October is ADHD Awareness Month, making it a good time to take a closer look at ADHD. This includes why people can easily confuse some ADHD symptoms with anxiety.
Attention Deficit/Hyperactivity Disorder (ADHD) and anxiety are two completely different diagnoses. Yet from the outside, they can often look like mirror images of one another. But what’s the difference, how can we tell the two apart, and why does it matter? Understanding what is actually driving someone’s symptoms is important. The same behavior may require a different approach depending on where it is coming from.
People with ADHD, anxiety, or both may struggle with procrastination, difficulty making decisions, feeling overwhelmed, and face challenges in relationships. While the presenting symptoms may look the same, the reasons behind them can be very different. Looking beyond the behavior itself can help us better understand what someone is actually struggling with. It can also help us understand what might be the most helpful for them.
Why ADHD and Anxiety Can Be So Hard to Tell Apart
One of the biggest differences between ADHD and anxiety is the “why” behind the symptoms. Part of that difference comes from what is happening in the brain. Neurotransmitters are chemical messengers that help different parts of the brain communicate.
Dopamine plays a role in motivation, attention, and reward. Research has associated differences in dopamine signaling with ADHD. Serotonin is one of several neurotransmitters involved in anxiety and plays a role in mood and emotional regulation. These distinctions are only one piece of a much bigger picture. However, they can help explain why ADHD and anxiety may lead to similar behaviors for different reasons.
In everyday life, those differences can show up in several ways. ADHD symptoms often connect to difficulties with executive functioning, such as task initiation, time management, or organization. Anxiety symptoms, on the other hand, often stem from worry or fear.
5 Ways ADHD and Anxiety Can Look Similar
ADHD and anxiety can lead to many of the same challenges in everyday life. The difference often comes down to what is driving the behavior. Here are five ways the two can look similar from the outside.
- Procrastination
Someone with ADHD may know what they need to do but struggle to initiate the task. This can happen because of difficulties with executive functioning. Someone with ADHD may plan to study for an exam but struggle to get started. They might open their notes, get distracted by other tasks, and realize later that they never actually started studying. Someone with anxiety may also struggle to get started, but for a different reason. They might put off studying because they are worried about failing the exam or not doing well enough. - Difficulty Making Decisions
For someone with ADHD, making a decision can feel like having 20 tabs open in your brain at the same time. Each tab contains a different piece of information competing for your attention, making it difficult to figure out which one actually matters most. With anxiety, the difficulty with decision making may come less from the amount of information and more from worrying about the outcome of the choice. Someone with anxiety may worry about making the “wrong choice” and become overwhelmed. - Difficulty Prioritizing
With ADHD, the challenge can be figuring out which of those 20 open tabs to click on first. When everything is competing for your attention at once, the computer starts to buffer. You might have an important work or school assignment due tomorrow. Suddenly, cleaning your room, doing the laundry, or washing the dishes feels like the priority.
With anxiety, you might get stuck on just one tab. For example, you might redo the same homework question over and over to make sure you got the answer right. This can make it difficult to move on to everything else that needs your attention. - All-or-Nothing Thinking
All-or-nothing thinking can show up with both ADHD and anxiety. For someone with ADHD, this might look like abandoning a plan to clean your room. You only have 20 minutes, so it feels like there is not enough time. For someone with anxiety, anything short of the desired outcome can feel like a failure. You might get a B on a test and immediately think, “I did terribly. I should have gotten an A.” In both cases, there is little room for the gray area between doing something perfectly and not doing it at all. - Challenges in Relationships
Both ADHD and anxiety can impact relationships, but the reasons behind these challenges can be very different. With ADHD, differences in processing and executive functioning can affect organization, time management, memory, listening, and communication. Other people may misinterpret these challenges as inconsiderate. With anxiety, relationship struggles often connect more to worry about how others perceive or interpret interactions. Someone might overanalyze another person’s tone or word choice, worry about how they are being perceived, or assume someone is upset with them. Both can create misunderstandings in relationships. With ADHD, those misunderstandings may stem from differences in processing. With anxiety, worry and perception are more likely to drive them.
Despite the different reasons behind these behaviors, both ADHD and anxiety can lead to negative self talk. When these struggles happen repeatedly, they can begin to shape how someone sees themselves. This is especially true when others misunderstand, misdiagnose, or mislabel them. A person might begin to believe that they are lazy, a bad friend, or not good enough. Over time, these beliefs can become tied to their self-esteem, identity, and ultimately, their sense of self-worth.
When ADHD and Anxiety Happen Together
So, what happens if someone has both ADHD and anxiety? This is where things can get a little more complicated. ADHD and anxiety commonly occur together, but because so many of their symptoms overlap, it is not always clear what is driving a particular behavior.
Someone might procrastinate, struggle to focus, feel overwhelmed, or have difficulty making decisions. As we just discussed, the behavior alone does not tell us whether ADHD, anxiety, or both are contributing to it. This is why a thorough assessment is important. It is not just about identifying which symptoms are present. It is about understanding the reason behind them. ADHD and anxiety can exist independently while affecting the same situation.
For example, someone might struggle to start an assignment because of difficulties with executive functioning related to ADHD, while also worry about getting the assignment wrong or not doing well enough because of anxiety. Both are contributing to the struggle for different reasons. When these patterns happen together often enough, they can start to become intertwined and influence one another. That can make it even harder to tell which experiences come from ADHD, which come from anxiety, and which involve both.
Why Understanding the Difference Matters
Understanding what is driving a behavior is important because similar symptoms may require different types of support. Think back to the example of procrastination. Someone with ADHD may put off an assignment because they struggle with time management, organization, or task initiation. Support might focus on breaking the assignment into smaller steps, creating structure, or finding strategies that make it easier to get started.
Someone with anxiety may put off that same assignment because they worry about getting it wrong. In that case, those strategies may not address what is actually keeping them stuck. Instead, support might focus on understanding the worry behind the avoidance and learning how to move forward even when that worry is still present, building resilience in the process.
The same can be true in relationships. Someone with ADHD may interrupt a partner because they struggle with impulse control or feel they need to say something before they forget it, which can lead the other person to feel unheard or frustrated. Someone with anxiety might frequently seek reassurance from a partner to ease worries about the relationship. While that reassurance may help in the moment, repeatedly needing it can put a strain on the relationship and make it harder for both people to feel secure.
When treatment does not address what is truly driving the behavior, someone may continue to struggle despite putting in the effort. Over time, this can reinforce negative self-talk and strengthen the belief that they are incapable, not good enough, or unable to succeed, negatively impacting their self-esteem.
Looking Beyond the Behavior
ADHD and anxiety can look very similar from the outside, but understanding what is driving the behavior can help us see where the two differ and how they may interact.
For example, someone may struggle to start an assignment because of executive functioning difficulties. This can lead to falling behind and increased worry about getting it done.That worry may then make the assignment feel even more overwhelming and harder to start. This is a blend of both ADHD and anxiety.
A therapist can help someone recognize and address both parts of this cycle. They can build strategies for getting started while also working through the worry that has developed around the task. Understanding how the two interact can help minimize the cycle before one challenge feeds into the other.
You Don’t Have to Figure It Out Alone
If you are having a hard time understanding whether ADHD or anxiety are contributing to what you are experiencing, you do not have to figure it out on your own. At Montgomery County Counseling Center, our therapists can help you explore your symptoms, recognize patterns, and better understand what may be driving them. From there, we can help you determine what kind of support makes sense for you.
About the Author
Jill Rubinstein, LGPC, is a licensed therapist at Montgomery County Counseling Center in Rockville, Maryland, specializing in anxiety, ADHD, self-esteem, relationship challenges, and life transitions. Drawing on DBT, CBT, Adlerian principles coupled with creative approaches such as art and music, she helps children, teens, and adults recognize their strengths, build practical skills, and navigate life’s challenges with greater confidence.
