Understanding ADHD and Anxiety Together
Your child's morning routine is a daily struggle.
They can't focus on getting dressed because they're worried about an upcoming test. They refuse to go to school, crying that they "can't do it," yet when they finally arrive, their teacher reports they're distracted and can't sit still.
Their homework takes hours, and not just because they struggle to focus, but because they erase and rewrite answers obsessively, terrified of making a mistake.
Many parents in La Jolla and throughout San Diego find themselves navigating the complex intersection of ADHD and anxiety in their elementary-age children.
These two conditions often occur together, creating a challenging combination that can be confusing for both parents and children.
Let's explore why ADHD and anxiety so often occur together, how to recognize when your child is struggling with both, and what evidence-based strategies can help your family find calmer, more confident days.
Why ADHD and Anxiety Often Occur Together
Research shows that approximately 30-40% of children with ADHD also experience an anxiety disorder. This isn't coincidental, as there are several reasons these conditions frequently coexist.
Shared brain pathways: Both ADHD and anxiety involve differences in how the brain regulates attention, emotion, and impulse control. The same neurotransmitter systems that affect focus and executive function also influence anxiety and worry.
The stress of living with ADHD: Children with ADHD face repeated experiences of failure, criticism, and falling behind their peers academically and socially. These experiences naturally create anxiety about performance, social situations, and school.
Executive function challenges: ADHD affects planning, organization, and time management. When children struggle with these skills, they often develop anxiety about managing daily tasks and meeting expectations.
Difficulty predicting outcomes: Children with ADHD often struggle to anticipate consequences or plan ahead. This uncertainty can fuel anxiety about what might happen in various situations.
How to Tell Them Apart: ADHD or Anxiety?
One of the biggest challenges parents face is distinguishing ADHD symptoms from anxiety symptoms, especially because they can look remarkably similar.
Difficulty concentrating could be:
ADHD: Distractibility due to difficulty filtering out irrelevant stimuli
Anxiety: Attention hijacked by worried thoughts
Both: Worry about performance, making existing attention problems worse
Avoidance behaviors could be:
ADHD: Avoiding tasks that require sustained mental effort
Anxiety: Avoiding situations that trigger fear or worry
Both: A child who's both overwhelmed by the cognitive demands and anxious about failure
Restlessness or fidgeting could be:
ADHD: Hyperactivity and difficulty sitting still
Anxiety: Physical manifestation of nervous energy
Both: Hyperactivity worsened by anxious feelings
Task incompletion could be:
ADHD: Losing focus and forgetting to finish
Anxiety: Perfectionism leading to task paralysis
Both: Starting impulsively without planning, then becoming anxious about doing it wrong
This is why a comprehensive evaluation from a child psychologist in La Jolla is so important. A thorough assessment can tease apart which symptoms stem from which condition, allowing for targeted treatment that addresses both issues.
Common Presentations of Comorbid ADHD and Anxiety
Children with both ADHD and anxiety don't all look the same, but certain patterns emerge frequently in my practice:
The perfectionist who can't start: These children want everything to be perfect, but their ADHD makes it hard to organize their thoughts and begin tasks. They spend hours on a single math problem or refuse to write anything because it won't be good enough. What looks like procrastination is actually anxiety-driven paralysis combined with ADHD-related executive dysfunction.
The school avoider: These children develop intense anxiety about school—often focused on specific triggers like tests, presentations, or PE class. Their ADHD makes school genuinely harder, and anxiety about performance leads to stomach aches, tears, and refusal to attend. The more school they miss, the further behind they fall, increasing both anxiety and ADHD-related academic struggles.
The socially anxious, impulsive child: ADHD impacts social skills—interrupting, missing social cues, being too loud or physical. When other children react negatively, anxiety develops. Now the child is both impulsive (ADHD) and worried about social judgment (anxiety), creating an exhausting internal conflict.
The worrier who can't sleep: ADHD makes it hard to settle down at bedtime, and anxiety fills the quiet moments with worries. These children lie awake ruminating about mistakes they made, things they forgot, or what might go wrong tomorrow.
The Role of Cognitive-Behavioral Therapy in Treating Anxiety and ADHD
While parent strategies are crucial, many children with both ADHD and anxiety benefit significantly from individual therapy. Cognitive-behavioral therapy (CBT) is the gold-standard treatment for childhood anxiety and is also effective in addressing ADHD-related challenges.
How CBT Helps Anxious Children with ADHD
Identifying and challenging anxious thoughts: Children with anxiety often have automatic negative thoughts that fuel worry and avoidance. CBT teaches them to notice these thoughts and evaluate whether they're accurate or helpful. A child who thinks "I can't do my homework. I'll get everything wrong" learns to challenge that thought: "I might make some mistakes, but I've done homework before and usually get some right."
Gradual exposure to feared situations: For school avoidance, perfectionism paralysis, or social anxiety, CBT uses exposure therapy by gradually facing feared situations in a controlled, supportive way. A child who refuses to go to school might start by driving past the school, then walking in for five minutes, then attending a half day, building up to full days. Each successful exposure reduces anxiety.
Learning coping skills: CBT teaches concrete tools for managing anxiety and ADHD challenges such as deep breathing, progressive muscle relaxation, breaking tasks into steps, time management strategies, and problem-solving skills.
Addressing perfectionism: Children with both conditions often develop all-or-nothing thinking: "If it's not perfect, it's terrible." CBT helps them develop more flexible thinking and tolerance for imperfection.
Building emotional awareness: Many children with ADHD struggle to identify and name emotions. CBT helps them recognize what they're feeling and choose appropriate responses rather than reacting impulsively.
Creating behavioral experiments: CBT therapists work with children to test their anxious predictions. "You think everyone will laugh if you raise your hand in class. Let's try it once and see what actually happens." Usually, reality is far less catastrophic than anxiety predicts.
What to Expect from Therapy at SoCal Child Psychology
When you bring your elementary-aged child to individual therapy with us, we create a treatment plan tailored to their unique combination of ADHD and anxiety. Therapy typically includes:
Child sessions: Your child meets one-on-one with a therapist who uses play, games, and age-appropriate activities to teach skills and gradually address anxious avoidance.
Parent consultation: We work closely with you to ensure therapy strategies are reinforced at home and to coach you on reducing accommodations and building your child's confidence.
School collaboration: With your permission, we can communicate with teachers to ensure your child receives appropriate support and accommodations in the classroom.
Progress monitoring: We regularly assess how your child is doing and adjust the treatment approach based on what's working.
If your elementary-aged child is struggling with both ADHD and anxiety, it can feel overwhelming. You might wonder if life will always be this hard for them, if they'll ever feel confident, if school will always be a battle.
Contact SoCal Child Psychology today to schedule a comprehensive evaluation or to learn more about our therapy services for anxious children with ADHD.
Evaluations for Kids and Children with ADHD and Other Concerns
When your child is struggling with focus, behavior, or school performance, it can feel overwhelming to know what’s really going on.
Our psychological evaluations at SoCal Child Psychology provide families across San Diego with answers and a roadmap for support. From ADHD and learning differences to anxiety and other concerns, we use evidence-based assessments to identify your child’s unique needs.
With this knowledge, you can advocate confidently at school and make informed choices about treatment. Reach out today to schedule a child ADHD evaluation in San Diego or La Jolla and give your family the clarity you deserve.