- Generalized anxiety disorder commonly co-exists with ADHD in adults.
- The anxiety-ADHD combination is associated with greater life difficulties than having ADHD alone.
- Effective treatments for the uncertainty inherent in adult ADHD may also benefit anxiety relief.
A recently published study from Canada examined the link between generalized anxiety disorder (GAD) and adult ADHD. Of the nearly 7000 respondents to a mental health survey, 682 had GAD; 272 had ADHD. More than 11 percent of the GAD group had co-existing ADHD, whereas only 3 percent of the sample without GAD had ADHD.
Within the adult ADHD group, 25 percent had GAD. Adults with both GAD and ADHD compared to those with only ADHD were more likely to have experienced at least one adverse childhood event, a history of substance abuse and depression, be female, and were white. The GAD-ADHD group also had lower educational attainment, income, and close relationships. These results were published in the Journal of Affective Disorders.
Anxiety has long been known to be the most common co-existing diagnosis with ADHD in adulthood. This also makes sense based on clinical experience. A core theme of anxiety is dealing with uncertainty, the not knowing what might happen, which can also manifest as intolerance of uncertainty. These factors underlie the more commonly associated issues of fear, risk, and threat associated with anxiety.
Well, ADHD by its nature is an uncertainty generating condition. Across-the-board difficulties with the consistent inconsistency inherent in living with ADHD stem from chronic self-regulation problems or executive dysfunction. The executive functions are a suite of skills, such as time management, motivation, and emotional self-control, that help keep you on track for goals and other behavioral plans important to you, including the have-to tasks that we just want to get out of the way and be done with.
ADHD makes much a daily life and adult roles more complicated to manage for adults with the diagnosis. It makes sense, then, that matters, such as getting out the door on time, keeping up with assignments and errands, and any other common responsibilities are met with apprehension. In clinical practice, many adults report anxiety that might not meet the specific diagnostic criteria for GAD but are nevertheless clinically significant and targets for treatment.
Fortunately, the available evidence-based treatments for adult ADHD, both medical and psychosocial, are effective both for ADHD and often have the side benefit of reducing anxiety. Stimulant medications approved for adult ADHD can be helpful even though it sounds counter-intuitive – wouldn’t they increase anxiety? In fact, such increased feelings of jitteriness can be a side effect.
However, many other people notice that reduced symptoms and improved functioning and follow-through on obligations and goals reduces anxiety. Similarly, cognitive-behavior therapy (CBT) adapted to adult ADHD helps with the implementation of the necessary coping skills for managing executive function difficulties. These skills also benefit from their use with existing CBT approaches for more effectively dealing with avoidance, which is a hallmark of both ADHD and anxiety.
So, yes, ADHD and anxiety are a common and frustrating combination for many adults. The main takeaway is there are many effective options for not only facing worries and managing ADHD, but also that can be used as springboards for newfound endeavors and experiences.
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Fuller-Thomson et al. (2021). Generalized anxiety disorder among adults with attention deficit hyperactivity disorder. Journal of Affective Disorders, online ahead of print.