Is It ADHD or Anxiety?

Although they may seem like two very different disorders, attention-deficit/hyperactivity disorder (ADHD) and generalized anxiety disorder (GAD) are actually often misdiagnosed as each other. 

A misdiagnosis occurs when a healthcare provider inaccurately identifies a person’s conditions or provides an incorrect explanation for the symptoms they are experiencing. Because the diagnosis determines the treatment, an inaccurate diagnosis usually leads to the wrong treatment. In the case of ADHD and GAD, the wrong treatment is not only unhelpful, it can make the actual condition worse. So, making sure you have the correct diagnosis is essential.

ADHD and GAD may seem like very different disorders. ADHD is a neurodevelopmental disorder that impacts attention as well as behavioral and emotional control. In contrast, GAD causes persistent and difficult-to-control worry over a variety of everyday topics.

Although these two may sound very different, the symptoms they cause can overlap in the following ways:

1. Inattention: Someone with both of these conditions can appear inattentive. For someone with ADHD, there is difficulty directing and sustaining focus. In contrast, someone with GAD may be so consumed by their worries that they are unable to focus on the task at hand. In both cases, people may complain that they are unable to focus at school or at work, and teachers/coworkers/loved ones may say they are easily distractible or appear to be day-dreaming.
2. Poor working memory: Working memory describes the ability to temporarily keep information in your mind and apply it to certain tasks, like problem-solving. For reasons similar to attention, working memory can be negatively impacted by both ADHD and GAD.
3. Procrastination: This is one of the most misunderstood symptoms. Often, people hear procrastination, and they immediately think ADHD. However, there are many different reasons someone has difficulty getting started on a task, and anxiety can be one of them. Yes, ADHD is often marked by difficulty getting started, especially when the task requires multiple steps, organization, or seems boring. But, anxiety can also cause procrastination, especially if someone is prone to being a perfectionist. If they are uncertain they can complete the task to the level they would like, they may avoid doing the task in total.
4. Physical restlessness: Someone with ADHD may feel restlessness related to the hyperactivity part of the disorder, which is thought to be partly related to dopamine dysregulation. Physical restlessness is also commonly seen in GAD. Worry can activate the sympathetic, or “fight or flight”, nervous system which can lead to increased heart rate, increased alertness, burst of energy, and feeling on edge.
5. Mental restlessness: Just like physical restlessness occurs when someone feels like their body needs to be in constant motion, mental restlessness occurs when someone feels like they have a constant stream of thoughts. Someone with ADHD often experiences this because their mind is prone to wandering and/or to racing thoughts. Similarly, someone with anxiety may have a constant stream of worry as well as mental habits aimed at quieting the worry, like constant anticipating and planning. This constant stream of worry and planning leads to mental restlessness. 
6. Sleep issues: Both of these conditions also cause poor sleep. When it comes to ADHD, irregular circadian rhythms are thought to be part of the condition. Additionally, symptoms of ADHD, such as racing thoughts, restlessness, and overall issues with time perception can all play a role in poor sleep patterns as well. When it comes to GAD, increased alertness, constant worries, as well as physical symptoms of anxiety, such as stomach issues and muscle tension, can all disrupt sleep.  
7. Poor self-esteem: Whether its the inability to sustain attention and plan for tasks in ADHD, or the constant and distracting worry related to GAD, both of these conditions can lead to underperformance, which can lead to poor self-esteem.

You can see how these two conditions can be confused with one another, especially if a provider is going through a check-list of symptoms without thoroughly asking about each one. Unfortunately, in the age of 15 minute health care visits, this is not uncommon.

Children can be most at risk for this misdiagnosis. Kids may be less able to describe what is going on in their bodies and minds. Because of this, they may just describe the major physical and mental symptoms they are experiencing without being able to describe the why. Also, commonly, parents and teachers may be the ones bringing up concerns to providers, and children may be unable to describe these concerns any further.

Overall, girls are more likely to be labeled as anxious and boys are more likely to be labeled as hyperactive or inattentive. We are now starting to question how much of the difference in diagnosis rates of GAD and ADHD between girls and boys is related to actual differences and how much is related to misdiagnosis.

The incorrect diagnosis can be problematic because the therapies and medicines used to treat these conditions are different. Furthermore, the medicines used to treat each condition can actually make the other condition worse. For example, stimulants, like Adderall XR and Concerta, are often used to treat ADHD; however, stimulants can worsen anxiety. When medicine is used to treat anxiety, SSRIs, like Lexapro and Zoloft, are often used. Although less problematic for ADHD than stimulants are for anxiety, these medicines will not help ADHD. Additionally, for some, SSRIs cause an overall feeling of cognitive fogginess, which could make ADHD more difficult to manage.

So, how do you protect yourself and loved ones from a misdiagnosis?

• Don’t be afraid to question. If what is being described to you doesn’t seem to hit the mark in terms of what you are experiencing, or you feel like there is important information about you or your loved one that the provider didn’t ask about, speak up. If you are unsure how, starters can include “You mentioned [fill in the blank], but that isn’t quite how it feels. I feel [fill in the blank].” “I’d like to add that I [fill in the blank].” “When I described that it may have sounded like [fill in the blank], but really it is [fill in the blank].” If you are not sure what to say, but just feel they missed the mark on understanding you, it also totally fine to just say “Hmm..I’m not sure that sounds like what I am experiencing.” They should be able to then ask questions to get a more accurate picture.
• Ask yourself the why. It’s OK if you can’t figure out the why right away. It’s a great start just to ask yourself. For example, if you are having difficulty focusing, stop yourself and get curious about it in real time. Take note of what you are thinking about and how you are feeling emotionally. Then shift your focus to your body. Take note if you are feeling tension anywhere, what your breathing or heart rate feels like, or if you are feeling energetic or restless at all. By consistently getting curious about what is going on in your mind and body when symptoms pop up, you can start to gather information about the why.
• If you are comfortable, talk to others. If someone else is having a similar experience, and you both feel comfortable, talk. Hearing someone else talk about their experience may help you put words to your experience. Alternatively, if there is someone you trust and spend a lot of time with, you can also ask them what their observations of you are. Ultimately, you are the expert on yourself, but it can help to know what other people observe when you are experiencing what you view as symptoms.