ADHD’, J. Nurse Pract., vol. 17, no. 1, pp. 65–69, Jan. 2021, doi: 10.1016/j.nurpra.2020.08.014.

[9] A. L. Chimiklis, V. Dahl, A. P. Spears, K. Goss, K. Fogarty, and A. Chacko, ‘Yoga, Mindfulness, and Meditation Interventions for Youth with ADHD: Systematic Review and Meta-Analysis’, J. Child Fam. Stud., vol. 27, no. 10, pp. 3155–3168, Oct. 2018, doi: 10.1007/s10826-018-1148-7.

[10] T. Halldorsdottir et al., ‘Treatment Outcomes in Anxious Youth with and without Comorbid ADHD in the CAMS’, J. Clin. Child Adolesc. Psychol., vol. 44, no. 6, pp. 985–991, Nov. 2015, doi: 10.1080/15374416.2014.952008.

[11] M. Maric, A. Bexkens, and S. M. Bögels, ‘Is Clinical Anxiety a Risk or a Protective Factor for Executive Functioning in Youth with ADHD? A Meta-regression Analysis’, Clin. Child Fam. Psychol. Rev., vol. 21, no. 3, pp. 340–353, Sep. 2018, doi: 10.1007/s10567-018-0255-8.

[12] A. Caye, J. M. Swanson, D. Coghill, and L. A. Rohde, ‘Treatment strategies for ADHD: an evidence-based guide to select optimal treatment’, Mol. Psychiatry, vol. 24, no. 3, Art. no. 3, Mar. 2019, doi: 10.1038/s41380-018-0116-3.

[13] S. Field, D. R. Parker, S. Sawilowsky, and L. Rolands, ‘Assessing the Impact of ADHD Coaching Services on University Students’ Learning Skills, Self-Regulation, and Well-Being’, J. Postsecond. Educ. Disabil., vol. 26, no. 1, pp. 67–81, 2013.

[14] D. R. Parker, S. F. Hoffman, S. Sawilowsky, and L. Rolands, ‘An Examination of the Effects of ADHD Coaching on University Students’ Executive Functioning’, J. Postsecond. Educ. Disabil., vol. 24, no. 2, pp. 115–132, 2011.

[15] E. Ahmann, L. J. Tuttle, M. Saviet, and S. D. Wright, ‘A Descriptive Review of ADHD Coaching Research: Implications for College Students’, J. Postsecond. Educ. Disabil., vol. 31, no. 1, pp. 17–39, 2018.