Spotting Anxiety in Kids with ADHD

All kids feel anxious sometimes, but many kids with ADHD experience anxiety more frequently and more severely than kids without ADHD. In fact, studies suggest that 30-40% of kids with ADHD also have an anxiety disorder. When kids struggle with anxiety on top of ADHD, it can make it harder for them to succeed at school and develop the social skills that they need to cultivate strong and lasting connections with their classmates and friends. The stimulant medications used to treat ADHD symptoms can also exacerbate anxiety, making these otherwise effective medications difficult to tolerate.

Identifying and treating anxiety in kids with ADHD is an important part of an effective intervention plan. While it might seem like spotting anxiety in a child with ADHD would be simple – you might expect that they’ll be telling an adult that they are nervous, worried, or have butterflies in their stomach – in reality, the signs of anxiety are often mislabeled by parents, teachers, and pediatricians as worsening ADHD symptoms. This happens in part because kids don’t always express their anxiety in the same way as adults. They may not be aware of the anxious thoughts or feelings they are having, and they may lack the more sophisticated language needed to describe complex emotions. On top of this, many of the signs and symptoms of anxiety in kids overlap directly with symptoms of ADHD.

Here are some of the key symptoms of anxiety in children:

  • Restlessness
  • Trouble concentrating
  • Irritability
  • Difficulty sleeping at night
  • Complaints about stomach problems or headaches
  • Excessive worry on most days (that they may or may not talk about with adults)
  • Avoiding certain activities or social situations

 

Many of these symptoms will seem very familiar to any parent or teacher of an ADHD child! Since kids with ADHD often experience restlessness, difficulty sleeping, difficulty concentrating, and even irritability, how can you tell when anxiety might be part of the picture? Here are a few clues that suggest a more thorough anxiety assessment is warranted:

  • Increased difficulty concentrating or increased restlessness Have you noticed a worsening in your child’s concentration problems or restlessness/hyperactivity? This change may be due to a worsening of their ADHD symptoms or a decrease in their ADHD medication’s effectiveness. But it could also be a sign that they have developed anxiety that is interfering with their ability to concentrate or sit still.
  • Increased irritability or oppositional behavior. Many kids with ADHD are prone to irritability or oppositional behavior. However, if a child has typically been easy going and this has suddenly changed, or if a child who was previously irritable occasionally is now irritable most of the time, then anxiety may be contributing to the problem.
  • A change in sleep patterns. Many kids with ADHD struggle to fall asleep or stay asleep throughout the night. However, if your child’s sleep challenges change (e.g., they have always had a hard time falling asleep, but now they are also waking up throughout the night), then anxiety may be playing a role.
  • Frequent complaints of stomach aches or headaches. Kids with ADHD don’t typically experience stomach aches or headaches more often than kids without ADHD (unless they are experiencing medication side effects). If these complaints persist and their pediatrician can’t find a medical cause, then they may be signs of anxiety.

 

  • Avoiding specific situations, places, or people. Kids with anxiety will try to do just about anything to avoid whatever it is that is triggering their anxiety. For example, if a child is anxious about school they may become very oppositional when it’s time to get out of the house in the morning or they may drag their feet and get ready as slowly as possible. Some kids might complain that they don’t feel well as an avoidance strategy, hoping that they will be able to stay home sick from school.

If you think your child may be showing some signs of anxiety, talk to their pediatrician. They can help you find a provider who can help tease apart your child’s symptoms and clarify whether anxiety is in fact part of the picture. The good news is that anxiety is highly treatable, especially in kids. Working with a clinician who can identify anxiety-related problems and provide evidence-based treatments can quickly lead to lasting improvements in your child’s symptoms.

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