Let’s talk about anxiety. Often used interchangeably with “stress,” anxiety is actually your body’s response to stress. Where stress is usually triggered by an identified circumstance or threat, the catalyst of anxiety may not be so easily recognizable.

Believe it or not, the main goal of anxiety is to protect you — to alert your body and mind of potential dangers (whether real or imagined) in the form of physiological signals. And the ability to recognize these signals early on can be game-changing when it comes to managing your anxiety.

Fight, flight, freeze: the physical response

When viewed through a biological lens, it’s easy to imagine situations that would trigger your fight, flight, or freeze responses, i.e., predator versus prey. And while that’s a very tangible and historic (and prehistoric) defense mechanism, something that’s surely unique to our modernized society is the role that our minds play in our varying levels of anxiety.

With pure intention (we like to think), our brains love to play protector, even when it’s unnecessary. Sometimes, it’s cycles of endless what-ifs in an attempt to prepare us for every possible scenario. Other times, it pulls us out of the present moment and into a circle of past or potential future events completely out of our control. Not surprisingly, these psychological mechanisms combined with our “fight or flight” stress hormones can commonly materialize outwardly in the form of disrupted sleep patterns.

Thoughts on loop: the psychological response

When viewed through a biological lens, it’s easy to imagine situations that would trigger your fight-or-flight responses, i.e., predator versus prey. And while that’s a very tangible and historic (and prehistoric) defense mechanism, something that’s surely unique to our modernized society is the role that our minds play in our varying levels of anxiety.

With pure intention (we like to think), our brains love to play protector, even when it’s unnecessary. Sometimes, it’s cycles of endless what-ifs in an attempt to prepare us for every possible scenario. Other times, it pulls us out of the present moment and into a circle of past or potential future events completely out of our control. Not surprisingly, these psychological mechanisms combined with our “fight or flight” stress hormones can commonly materialize outwardly in the form of disrupted sleep patterns.

Overthinking and avoidance: the social response

A persistent self-critique is anxiety’s way of trying to secure and perfect your social position. What for many are fleeting moments of replayed interactions and attempts to control others’ views of them, for the anxious mind these can be a slippery slope into rumination, intrusive thoughts, negative thought patterns, and mental spirals. And when these social responses become too strong, the anxious brain might encourage you to avoid social situations altogether. 

A new perspective

Though it can feel isolating at times, anxiety is something that connects many of us. Millions of people experience anxiety in some form, and while it may always play a role in your life, it doesn’t have to be a dominant one. By recognizing the common signs of anxiety and learning to effectively manage them, you have the power to regain control of your well-being now and in the future.

Whether you pursue independent coping strategies like breathing and movement techniques, mindfulness practices to ground you, or cognitive methods to help navigate thought patterns — or if you’re seeking support through various groups, communities, or mental health professionals — you are not alone in your experience (and you never have to be).

About 50% of adults with ADHD also suffer from an anxiety disorder. ¹  

While having both conditions does not quite double the symptoms (there is some overlap between ADHD and anxiety), managing both together can feel like double the work. Because, essentially, the symptoms of ADHD can amplify anxious responses and anxiety can make ADHD symptoms feel worse.

But there is good news: you’re not alone and with the right tools and understanding, you can transform challenges into opportunities.

The ADHD-Anxiety Connection: Why It Matters

Dr. Marcy Caldwell, a clinical psychologist and ADHD advocate, explains that anxiety often develops as a response to ADHD. Here’s how it happens.

One of the hallmarks of ADHD is difficulty with emotional regulation. ADHD brains often experience intense highs and lows. Instead of moving through a gradual response, those with ADHD tend to operate on an all-or-nothing scale. This emotional intensity can make moments of anxiety feel even more consuming as the brain struggles to transition out of these heightened emotional states. 

“This difference in regulation is why ADHD brains often feel flooded with emotions,” says Dr. Caldwell. “Anxiety adds another layer of intensity, making it even harder to find that middle ground.”

Practical Strategies for Managing ADHD and Anxiety

While the challenges of ADHD and anxiety are significant, actionable strategies can help manage both sets of symptoms and live a happier and calmer life.

1. Identify Anxiety Triggers

Understanding what fuels anxiety is the first step. Whether it’s fear of failure, an overwhelming schedule, or unresolved concerns, pinpointing triggers allows you to address them directly.

2. Create Consistent Routines

Structure is a powerful tool for managing both ADHD and anxiety. Routines reduce unpredictability and provide a sense of control. Break tasks into smaller steps, and use tools like task management apps, visual schedules, and timers to stay focused.

3. Incorporate Physical Activity

Exercise is a proven way to regulate emotions and reduce anxiety. Activities like walking, yoga, or even dancing can help release tension, improve focus, and stabilize mood.

4. Face Avoidance Head-On

Avoiding anxiety-inducing tasks or situations may feel easier in the short term, but it allows anxiety to grow. Start small and gradually face avoided activities to regain confidence and control.

5. Seek Professional Support

A proper diagnosis and tailored treatment plan can make all the difference. Options include:

• Online ADHD Assessments: Convenient and expert-led evaluations.
• Medication: Stimulants like Adderall can be transformative when used appropriately.
• Therapy: Approaches like cognitive-behavioral therapy (CBT) are highly effective for managing anxiety and emotional regulation.

Ready to take the next step? Begin your journey today with the ADHD Diagnostic Evaluation.

This article draws on insights from a podcast conversation hosted by ADHD Online, featuring Dr. Marcy Caldwell. Her perspectives provide valuable guidance for understanding and managing ADHD and anxiety. 

¹ https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd

Untreated ADHD can be a breeding ground for anxiety. It’s a common pairing with frequently overlapping symptoms — things like difficulty concentrating, sleep irregularities, and constant feelings of restlessness. Days riddled with missed deadlines, misplaced keys, and countless social blunders create an ambient hum of chronic worry.

Edward Hallowell, MD and founder of The Hallowell ADHD Centers, says:

“Pretty much everyone with untreated ADHD has anxiety, because ADHD leads you to make a lot of mistakes — you forget or overlook things, misspeak, misplace, fall behind, lose track of time … It’s an anxiety generator.”

Nearly half of us living with ADHD also grapple with the weight of an anxiety disorder. But in a world where every oversight and impulsive decision seems to catalyze symptoms, embracing a diverse approach to treatment can lead you to a place of calm coexistence.

A prescriptive approach: medication for ADHD and anxiety

Stimulants and non-stimulants

Stimulants, like Adderall and Ritalin, are often the initial treatment choice for ADHD, with proven effectiveness for about 70% of patients. While some worry that stimulants will exacerbate the anxious mind, many experts argue that addressing ADHD head-on can in fact alleviate anxiety.

Think about putting on a pair of glasses for the first time; suddenly, the world comes into sharper focus — and with it, a sense of calm.

There are two types of medication that are approved by the U.S. Food and Drug Administration (FDA) to treat ADHD: amphetamines, such as Adderall, Vyvanse, Dexedrine, and Adzenys; and methylphenidate, such as Ritalin, Focalin, and Methylin. Mental health professionals also prescribe modafinil, commonly known as Provigil, which is another stimulant that’s used off-label to treat ADHD symptoms.

“We’ve got over 70 years of experience with both of these stimulants, yet there is so much misinformation about them.” Dr. Hallowell advocates for the efficacy of these medications when used properly, noting that amphetamines were first used to treat ADHD in 1937 and methylphenidate has been in use since around 1950. “Nothing lasts that long unless it’s safe and effective,” he says.

For those who find the effects of stimulants too intense or anxiety-provoking, non-stimulant medications offer an alternative path:

• Selective Norepinephrine Reuptake Inhibitors (SNRIs): Medications like Strattera (atomoxetine) and Qelbree (viloxazine) can improve focus without the “jittery” feeling some experience with stimulants.
• Alpha-2 Agonists: Originally marketed as blood pressure medications, research has shown that medications like Intuniv (guanfacine) and Kapvay (clonidine) have proven benefits for both ADHD and anxiety symptoms.
• Antidepressants: While not specifically approved for ADHD, certain antidepressants like Wellbutrin (bupropion) can help with both attention and mood regulation.

Antidepressants and ADHD

Mental health professionals may prescribe antidepressants, either alone or with a stimulant. But Dr. Hallowell insists that  SSRIs — one type of antidepressant — should be a last resort for treating ADHD.

“SSRIs are safe, but there are two side effects that I think make them particularly not worth going on unless you really need them,” he says. “The first is that they’re cognitively dulling. The second is that they reduce libido, a natural, affirming, joy-producing life force.”

While antidepressants aren’t approved by the FDA to treat ADHD, those living with both ADHD and an anxiety disorder may need to take both a stimulant and an anti-anxiety medication.

Stimulants’ effects on anxiety

It is commonly believed that stimulants can lead to increased anxiety. And while this can be true, Dr. Christine Sauer, MD and Certified Brain and Mental Health Coach, explains: “For many of my patients, treating their ADHD with stimulants actually reduces their anxiety. When they can focus better and make fewer mistakes, their anxiety naturally decreases,” a sentiment also acknowledged by Dr. Hallowell.

“A trial of medication is just that … You may continue to use it, or you may not,” Dr. Hallowell says. “It’s just a shame that people are afraid of using a stimulant because whatever it does, good or bad, it only lasts for a matter of hours.” According to Hallowell, a primary reason for stimulant failure is using too low of a dose. He explains, “The beauty of stimulants is they give you an automatic feedback reading — your body will tell you if you’re taking too much,” noting that the five variables to watch are weight, heart rate, blood pressure, sleep, and how you feel.

A delicate balance

In some cases, a combination of ADHD medication and traditional anti-anxiety medication may be the most effective route. However, this approach requires careful monitoring and open communication with your healthcare provider to avoid potential interactions and side effects.

A classic coupling

While medication can be a game changer, it’s only one piece of the puzzle. An effective treatment plan is a comprehensive one, marrying various pharmaceutical and non-pharmaceutical strategies to address both ADHD and anxiety.

Psychotherapy and rewiring the brain

Cognitive Behavioral Therapy (CBT) is particularly effective for both ADHD and anxiety, helping individuals identify and change negative thought patterns and behaviors. For those with trauma-related anxiety, Eye Movement Desensitization and Reprocessing (EMDR) therapy can be transformative.

By way of movement

Regular physical activity is a powerful tool for managing symptoms of ADHD, anxiety, and virtually every other condition. Whether it’s a brisk walk, a swim, or hitting the gym, exercise releases endorphins that can quiet the anxious mind and improve focus.

Mindfulness, meditation & the present moment

Incorporating mindfulness practices into your daily routine can make a world of difference. These techniques help cultivate a sense of presence and awareness, allowing you to observe anxious thoughts without getting swept away by them. Apps like Headspace and Calm offer guided meditations specifically designed for those with ADHD and anxiety.

Fueling the brain and the body

Research shows that what you eat can significantly impact both ADHD and anxiety symptoms. While a balanced diet rich in omega-3 fatty acids, complex carbohydrates, and lean proteins can help stabilize mood and improve focus, some also find that reducing caffeine and sugar intake helps manage anxiety symptoms. Dr. Uma Naidoo, a nutritional psychiatrist at Harvard Medical School, recommends incorporating foods like fatty fish, leafy greens, and fermented products to support brain health and function and reduce anxiety.

Sleep hygiene matters

Both ADHD and anxiety can wreak havoc on sleep patterns. Establishing a consistent sleep routine, creating a relaxing bedtime ritual, and limiting screen time before bed can significantly improve sleep quality and, in turn, reduce symptoms of both conditions.

The road ahead

Navigating ADHD and anxiety is a journey that requires patience and self-compassion. And though the path may seem like an isolating one, it’s important to remember that you are not alone. By seeking support and advocating for your needs, you can reclaim your power and live a fulfilling life. The goal is not about achieving perfection; it’s about finding a balance that allows you to thrive.

Take care of your mental health today with our Diagnostic Evaluation, a diagnostic evaluation that offers a diagnosis (when warranted) and insight into a growing range of mental health conditions. 

Election Cycle Anxiety: 5 ways to get to November

About 73% of U.S. adults feel particularly anxious about the upcoming election cycle.

Introducing relatively high levels of uncertainty, elections are, by nature, anxiety-producing events. But our current election season has been producing more anxiety for Americans than ever before. 

Do you have symptoms of anxiety?

While a certain amount of anxiety is part of life for all of us, living in a heightened state of anxiety for an extended period of time isn’t good for anyone. Feeling persistent worry, increased irritability, difficulty sleeping, or dealing with daily headaches, muscle tension, and fatigue are all symptoms of anxiety to watch out for as we move toward November.

What can we do?

Anxiety will do its best to pop up daily, if not several times a day, between now and November. But using these tools can help put it back in its place and help you find more ease.

1. Limit and manage news exposure

This tip appears on every list and for good reason. Taking in a never-ending cycle of news, polls, pundits, and reports is like drinking from a firehose for our brains. Overwhelmed with updates and struggling to parse through details can send us into a spiral. If we don’t step away and take a break, we can end up feeling as if there is no way out. If cutting back on your media intake also creates spikes in anxiety for you, try these tips:

• Take a break when your anxiety symptoms increase. Sometimes that quick reset is all you need.
• Try to delay refreshing your feed. If you normally check the headlines every half hour, try going an hour and see how that feels. The more space you give yourself, the better.
• Select a handful of sources to give up. Start with the ones that you find to be least helpful or informative–or the ones that cause you the most stress.

2. Contribute positivity

Anxiety thrives in avoidance and inaction. So try doing the opposite. Consider ways that you can positively contribute–not just to the election but to your community as a whole. For example:

• If you want to get involved in the election, consider canvassing for your favorite candidate or volunteering to work the polls on election day.
• If you want to get a break from the election, visit your local library or community center and see if they need help or volunteer at your children’s school.

3. Lean into mindfulness

When the world is loud around you, reclaiming the quiet in your mind can help. If you’ve never meditated or practiced mindfulness before, it’s very easy to start small. Here are a few ways:

• Set a timer for a minute and just sit and focus on your breath until the timer rings.
• Concentrate on a somewhat mundane task, like washing the dishes. Pay attention to the feeling of the water and the movement of your hands to give your brain a rest.
• Try one of the popular meditation apps out there for a more guided experience.

4. Move your body

You’ve likely seen the headlines that physical activity is just as good for your mental health as it is for your body. It’s all true and incredibly useful during this season. Take a walk, go for a run, try a new exercise class, or find a workout routine online. The endorphins you create will make everything feel more manageable.

5. Focus on what you can control

Anxiety thrives on uncertainty which is why elections can feel particularly tricky for those of us with ADHD, Anxiety, or Depression. Just like with any other situation that makes you feel anxious, try talking back or questioning your anxiety. Rather than thinking about the worst-case scenario, think about how likely that scenario is and remind yourself of the tools you have to cope with it. 

We can’t eliminate the uncertainty and we can’t control all aspects of the cycle we’re in. But we can change how we respond to them and protect our own mental health.

The Link Between ADHD and Other Mental Health Disorders

A groundbreaking study from Sweden, analyzing health records of 5.5 million adults, revealed startling figures: individuals with ADHD are significantly more likely to be diagnosed with other psychiatric conditions such as bipolar disorder, depression, anxiety, and substance use disorders. Dr. Barry Herman, Chief Medical Officer at Mentavi Health, highlights the importance of recognizing these comorbidities. “Over 80% of patients with ADHD will have at least one additional psychiatric disorder, with many facing two or more,” he explains. This interconnection underscores the necessity for comprehensive assessments to diagnose and manage ADHD alongside these comorbid conditions accurately.

The Challenge of Diagnosing ADHD and Comorbidities

Identifying ADHD in the presence of other mental health issues is challenging due to overlapping symptoms. Conditions like depression and anxiety can exhibit symptoms similar to ADHD, making it difficult to tease apart the contributions of each condition. Dr. Herman emphasizes the significance of distinguishing these conditions for effective treatment. “Understanding what condition is contributing to what symptoms is crucial. Often, symptoms in depression or anxiety can look like ADHD symptoms, requiring skillful clinicians to ask the right questions.

Telehealth: A New Dawn for ADHD Care

Mentavi Health, under Dr. Herman’s guidance, is pioneering the use of digital health platforms to improve access to mental health care. Through its smart asynchronous assessment, Mentavi offers a comprehensive, tailored evaluation that can pinpoint ADHD and its common comorbidities. This digital approach allows patients to complete assessments at their convenience, potentially reaching those who might otherwise struggle to access traditional healthcare services due to geographical or logistical barriers.

ADHD and Adults

Dr. Herman is optimistic about the future of ADHD treatment, particularly for adults. Historically, ADHD was considered a condition that only affected children. However, it’s now recognized as a lifelong condition that can significantly impact adults. “There’s a huge unmet need for adults with ADHD,” says Dr. Herman. Through innovative approaches like the asynchronous assessment offered by Mentavi Health, there’s hope for better identification and treatment of adults living with ADHD and its comorbidities.

The intersection between ADHD and other mental health conditions is complex, requiring careful and comprehensive evaluation. Dr. Barry Herman and Mentavi Health’s approach to telemental health represents a significant step forward in making mental health care more accessible and effective. By recognizing and addressing the comorbidities often associated with ADHD, individuals can receive the holistic care they need to navigate their mental health challenges successfully.

Sources:

• PLOS ONE
• BMC Psychiatry
• European Archives of Psychiatry and Clinical Neuroscience
• National Comorbidity Survey
• Nordic Journal of Psychiatry
• Psychological Medicine
• International Journal of Adolescent Medicine and Health
• Current Opinion in Psychiatry
• The Primary Care Companion for CNS Disorders

To conclude ADHD Awareness Month, ADHD Online hosted two webinars, the third and fourth in its series of webinars this autumn. Four ADHD experts discussed two topics: Non-stimulant medication options for patients with ADHD and connections between ADHD, depression and anxiety.

Non-stimulant medication

In the third webinar on October 24, ADHD Online’s Chief Medical Officer Barry K. Herman, M.D., a board-certified psychiatrist, and Lakeisha Love, a nurse practitioner who is dual-certified in family medicine and family psychiatry, spoke about non-stimulant medication for ADHD.

Although doctors typically prescribe stimulant medications to patients with ADHD, non-stimulants are also an option — particularly for patients who don’t respond well to stimulants.

“About 20 to 30 percent of patients who have ADHD and are treated with stimulants do not do well for one reason or another,” Dr. Herman said. “Either they … don’t really improve that much with either class of stimulants or they have side effects that are very difficult for them to manage, (including) poor appetite, poor sleep, weight loss, (or feeling) jittery or agitated.”

Non-stimulants usually work for only 50% to 60% of patients with ADHD. But when they’re effective, there may be advantages to using them, the experts said.

“The non-stimulant medications are not scheduled drugs, meaning they don’t carry the same kind of risks that stimulants do for misuse or addiction,” Dr. Herman said.

Patients with ADHD need to be patient once they begin taking non-stimulants, Love said.

“You have to take it over time in order to see the long-term benefits to manage your ADHD symptoms,” Love said. “Typically, it can take about four to six weeks to see the full benefits. But you can start seeing some improvement as early as two weeks.”

During the webinar, Dr. Herman and Love also answered questions about the safety of non-stimulant medications for ADHD during pregnancy, the benefits of non-stimulants for patients with high blood pressure and whether stimulants and non-stimulants have different side effects.

ADHD, anxiety and depression

The fourth and final webinar, on November 2, featured David Toomey, D.O., a family physician with experience in psychological childhood trauma counseling, and Nicole Falcon, a certified family nurse practitioner who specializes in child, adolescent and adult psychiatry. They spoke about connections between ADHD, depression and anxiety.

It’s common for patients with ADHD to also have depression or anxiety.

“Eighty percent of the time, ADHD has a coexisting condition. Fifty percent of the time, people experience anxiety, and about another 15 or so percent is depression, with 7 to 8 percent of that is bipolar,” Dr. Toomey said.

Some patients with ADHD don’t realize that they also have anxiety or depression. The reverse is also true.

“They may get treated for anxiety or oftentimes depression, and sometimes the medicines don’t quite work,” Dr. Toomey said. “We (may) find that really underlying all of it is their ADHD.”

A number of treatments are available for all three conditions. Some medications can effectively treat ADHD while also treating anxiety or depression or both. But some patients need to take more than one medication — one to treat ADHD and another for depression or anxiety.

“I see a lot of patients that still need their antidepressant,” Falcon said. “The stimulant isn’t always effective in (treating) all of their symptoms.”

During the webinar, Dr. Toomey and Falcon talked about the impact that exercise can have on ADHD, depression and anxiety. They also answered questions about the importance of adopting healthy lifestyle changes, possible links between ADHD and autism and whether ADHD medication may cause symptoms of anxiety or depression.

Join our insightful webinar to uncover the relationships between ADHD, anxiety, and depression. Have you ever wondered how these disorders coexist and overlap, making diagnosis and treatment challenging? You’re not alone.

In this webinar, you’ll engage in a dynamic Q&A session led by two experienced speakers:

Dr. David Toomey: With 30 years of practice and a deep understanding of childhood trauma and family medicine, he will shed light on anxiety.

Nicole Falcon, FNP-C: A passionate advocate for holistic mental healthcare, she will explore depression comprehensively.

Does your heart always beat faster when you think about starting a conversation with a stranger — and not in a good way? Or maybe you practice saying your order as you wait in line to get coffee, palms sweating and stomach twisting? Perhaps you have social anxiety — one of the most common mental health conditions that can happen along with ADHD.

Defining Social Anxiety

Social anxiety disorder, or SAD, also known as social phobia, is one of the most prevalent subtypes of anxiety. According to The Anxiety and Depression Association of America, around 15 million people in the United States have it, making it the second most common type of anxiety diagnosed.

It’s crucial not to mistake social phobia for shyness. Shyness can be a natural personality trait; social anxiety or social phobia is a condition that often makes everyday functioning — not to mention leading a fulfilling life — difficult.

Social anxiety is characterized by intense, persistent fear of being judged negatively or rejected. This fear arises when a person encounters specific triggers.

Each person’s triggers can be different. Some people may have trouble using a public bathroom or ordering food but be OK with making phone calls or even giving a presentation.

Still, there are some common symptoms, such as:

• Fear of everyday social situations, such as striking up a conversation, ordering food or shopping
• Avoidance of social activities, such as parties, meetings and extracurricular activities
• Worrying about an event days or even weeks before
• Low self-esteem
• Physical symptoms, like gastrointestinal issues, dizziness, excessive sweating and heart palpitations
• Avoiding eye contact

In extreme cases, social anxiety can isolate you to the point of missing school or work and opportunities to truly experience life. This significant loneliness may lead to a higher risk of depression or substance abuse.

ADHD and Social Anxiety

Social anxiety disorder is one of the most common comorbidities of ADHD, or conditions that happen along with ADHD. One 2019 study in the journal Drugs in Context cited research that found that up to 60-70% percent of people with social anxiety disorder had been diagnosed with ADHD in childhood.

However, there is no clear answer as to why the connection exists between these two conditions.

ADHD symptoms such as distractibility, impulsivity or hyperactivity may contribute to social anxiety as they may make connecting with others more difficult. Also, people with ADHD are at a higher risk of bullying and discrimination, which can be a factor in social anxiety.

“Individuals with ADHD might struggle with paying attention to social cues, which can contribute to difficulties in forming and maintaining relationships,” says David Tzall, a licensed psychologist based in Brooklyn, N.Y. “This can result in social isolation and lead to social anxiety due to negative experiences and low self-esteem.”

Tzall says the hyperactivity and impulsivity associated with ADHD might lead to impulsive behaviors during social interactions. These behaviors could be socially inappropriate or disruptive, potentially leading to negative social feedback and triggering social anxiety, he says.

“People with both (ADHD and social phobia) might experience excessive worry and overthinking,” he says. “While ADHD might contribute to racing thoughts, social anxiety could exacerbate these thoughts by focusing on potential negative outcomes in social situations. ADHD-related difficulties in attention and organization could lead to challenges in school or work settings, which might contribute to performance anxiety. This anxiety could extend to social situations where the individual fears being judged based on their performance.”

Managing Social Anxiety with ADHD

How can you manage social anxiety when you have ADHD? A good start is learning as much as possible about ADHD and social anxiety to understand how they impact you, says Tzall. This helps you identify your specific triggers and challenges.

Here are some other expert recommendations in managing social anxiety when you have ADHD:

• Nurture self-compassion

ADHD and social anxiety can lower your self-esteem and inviting negative self-talk, harsh judgment and constantly comparing yourself to others. All of that fuels the anxiety.

Becoming more self-compassionate is key to silencing your inner critic and calming your fears. Be patient with yourself and accept your mistakes. You’re perfectly human, and that’s OK. You’re allowed to make mistakes or not be liked by some people. It doesn’t mean you’re unlovable or unworthy of respect, acceptance and care.

You can try to treat yourself like you would a loved one. Would you yell at them, or call them stupid or hopeless? You deserve the same love and understanding you give others.

• Take It Slow

It may be tempting to give in to that ADHD impulse to do everything all at once and throw yourself into the deep end right from the start. Try to resist this urge. Jumping too far out of your comfort zone can discourage you from trying again and significantly worsen your mental health.

Instead, set small, specific and achievable goals. Those might include posting on an online forum, complimenting a coworker or engaging in small talk with a barista.

Be prepared for a lot of discomfort and difficult emotions. You will fight against old mechanisms and negative perceptions of yourself. While they are an unavoidable element of change and growth, it’s essential to take it as slow as you need and ask for help — whether from a loved one or a mental health professional.

Learning coping techniques or asking a supportive family member or friend to cheer you on can help you stay accountable.

• Learn to Self-regulate

As we’ve mentioned, coping strategies can help you calm your anxiety and bring inner balance. In other words, you can self-regulate by calming down your nervous system. You can do that through techniques like breathwork or engaging your senses. Try several of them a few times to see which ones work best for you.

You can also try regular walks, yoga, meditation or journaling, which is simply writing out your thoughts and feelings to help you better understand them.

• Medication

If ADHD significantly influences your social phobia, stimulant medication can help you manage the symptoms and thus lessen the anxiety.

“I often tell people with ADHD and anxiety that their anxiety may improve with adequate treatment of ADHD,” says Bruce Pace, a licensed psychologist in western New York state. “Once attention and memory are improved, people with ADHD begin to have confidence that they can complete tasks and not disappoint people. They begin to relax and feel less anxious. This may happen quickly after treatment with medications.”

However, stimulant medication can heighten anxiety as a side effect. In this case, you might try non-stimulant medications that can help.

Your doctor will be your most important guide. If your doctor decides to focus on your social anxiety, there are several treatment options available. They include anti-anxiety medication like benzodiazepines and antidepressants, such as selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SNRIs.

• Therapy

Certain medications, including benzodiazepines, can be highly addictive and thus should not be used long-term. But plenty of non-medication treatments are available to help you manage social anxiety and ADHD.

Tzall suggests consulting with a mental health professional who has experience with both ADHD and social anxiety if possible. “They can provide an accurate diagnosis, personalized strategies and potentially recommend a combination of therapies and medications,” he says.

Certain types of therapy, such as cognitive-behavioral therapy, or CBT, seem effective in both ADHD and social anxiety.

Another alternative is exposure therapy, designed to lessen your social anxiety by helping you face your stressors. “It entails exposure to the anxiety-producing environments where a person can practice breathing relaxation and thought-changing techniques,” says Pace.

Mental health concerns — such as feeling inadequate, anxious, depressed or distracted — can be difficult to define. Is it ADHD? Is it anxiety? Both? Neither? The answer isn’t always clear, thanks to symptoms that often overlap and co-occur.

Nearly 50% of adults with ADHD also suffer from an anxiety disorder, according to the Anxiety and Depression Association of America. And ADHD and anxiety have a lot in

common. A lack of motivation and the inability to focus are well-known symptoms of ADHD, and they can also be signs of anxiety disorder. Moreover, the result of ADHD symptoms — missing a deadline or forgetting an appointment — can lead to feelings of anxiety.

“I often explain to clients and families that ADHD and anxiety have a ping-pong effect,” says therapist Lee Wells, co-owner and clinical director of Mind Chicago, a family-focused therapy and testing practice in Chicago. “When ADHD symptoms interfere with functioning, anxiety symptoms increase — and as anxiety increases, it’s more difficult to manage the symptoms of ADHD.”

Understanding Anxiety

Anxiety often involves frequent or excessive worry or dread that is difficult to control, according to the American Psychological Association. The worries might be focused on specific facets of life, such as work or family, or they might just be an overarching, overwhelming feeling of general anxiety with no apparent trigger. The anxiety can manifest in restlessness, irritability, fatigue or any of an array of other negative responses.

Some people with anxiety find symptom relief from treatments like medication, therapy or mindfulness exercises. But treatment doesn’t seem to help others, which begs the question: Might it be something more than (or other than) anxiety? Like ADHD?

In two recent ADHD Online-sponsored Refocused podcasts — “Understanding ADHD and Anxiety,” part 1 and part 2 — clinical psychologist and ADHD advocate Marcy Caldwell discussed the often-missed connection between ADHD and anxiety.

Caldwell is the founder of Addept.org, a blog and digital resource that promotes approachable, science-backed strategies for adults with ADHD. She is also the director and owner of Rittenhouse Psychological Services in Philadelphia.

“Not only is the connection between ADHD and anxiety incredibly strong — right around 50% — but anxiety and all of its lovely symptoms tend to be more severe for the neurodiverse crowd,” Caldwell says.

Caldwell explains that anxiety is normal and a natural, adaptive and healthy response to a perceived threat. The worry, concern and physical sensations help people to respond to the threat to keep them safe.

“The problem comes in when that natural response is over-applied,” Caldwell says. “We don’t do this consciously; our brains hijack the system and cause us to over-respond to threats to misinterpret situations as threatening. It’s an over-reliance on this very natural system.”

The anxiety itself is not necessarily problematic, Caldwell say. But it can result in more concerning behaviors, such as panic and avoidance.

“The way our brains interpret the symptoms of panic is so incredibly uncomfortable,” she says. “Our brains say our life is ending, this is a life-ending threat and we have to respond. And that feels so terrible that people tend to try to make that stop and subsequently avoid anything that could cause that feeling again.”

Avoidance can happen without panic too, according to Caldwell. In either case, it can shrink people’s lives as they avoid more and more things.

When ADHD Is Also Involved

A certain level of anxiousness can be a normal, healthy thing. It can alert us to important dangers. But for someone with anxiety disorder, the emotions can be difficult to manage. And for people who are dealing with anxiety on top of ADHD, the difficulty can be even greater.

ADHD doesn’t cause anxiety, but anxiety can develop as a response to ADHD, thanks to the inconsistency that ADHD creates in a person’s life.

“I think it’s very easy for somebody with ADHD to feel like, ‘I’m wrong. I just need to stop doing this thing. I just need to stop going to extremes. I just need to chill out,'” Caldwell says. “ADHD brains tend to naturally fall in extremes, which can make attempts at self-regulating fall short.”

It’s this difference in the ability to regulate that can make dealing with anxiety “more extreme” for people who have ADHD, she says.

Making the Diagnosis

ADHD and anxiety can be confused for one another. They can coexist separately. Recognizing the connections, similarities and differences can help isolate the two disorders so that a proper diagnosis can be made.

Because ADHD and anxiety can manifest in similar ways, making a diagnosis must go beyond looking at just a list of symptoms, according to Caldwell. She says that experiencing big emotions or becoming easily distracted — symptoms that might be present for either disorder — have to be evaluated more closely.

Both disorders involve what Caldwell calls “big emotions.” But what the emotions react to can be different for those with ADHD versus those with anxiety.

“ADHD is known for flooding the brains with big feelings: good, bad and otherwise,” she says. “Anxiety can also flood the brain. But as a standalone disorder, it tends to only flood with worry, concern or fear. So the provider considering the diagnosis should ask: ‘Are the big emotions covering lots of topics or only anxiety-related feelings?'”

Another symptom found with both ADHD and anxiety is distraction. Examining distraction more closely is another possible way to distinguish the two disorders.

“Anxious brains are very prone to distraction and it can be really hard to focus when you have anxiety,” Caldwell says. “But that distraction — the thing that pulls the brain away — is usually worry or fear. With ADHD, however, distraction can be caused by anything.”

Caldwell says that a proper diagnosis will take time and involves the collection of a lot of information.

Treating Anxiety and ADHD

For the most part, there aren’t single treatments that can help both ADHD and a separate diagnosis of anxiety. Therefore, they should be treated separately but simultaneously.

Treatments for ADHD often include medications, such as stimulants, that increase levels of certain chemicals in the brain. The medication may be combined with therapy, such as behavior therapy or brain-training therapy, like neurofeedback.

Treating anxiety requires a different mix of medication and/or therapy. Antidepressants and anti-anxiety medications may be prescribed as a long-term treatment. And cognitive behavioral therapy is considered to be an effective treatment for anxiety disorders.

Because symptoms can overlap and because ADHD can exacerbate anxiety and vice versa, effectively treating one disorder often improves symptoms for the other. So it’s important to treat both.

“Anxiety is much more manageable when individuals have greater emotional regulation and can better meet personal and social expectations — which can be achieved with ADHD treatment,” Wells says.

Jaye Lin was the first and only ADHD-trained peer coach at Google, where she also co-founded and co-led the ADHD-Women@Google ERG. She received her coaching training from ADDCA and an e-Learning Instructional Design graduate certificate from the University of Washington. She also has a BS in Hospitality Management from San Jose State University, along with a culinary diploma from the Professional Culinary Institute, and is currently writing a cookbook for those with ADHD.

Resources mentioned in the podcast:

Website: The Monoceros Initiative 

Book: “The Four Agreements: A Practical Guide to Personal Freedom” by Don Miguel Ruiz

Jaye’s Podcast: Now Presenting: ADHD