“Cassie” is an anxious adult. She stresses and puts off tasks that should be simple. Seeing others succeed makes her feel inadequate. It’s easier to avoid challenges than risk failing again. She has taken anxiety medication but it didn’t help much.
This hypothetical example illustrates a situation many people have faced. Social media abounds with stories of people who have, without success, taken medication for anxiety and are now wondering about possible undiagnosed ADHD.
So, how can you tell if it’s anxiety or ADHD, or both? And why does it matter?
Read more: Myths and stigma about ADHD contribute to poorer mental health for those affected
ADHD and anxiety can go hand-in-hand
Anxiety and depression can mimic ADHD. Either can be associated with lack of motivation and difficulty focusing the attention.
On the other hand, a pattern of being late, missing deadlines and forgetting appointments due to ADHD may lead to anxiety and a sense of failure.
Anxiety and depression are both commonly associated with ADHD, particularly in women. Anxiety tends to be more severe and persistent and with a younger age of onset in people with ADHD.
Generalised anxiety features symptoms such as frequent and excessive worry about different aspects of life (such as work, school and family). The worry can be difficult to control. Restlessness, fatigue, irritability and sleep problems are common.
For some, anxiety can be controlled through therapy, mindfulness techniques, a change in life or at work and/or medication.
For others, no amount of anxiety treatment seems to help. The problems persist. For these people, it could be worth investigating whether undiagnosed ADHD is a factor.
Successful treatment of co-existing ADHD may, for some, be the best way of getting relief from chronic anxiety.
Could ADHD be a factor?
ADHD is often subtle in girls and women, who are less likely to show the disruptive hyperactive behaviour that draws attention to ADHD in men and boys.
This matters because women with ADHD have higher rates of depression, anxiety, eating and sleep disorders.
Old school reports may give telling clues, such as:
Cassie spends more time socialising than working. She is capable, but is frequently distracted and is not achieving her potential.
“Cassie’s” parents may recall hearing such comments from teachers. She may remember feeling bored in class and looking out the window instead of listening and concentrating.
However, not all adults with ADHD showed signs of it in childhood.
ADHD in adulthood
ADHD is generally diagnosed according to the criteria of the American Psychiatric Association.
Problematically, these criteria require that to be diagnosed with ADHD, an adult should have experienced difficulties before the age of 12.
Studies have identified ADHD in adults who didn’t show evidence of it when previously assessed in childhood.
And ADHD is generally assessed in adults as if it were a continuation of the childhood condition. The diagnostic criteria – such as interrupting, fidgeting, not completing tasks, losing things, forgetting things – are derived from observations of children.
When applied to adults, these criteria still relate to behaviour seen from the outside by an observer. They miss the depth and insight an adult can provide about their inner world and mind.
A woman with no history of ADHD-related problems in childhood and no overt signs of restlessness or hyperactivity may have had her ADHD missed, particularly if she’s developed coping skills to seemingly stay on track.
She may feel stigmatised by those who believe ADHD is being self-diagnosed in treatment-seeking adults who are over-influenced by social media.
If I suspect ADHD, what now?
If you suspect ADHD but are able to get on fine in life, you probably don’t need a diagnosis. You should only consider a diagnosis of ADHD if you’re facing significant difficulties.
This could mean disorganisation, inefficiency, difficulty with relationships at work or in the family, or depression or anxiety so severe it affects your ability to function.
To be assessed for ADHD, you’ll need a GP referral to a psychiatrist. However, many people who outwardly appear to be coping well may find it difficult to convince a GP an assessment is necessary.
You could bring copies of school reports if they suggest ADHD. Checklists with ADHD criteria can help, but cannot reliably either diagnose or exclude ADHD.
Clear descriptions of difficulties you experience when attempting mentally demanding task can help.
These may include repeated lapses in attention, or having to multitask to provide sufficient stimulation to keep working.
You might detail, for example, the average number of minutes per hour of your working day you are actually working productively or how long you can focus on a hard task before losing concentration. How often do you get distracted? How long does it take to get back on task? What strategies have you tried?
An ADHD diagnosis can be a relief for some, who may find treatment helps alleviate problems they’d previously blamed on anxiety. It can also provide an explanation for past difficulties attributed to personal inadequacy.
ADHD treatments can include medication, learning more about it, developing new strategies, counselling and having an ADHD coach.
Read more: ADHD: claims we're diagnosing immature behaviour make it worse for those affected