How to Tell The Difference with Dr Lindsey Dogali
As a therapist who works with anxiety in teens pretty often, I regularly see the overlap between anxiety and ADHD diagnoses. One of my big “soap box” moments is talking about how the behavioral symptoms often look so similar in small children. Misdiagnoses are common and medicating with stimulants makes anxiety worse! So in an interest to get to the bottom of this, I interviewed Dr. Lindsey Dogali to talk about the difference and the overlap in anxiety and ADHD!
Watch the video below or scroll down for a breakdown of the interview with timestamp intervals for every topic!
5:00 What is the difference between Anxiety and ADHD?
Both conditions are real biological conditions that affect the pre-frontal cortex. This is place in the brain that controls task completion.
Anxiety is a perceived threat in the environment. The amygdala, the emotion center, is activated to help you get to safety. When fight or flight kicks, the amygadla shuts down the pre-frontal cortex. So logical thinking, memory, productivity is at a loss.
On the other hand, ADHD starts with a dysfunction in the prefrontal cortex. There are structural differences and chemical differences in the prefrontal cortex of an ADHD brain. The neurotransmitters necessary to stimulate the pre-frontal cortex activity (executive functioning) are out-of-whack.
11:30: What do the differences between anxiety and ADHD in children look like to an outside observer
Attention: When someone is anxious, all of their concentrate is devoted to worrying and not a task in front of them. They look distracted. The same thing can happen to someone with ADHD but it is because they aren’t activated enough for their brain to stimulate attention. And then when they are interested in something, their brain chemicals surge to such a high level that it is no longer productive, hence the hyper-attention.
Looking at what setting distraction happens is key! For clients with anxiety, you will only see distraction symptoms when worried. For clients with ADHD, you will see distraction symptoms for anything that doesn’t hold interest.
It can be very difficult to tell the difference because this is an internal distinction rather than an external one.
Restlessness and impulsivity happen with both ADHD and Anxiety. Physical restlessness symptoms happen more with anxiety. This includes fidgeting, nail biting, skin picking, muscle tension. Emotional restlessness and inability to sit still and relax may be more common in ADHD.
19:00 Comorbidity. Where there is ADHD, there is likely to be anxiety.
It’s quite likely that as as adult if you struggle with attention and have never been diagnosed, you are looking at BOTH and not one or the other. In adults, if you have ADHD you have a 50% likelihood of having anxiety. With kids its about 30% likelihood.
Left untreated,, ADHD causes anxiety. ADHD is a disorder of your brain being consistently inconsistent. Not feeling like you can trust that your abilities will cause anxiety! “I am I going to show up today or am I not” wears on you.
Because it can become both, it can be very hard to parse out the differences without a formal assessment.
23:30 When is the right time to get a formal assessment?
Definitely for a child if there noticeable functional impairment. Declining in grades and increased family frustration in nagging for tasks and transition times are common. Ironically we often see adults who resonate with these symptoms when they come in for testing for their kids! There is definitely a biological, genetic component to this.
Diagnosing is often really validating to both kids and parents to understand why thing things are happening. A clinical label is much healthier than thinking “I’m dumb” or “my kid is misbehaved”. There is relief in naming and knowing the treatment path for any diagnosis.
Others experience fear in the stigma of a label which is why some people shy away from testing. But it doesn’t have to define yours or your child’s life. Rather it can guide towards the right type of help. Your kid is the same with or without the diagnosis.
29:00 When therapists need to refer out for an assessment
For a therapists wanting to help their clients, it can be easy to provide diagnoses without a full range of testing in an effort to help. But it may not be helpful in the long run. It takes a very responsible clinician to refer out when something is beyond their area of expertise.
It is so important as therapists to know the limitations of our roles.
30:00 What do you treat first if it’s both ADHD and Anxiety?!
The best case scenario is that with unlimited time and resources, you address both anxiety and ADHD at the same time with therapy, parent coaching, and executive functioning coaching.
With limited resources, it’s important to pin down the primary problem. If one is exacccerabing the other, you have to start with which is more severe. If the ADHD is so severe, it may be hard to benefit from CBT or DBT work for anxiety. Psychological testing can help identify which aspect to start with.
Regarding medication management, is may not be helpful to treat both at the same time. It might be helpful to start with one type of medication and see what the impact is before adding in multiple variables. My limited perspective regarding med management is to start with anxiety medications. Other than standard side affects, these meds can’t do much harm to your mental health even if they are not making a world of helpful difference. On the other hand, giving a stimulant to an anxious mind is a bit riskier in terms of having harmful mental health impacts.
37:10 What else do you recommend other than meds for treating ADHD
For older kids, executive functioning coaching! This can be either 1-on-1 coaching or a class boot camp type of thing. For families of younger kids with behavioral issues, parenting coaching is most recommonded!
Learning how to do behavior management with positive rewards and reinforcement is so much more effective than punishing the negative behaviors. Create a behavioral plan to get the behavior you DO want to see by identifying obstacles that are in the way and solving those.
These behavior plans can be complicated to implement with the anxiety presentations. We want to help teach their kid self soothe during anxiety rather than produce correct behaviors. Again, getting to the root of this is so important to reduce frustration at taking a shot in the dark at solutions.
42:10 What is the process of an assessment like?
Dr Dogali is doing virtual consultations and then in person testing. Testing usually happens over 5-6 hours. Often split up into periods. She does cognitive IQ testing, attention executive function and memory testing, audio and visual processing testing for learning disabilities, and social-emotional testing.
Some facilities use grad students to do the testing. Lindsey does all of it herself. The clinicians judgment is very important to the process.
So many times I am diagnosing something and it is not even based on the testing scores but based in what I saw in the room.
And as a family therapy I resonate with this too. My assessment of family functioning in the room is just as important as the content reported by the family!
After testing, it usually takes about a week to finalize the report. Dr Dogali will also gather data from other sources like teachers, coaches etc.
47:00 Final thoughts and where you can find Dr Lindsey Dogali
The school system is great but teachers can’t always see all the things you see at home. And they don’t have a trained eye. This is especially true during virtual learning. You can’t rely on school to tell you when to seek testing.
As a family therapist I will say too, if the problems are ONLY showing up at home that’s typically an indication of a family dynamic at play. Anxiety may be spreading amongst family members in particular way. Have a family therapy consult if the behavioral problems are only happening at home.
Don’t wait!! It’s worth the investment of time and resources for your child’s future.
Montgomery County Counseling Center has options for you!
Our quarterly parent workshop for parents of struggling teens and young adults may be a good place to seek support for parents of older kids. If you are a parent of a teen who you already know will struggle, consider reserving a spot now for the next session ASAP
Montgomery County Counseling Center offers a variety of therapy services in Rockville, MD. And with Telehealth we can now serve all areas of Maryland and Washington DC. Our counseling services include dialectical behavior therapy (DBT), parent coaching, family therapy, teen therapy, and child therapy.