ADHD and anxiety together in adults

Many adults who come in asking about ADHD have already been told they have anxiety. Some have been treated for anxiety for years and still miss deadlines, lose track of tasks and feel scattered. Others wonder whether constant worry is the real reason they cannot focus. Both situations are common, because ADHD and anxiety disorders overlap in their symptoms and often occur in the same person. This page explains how often that happens, how an evaluation tells the two apart, and what clinical guidelines say about the order of treatment.

If your main question is whether your symptoms are ADHD or anxiety, start with ADHD or anxiety: how to tell the difference. This page is about having both.

How often ADHD and anxiety occur together

The largest US data set on adults comes from the National Comorbidity Survey Replication, a nationally representative survey published in 2006. Among adults who met criteria for ADHD:

• 47.1% had at least one anxiety disorder in the previous 12 months.
• Social phobia was the most common (29.3%), followed by post-traumatic stress disorder (11.9%), panic disorder (8.9%) and generalized anxiety disorder (8.0%).
• Only 25.2% of those who had received any mental health or substance treatment in the past year had been treated for ADHD.

That last number matters. It means many adults with ADHD are already in care for something else, often anxiety or depression, while the ADHD itself goes unaddressed. A 2017 review in BMC Psychiatry adds that people with both conditions tend to have more severe anxiety that starts earlier, and that ADHD is often diagnosed later in people with anxiety, possibly because anxiety can dampen impulsive behavior. An anxious, careful adult may not look like the stereotype of ADHD at all.

Why the two are easy to confuse

The National Institute of Mental Health (NIMH) describes generalized anxiety disorder as worry that is hard to control on most days for at least six months, along with symptoms such as restlessness or feeling on edge, being easily tired, trouble concentrating, irritability, muscle tension and sleep problems. NIMH's description of adult ADHD also includes difficulty paying attention and feelings of restlessness, so two people with the same complaint can have different conditions, or both.

What separates them is the overall pattern and the history, not any single symptom:

When both conditions are present, the ADHD pattern goes back to childhood and the anxiety adds its own symptoms on top. Sorting out which symptom belongs to which condition is the core of the evaluation.

The before-age-12 rule and the five-symptom threshold for adults come from the diagnostic criteria as summarized by NIMH. For the full list, see adult ADHD diagnostic criteria explained.

How an evaluation handles both

Guidelines expect an ADHD evaluation to look beyond ADHD. The UK's NICE guideline NG87 says a diagnosis should rest on a full clinical and psychosocial assessment with a developmental and psychiatric history, and that the diagnostic process should include an assessment of coexisting conditions. NICE also lists adults with a mental health condition among the groups in whom ADHD may be more common. A 2024 review in American Family Physician says other mental disorders, including anxiety, should be part of the differential diagnosis when evaluating adults for ADHD, because the symptoms overlap and the conditions often occur together.

In practice, that means the clinician asks questions such as:

• Were the attention problems there in grade school, before the anxiety started?
• Do the focus problems continue on calm days, on vacation, or when the work is interesting?
• Is the worry mostly about consequences of ADHD symptoms (forgetting, being late) or about many unrelated things?
• Are there panic attacks, social fears or trauma symptoms that need their own attention?

Dr. Shershow's adult ADHD evaluation covers current symptoms, childhood, school and work history, health, sleep and substances, and other explanations such as anxiety, depression or stress, either instead of ADHD or alongside it. It ends with what the evaluation found and the treatment options that fit. Anxiety is considered as part of that evaluation; the practice does not offer therapy or standalone anxiety treatment. More about how that works is on ADHD and anxiety evaluation in NYC and NJ.

Which to treat first: what guidelines say

No US adult ADHD guideline has been published as of October 2026 (see ADHD clinical guidelines for adults), so clinicians draw on Canadian and UK guidance.

• Treat the most impairing condition first. The Canadian CADDRA guidelines, as summarized in the 2017 BMC Psychiatry review, advise treating the most impairing disorder first when ADHD and an anxiety disorder occur together, to "start low, go slow" with medication while still reaching an effective dose, and to consider adding cognitive behavioral therapy.
• Same medication options. NICE recommendation 1.7.18 says people with ADHD and an anxiety disorder should be offered the same medication choices as other people with ADHD. Anxiety is not, by itself, a reason to rule out stimulants.
• Slower changes, closer follow-up. NICE recommendation 1.7.28 calls for slower dose adjustment and more frequent monitoring when anxiety disorders are present.
• Weigh the whole picture. NICE recommendation 1.5.2 asks clinicians to build the treatment plan around the relative impact of other mental health conditions, not ADHD alone.

What the medication evidence shows

Stimulant labels list anxiety among possible side effects. The Adderall XR prescribing information, for example, includes anxiety and insomnia among the most common adverse reactions in adult trials. That is one reason guidelines favor careful, gradual adjustment.

Nonstimulants are another route. The 2024 American Family Physician review lists atomoxetine, viloxazine and bupropion as options for adults with concurrent anxiety or depression. In a 14-week randomized trial of 442 adults with ADHD and social anxiety disorder, atomoxetine improved both ADHD symptoms and social anxiety more than placebo. The 2017 review also notes studies in which an antidepressant used for anxiety was combined with a stimulant.

The medication guide covers these options in detail: ADHD medication and anxiety, Strattera (atomoxetine) for adults and how doctors choose an ADHD medication. Which option fits an individual is a decision for the prescriber and patient together.

What treating ADHD can and cannot do for anxiety

The 2017 review cites studies in which anxiety improved when ADHD was treated effectively. It does not follow that ADHD treatment replaces anxiety treatment. NIMH notes that anxiety disorders such as generalized anxiety disorder are typically treated with psychotherapy, medication or both, and cognitive behavioral therapy is a commonly used, well-studied option. If therapy is part of the plan, it comes from a therapist or psychologist; the practice does not provide therapy.

When to talk to a clinician

If anxiety treatment has helped your worry but focus, organization and follow-through are still a problem, or if attention problems go back to childhood, it may be worth asking about ADHD. The adult ADHD self-test can help you organize what you notice; it is a screener, not a diagnosis. To arrange an evaluation, see ADHD testing in NYC or ADHD testing in New Jersey, or call the office.

If anxiety ever comes with thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911 in an emergency.