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Concentration Problems: Distinguishing Between Anxiety and ADHD

The pandemic has made it difficult to tease apart symptoms of anxiety and ADHD.

Key points

  • Anxiety and ADHD can both cause difficulties with concentration, which many people have experienced during the pandemic.
  • Distinguishing the diagnoses of anxiety and ADHD involves timing of onset, the theme of the person's worries, and psychological testing.
  • Anxiety is more common than adult ADHD.
Photo by Andrea Piacquadio from Pexels
Source: Photo by Andrea Piacquadio from Pexels

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.

3. Testing

  • Several free rating scales are available online and are widely used in primary care clinics. The Adult ADHD Self-Report Scale (ASRS-v1.1) and Generalized Anxiety Disorder 7 (GAD-7) rely on self-report and are not diagnostic.
  • A clinical history by a professional should follow up with more detailed questions related to areas of overlap, medical problems, and family history.
  • A full battery of testing by a trained psychologist is ideal but difficult to access due to insurance limitations and lack of providers. Measures like processing speed and working memory are combined with the types of errors made on computerized tests.
  • Some testing options may be limited during telehealth visits.

The Pandemic Complicates Diagnosis

Correct diagnosis is essential for appropriate medication management as ADHD is treated primarily with stimulant medications while anxiety typically responds to antidepressants like selective serotonin reuptake inhibitors (SSRIs). Cognitive therapies can be directed at the thought component for anxiety, while patients with ADHD may benefit from a coaching approach around organizational skills and time management.

In the end, whether a patient is suffering from anxiety or ADHD, many recommendations are the same. Creating a routine, scheduling a mix of activities (work, chores, play/relaxation), and exercise will help manage symptoms.

Teasing out anxiety symptoms versus adult ADHD was more challenging than ever over the past year due to the unusual circumstances of COVID-19. Given the complexity and risks associated with medications, psychiatric providers are likely to continue to require objective psychological testing before jumping to a prescription.

LinkedIn image: Narith Thongphasuk38/Shutterstock

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