Anxiety and Adult ADHD

Attention-deficit/hyperactive disorder, or ADHD, was considered only a childhood disorder until the 1970s. Since then we’ve learned that about 60 percent of children with ADHD in the United States become adults with ADHD, which translates to some 4 percent of the adult population, or 8 million adults. Less than 20 percent of adults with ADHD have been diagnosed or treated, and only about one-quarter of those adults seek help. Furthermore, many adults with ADHD have complicating co-occurring conditions; for example, about 50 percent suffer from an anxiety disorder.

What is an anxiety disorder?
Anxiety disorders are a unique group of illnesses that fill people’s lives with persistent, excessive, and unreasonable anxiety, worry, and fear. They include generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and specific phobias. Click here to read a more detailed overview.  

What is ADHD?
ADHD stands for attention-deficit/hyperactivity disorder, a well-recognized condition that is characterized by inattention, hyperactivity, impulsiveness, or a combination. The condition is thought be biological and most often genetic, and it begins to take place very early in brain development.

Neuroimaging studies suggest that the brains of children with ADHD handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from those of their peers. Most children with ADHD also have at least one other developmental or behavioral problem; 25 percent of children with ADHD show symptoms of an anxiety disorder.

What is adult ADHD?
Adults with ADHD may exhibit the same symptoms they had as children. Although hyperactivity often diminishes by adulthood, inattentiveness and impulsivity may persist.

ADHD symptoms are often exhibited as an inability to focus, disorganization, and restlessness. Adults with ADHD may have a hard time organizing things, listening to instructions, remembering details, or difficulty completing tasks. As a result, their symptoms may interfere with or affect their relationships at home, school, or work. People with ADHD may exhibit different symptoms, and they may experience them at different levels of severity, ranging from mild to significant impairment.

Are people with ADHD more likely to suffer from an anxiety disorder than another disorder?

Adults with ADHD are likely to have a comorbid psychiatric disorder such as an anxiety disorder, depression, or bipolar disorder. About 50 percent have a comorbid anxiety disorder.

It is not clear if comorbid psychiatric conditions are a psychological effect of having ADHD or if ADHD makes people more vulnerable to psychiatric conditions.

Adult ADHD symptoms that coexist with an anxiety disorder or other disorders may significantly impair a person’s ability to function.

How can I get an accurate diagnosis?
Clinicians and researchers agree that much remains unknown about diagnosing and treating ADHD in adults, who are usually capable of controlling their behavior and or hiding difficulties.

Proper diagnosis relies on a comprehensive clinical evaluation. A health professional will take into account a patient’s history, self-reported symptoms, and mental-status testing. It also requires attention to early development problems and symptoms of inattention, distractibility, impulsivity, and emotional instability. Overlapping symptoms of comorbid psychiatric conditions, such as generalized anxiety disorder, depression, bipolar disorder, substance abuse, and personality disorders, often complicate the ability to diagnose ADHD accurately.

What are the treatment options for adult ADHD?
Medication is the cornerstone of treatment for adults with ADHD. Research has shown that stimulants and some non-stimulants can improve the symptoms of ADHD, helping people pay attention, concentrate, and control their impulses.
Click here for more information about types of medication for the treatment of adult ADHD.

Most people also benefit from behavioral, psychological, educational, and coaching interventions. A helpful resource for locating support groups or professionals with appropriate expertise is CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder).

What about treatment options for ADHD with an anxiety disorder?
Anxiety disorders and other comorbid conditions may be a secondary outcome of living with ADHD. Comorbid anxiety disorders can make treatment more complicated, especially if unrecognized.

Following a comprehensive evaluation, a health professional will devise a treatment plan, which serves to define the areas of impairment (such as problems relating to attention or impulsivity at work or school, sleeping, or family life) and help select the most favorable treatment option.

Depending on the individual, a physician may prescribe medication for ADHD and CBT (cognitive-behavior therapy) for comorbid anxiety. Some stimulant-drug treatments for ADHD may worsen anxiety in patients with comorbid anxiety disorders, although this has not been studied systematically. And a recent study indicates that a nonstimulant medication for ADHD is effective in children with ADHD comorbid with generalized anxiety disorder or separation anxiety disorder. Treatment studies are now being conducted in adults with ADHD and comorbid anxiety disorders, but the results are not yet available.

It’s important for a health professional to give the most attention to the most severe disorder, the one associated with the highest degree of impairment. The first step is to determine if ADHD is the cause of anxiety. If so, treating the ADHD may reduce the anxiety. If anxiety is independent of ADHD, however, a health professional will determine the proper medication. One health professional may decide to treat the anxiety first; another may treat both conditions simultaneously.

Where can I find help?
ADAA offers a nationwide searchable listing of mental health professionals who have indicated a special interest in treating patients with anxiety disorders. Click here to find a therapist.

Additional ADAA resources provide information about the variety of treatment options for people with anxiety disorders, support groups that empower people to help themselves and others, and useful tips you can use to help a family member suffering from an anxiety disorder.

For more information about adult ADHD, click on these links:

AdultADD.com

Attention Deficit Disorder Association

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

National Institute of Mental Health, Attention-Deficit Hyperactivity Disorder in Adults

WebMD

References

Adult ADHD: Evaluation and Treatment in Family Medicine

Comorbid Psychiatric Illness Often Found in Adults With ADHD

Comorbidity in Adult ADHD: An Expert Interview With Lenard Adler, MD

The Complexity of ADHD: Diagnosis and Treatment of the Adult Patient With Comorbidities

Treatment for Adult ADHD: A Newsmaker Interview With Timothy Wilens, MD