ADHD and Anxiety: A Psychological Perspective

In Honor of All Who Struggle Without Knowing Why

I recently began working with a wonderful new client in her late 20s who shared that she had experienced intense anxiety for as long as she could remember. Her story is what inspired me to write this blog — in the hope that it might resonate with others facing similar challenges.

Throughout her life, anxiety had significantly impacted her daily functioning. It led her to withdraw from social activities, avoid gatherings with friends, and struggle with consistent participation in everyday responsibilities. Despite years of therapy and various medications, she continued to feel stuck and misunderstood. Eventually, she was referred to me by one of my former students.

After conducting her intake, I had a gut feeling that my client was experiencing something more than the anxiety she disclosed. I asked her if she would be open to completing two assessments: the GAD-7, which screens for Generalized Anxiety Disorder—her primary concern and the reason she initially sought support—and the ASRS v1.1, the Adult ADHD Self-Report Scale. As expected, she scored in the "severe anxiety" range on the GAD-7. However, she was completely taken aback to discover that her ASRS results placed her in the 98th percentile, indicating symptoms highly consistent with ADHD. In my client's case, she would have never found total relief from her anxiety if this had not been discovered.

When I taught graduate-level psychology, I always emphasized the importance of identifying the root cause of a client’s distress. What presents on the surface is often just a symptom—not the true core of the issue. In this case, what she had always believed to be lifelong anxiety was, in fact, largely the result of years of undiagnosed ADHD.

From a clinical psychology standpoint, Attention-Deficit/Hyperactivity Disorder (ADHD) and anxiety disorders frequently co-occur, with research suggesting that 25–50% of individuals with ADHD also experience significant anxiety symptoms. While they are distinct conditions, there is a strong bidirectional relationship between the two — especially in cases where ADHD remains undiagnosed or untreated.

Why ADHD Can Lead to Anxiety

1. Chronic Executive Dysfunction - ADHD impairs executive functions like planning, working memory, attention regulation, and task initiation. When these challenges are not understood (due to lack of diagnosis), individuals may experience repeated failure or underperformance, leading to self-doubt, shame, and fear of future mistakes — all core components of anxiety.

2. Internalized Stress From Inconsistency - People with ADHD often know what they need to do, but struggle to act on it consistently. This disconnect between intention and action — sometimes called "inconsistent performance syndrome" — can create a constant internal pressure. The fear of letting others down, missing deadlines, or forgetting important tasks fosters persistent anxiety, especially in academic or work environments.

3. Negative Self-Talk and Misattribution - Without a diagnosis, individuals may attribute their ADHD-related difficulties to character flaws — such as laziness, irresponsibility, or lack of discipline. Over time, this erodes self-esteem and leads to anticipatory anxiety, particularly around performance, social judgment, or daily functioning.

4. Sensory and Emotional Dysregulation - ADHD is not just about focus — it also involves emotional impulsivity and sensory sensitivity. This heightened reactivity can cause overstimulation and overwhelm in situations that might seem mundane to others, contributing to somatic symptoms of anxiety (like racing heart, panic, or irritability) without an obvious cause.

5. Compensatory Perfectionism and Hypervigilance - To manage their impairments, many undiagnosed individuals adopt coping strategies like perfectionism, hyperplanning, or people-pleasing. These can be temporarily effective, but unsustainable — eventually leading to burnout, worry, and generalized anxiety.

Why Diagnosis Matters

When ADHD is diagnosed and understood, individuals can reframe their struggles as neurological, not moral, reducing shame and anxiety. Evidence-based treatments — including behavioral strategies, psychoeducation, medication, and coaching — not only improve focus and task management, but often reduce anxiety as a secondary benefit. In contrast, treating anxiety alone (e.g., with CBT or anti-anxiety medication) without recognizing underlying ADHD may yield limited results, since the root causes — disorganization, time blindness, and mental restlessness — are still unaddressed.

Undiagnosed ADHD can create the conditions for chronic anxiety through a combination of cognitive overload, repeated failure experiences, social misunderstanding, and harsh self-judgment. When properly identified, many individuals find that what they thought was lifelong “anxiety” was actually a response to living with unmet neurodevelopmental needs.