Is it ADHD or Anxiety?

The answer to this question was addressed in an illuminating lecture for continuing medical education for physicians by John Waldrup, M.D. from Weill Cornell Medical College at a conference presented by the Nevada Psychiatric Association.

Dr. Waldrup presented the idea that children with anxiety disorders will usually start showing symptoms by 6 to 12 years of age, while being frequently underdiagnosed and undertreated. 

Confusing the picture of whether or not it is anxiety or ADHD is the fact that generalized anxiety disorder (GAD) and inattentive presentation of ADHD clinically show much the same symptoms of inattention, leading to frequent misdiagnosis (e.g., ADHD misdiagnosed as anxiety and vice versa).

And although both anxiety disorders and ADHD manifest similar symptoms of inattention, there are important distinctions to be made between these two disorders, especially in regards to providing effective treatment for symptoms.

To obtain a clearer picture of the differences between ADHD and anxiety, let’s first look at the symptoms of each disorder.

Anxiety Symptoms

When discussing anxiety symptoms, it’s important to note that anxiety is a normal emotional response to difficult and uncomfortable situations.

However, problems arise when the anxiety or fear reaction becomes excessive, irrational, or out of proportion to the activity that’s either occurring or about to occur (e.g., excessive worrying about school assignments).

Indeed, anxiety can cause a whole host of debilitating physical and psychological symptoms, some of which are listed below:

Physical Symptoms of Anxiety

• Digestive dysfunction
• Easily fatigued
• Restlessness
• Muscle tensions in neck and shoulder
• Somatic symptoms (sweating, nausea, diarrhea)
• Frequent urination
• Bruxism (teeth grinding or clenching)
• Headaches
• Cold or sweaty hands
• Palpitations (heart pounding)
• Trembling

Psychological Effects of Anxiety

• Clinging Behavior
• Fear of separation from parents
• Refusal to go to school
• Difficulty concentrating
• Temper Tantrums
• Avoidance of social situations
• Nightmares
• Irritability
• Feeling on edge
• Racing thoughts

In addition to these symptoms, a recent study from Harvard Medical School (Internal Medical News, May 1, 2016), found an association in adults between an over-activated amygdala (limbic system) and an increased risk of cardiovascular events like a heart attack or a myocardial infarction.

Studies have shown that a dysregulated amygdala can negatively impact the brain’s ability to moderate the fear response system, leaving the individual in an increased state of “fight or flight”.[i] They can be in an abnormal state of heightened psychophysiological arousal that sustains their anxiety.

ADHD Symptoms

Like anxiety, ADHD has a neurophysiological effect on afflicted individuals, causing them to experience diminished cognitive functioning.

ADHD (Inattentive presentation):

• Inattention
• Easily Distracted
• Lack of sustained focus on non-preferred tasks
• Difficulty finishing tasks such as homework without supervision
• Poor short-term memory (i.e. difficulty following a series of instructions)
• Often forgetful such as forgetting homework or turning it in
• Poor listening skills

ADHD (Hyperactive-impulsive presentation):

• Impulsive (acting without thinking of the consequences, blurting out answers, interrupting, experiencing difficulty waiting one's turn)
• Hyperactive (fidgety and/or difficulty sitting still)

ADHD (Combined presentation):

• Inattentive symptoms along with hyperactivity/impulsivity

ADHD: (Unspecified ADHD):

• Significant clinical impairment but does not meet full criteria of ADHD symptom

ADHD vs Anxiety: What’s the Difference?

The difference between ADHD and anxiety ultimately comes down to whether or not the individual is not focused because of fearful, apprehensive thoughts, or is not focused because of being easily distracted even though their mind is calm.

In sum, children with generalized anxiety disorders will have poor focus because their minds are dominated by anxious, worrisome thoughts. Their anxiety can permeate all academic assignments.

In contrast, an inattentive ADHD child’s mind can be quiet, but easily distracted, which results in their inattention. They may only show anxiety sometimes about a specific academic task or challenge.

A thorough clinical history is important in helping differentiate the cause of the inattention and evaluating if it may be primarily an anxiety disorder.

Below are some important questions to ask when attempting to make a diagnosis.

Is it Anxiety or ADHD? 

To further help distinguish between ADD and anxiety, below are some baseline questions that should be asked:

• Is your child a worrier? Ask your child if he/she has worries that will not go away regardless of what they do. Ask your child if worries make it hard for him/her to do things they want to do.
• Is your child shy?
• Ask your child if there are things that make them very scared when they think about them.
• Is your child anxious about going to school or do they even feel homesick at school?
• Does your child become anxious or irritated if they have to leave the house?
• Is there a family history of anxiety?
• Does either parent suffer from anxiety? 

These are essential questions to answer in determining a proper diagnosis, then developing an effective treatment plan for the child or adolescent experiencing problematic symptoms.
 
If the anxiety symptoms are very troublesome and if there is a family history of anxiety, then the child probably should be treated for the anxiety symptoms first.

Then, when the anxiety symptoms are reduced or resolved and the child still has inattentive symptoms interfering with school, ADHD treatment can follow.
 
If the anxiety symptoms are mild, but the inattentive symptoms are prominent, then treatment should be provided the other way around, with ADHD treatment offered first. 

Treating ADHD and Anxiety at the Drake Institute

For 3 decades, the Drake Institute has successfully treated patients for both ADHD and anxiety without the use of drugs or invasive protocols.

At the Drake Institute, we believe that the best strategy for helping ADHD and anxiety symptoms is to enable the patient to mobilize their brain’s natural ability to self-regulate optimally, which is why we utilize qEEG brain mapping to identify the areas of the brain that are under or over-activated. 

Once we have a clear picture of where the dysregulation is occurring, we can then develop a treatment plan (Biofeedback/Neurofeedback and Neuromodulation) that is tailored to the patient’s individual needs.   

Since specific regions of the brain can have multiple functions, whereby both "attention" and "emotional regulation" can come from the same region, one of the major advantages of brain map-guided neurofeedback is that treating one dysregulated region or functional network can result in simultaneous improvement of both anxiety and inattention symptoms.

Stress biofeedback can also be utilized in enabling patients to reduce debilitating psychophsiological tensions that sustain anxiety.

Again, the priority order for treatment procedures depends on whether anxiety or inattentive ADHD is determined to be the primary problem experienced by the patient. This is not a one-size-fits-all approach, but a custom-tailored strategy based on individual needs.

What’s more, because our treatment protocols don’t rely on drugs but on improving self-regulation, symptom relief can be experienced well after treatment has ended, in other words, long-term.

Contact the Drake Institute

If ADHD or any anxiety-related disorders are significantly impacting your quality of life or a loved one, please call us today to schedule a no-cost screening consultation.