Concentration Problems: Distinguishing Between Anxiety and ADHD

Concentration Problems: Distinguishing Between Anxiety and ADHD

July 13, 2021

by Candace Good MD


Throughout the pandemic, many adults worried about more than their physical health and finances. Parents witnessed their children's academic struggles firsthand as schools closed, and classes moved to online learning. Adults also had difficulty adjusting to remote work, with the lack of structure and routine making it harder to complete tasks.


Anxiety and ADHD Can Cause Concentration Difficulties

Did worry make it hard to focus, or was it something else, like Zoom fatigue or undiagnosed ADHD? Health insurers began to report increases in ADHD-related visits. The support organization Children and Adults with Attention-Deficit/Hyperactivity Disorder reported a 67 percent increase in traffic to their website.

Anxiety disorders and ADHD have much in common as these conditions cause difficulties concentrating and restlessness, and sleep problems. Feelings of boredom and isolation related to COVID-19 stay-at-home orders can mimic adjustment, sleep, and depressive disorders.

Anxiety Is More Common Than Adult ADHD

According to the National Institute of Mental Health, anxiety is more common than adult ADHD, with a prevalence of 19.1 percent vs. 4.4 percent.

Providers don't rely on the numbers alone as most adults with ADHD have co-morbidities, especially depression, social phobia, or generalized anxiety disorder.

Getting the Correct Diagnosis

1. Timing

  • When did symptoms begin? ADHD is a neurodevelopmental condition, so the DSM-5 requires several signs before the age of 12 years. Anxiety can start at any age.
  • Both anxiety disorder and ADHD can begin in childhood but only cause impairment later in life or under extreme conditions when stress exceeds the ability to cope.
  • A careful history is required as adults may have poor recall of or limited insight into their childhood behavior.
  • Collateral information from teachers or parents can be impossible to get and unreliable as inattentive symptoms are often underreported. Inattention is less disruptive than hyperactivity and impulse control issues.

2. Theme​​​

  • What types of conditions trigger worry? The anxiety related to ADHD is generally performance-related or kicks in when up against a deadline.
  • Patients with generalized anxiety disorder have safety concerns and get caught up in overthinking the "what ifs?"
  • The fears of someone with social anxiety disorder may be related to the size of crowds or being evaluated for their appearance.
  • People with ADHD also experience social anxiety but worry more about self-control, like blurting out the wrong thing. Someone with ADHD may fear embarrassment from talking too much or doing something impulsive.

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