Anxiety vs ADHD? How to Tell the Difference



One of my jobs as a child psychologist is to discern what underlying issues are present when a child presents with symptoms of inattention and hyperactivity.


I’d like to give you a peek “behind the curtain” to see how I assess symptoms and what leads me to my diagnostic conclusions.


When a child presents with inattention, lack of focus, hyperactivity and other signs of dysregulation, I immediately ask parents about their child sleeping and eating habits.


Why sleeping and eating?


Because a tired brain is inefficient and unfocused and the body can use adrenaline and epinephrine boosts to keep a body awake. When this happens in children they can look very “wired.”


This is why overtired baby is so cranky and difficult to soothe, rather than sleepy and drowsy. The same happens in older kids (and adults) as well, but can look like ADHD symptoms.


In the same way, a child who doesn’t eat well has a “hungry” brain. Our children’s developing brains need a lot of protein and carbohydrates to function optimally. Kids who are not consuming enough of either, or too many empty calories, will have under functioning brains and can again, appear to have ADHD symptoms.


If your child is sleeping and eating relatively well, I shift my assessment to consider if inattention and hyperactivity are related to possible anxiety.


How do I do this?


I look for patterns in the symptoms and ask the following questions:

  • Do symptoms happen at home and school ,or only in one place?
  • Are symptoms consistent throughout the day or only occur at certain times?
  • Are there other indications of anxiety, such as expressed fears/worries, avoidance of certain people/places/things/topics?

Depending on those answers I can better determine the answer to the ADHD vs Anxiety question.


As a general rule, ADHD symptoms are consistent across settings and occur throughout the day from wake up to bedtime. Teachers see inattention and/or hyperactivity. You experience these during school days and on weekends. Your child may try to focus or sit still, but just can’t contain their impulses.


On the other hand, anxiety can be more time, place, context specific. Your child may appear hyperactive in social situations, but not at home playing with a sibling. Or they appear unfocused when taking a test, but can focus just fine on a crafting project at home or in school.


Why Do anxiety and ADHD Look Similar?


Children who are anxious typically don’t have the awareness that they are behaving as a result of worries. They are just reacting to a situation that is uncomfortable. When children are anxious they appear inattentive because they can’t focus on what is going on around them when they are worrying in their mind.


The same holds true for hyperactive behavior. Anxiety can trigger our bodies “spring into action” as part of our innate fight or flight response. When a child is anxious they can start to move quickly and erratically as they try to cope with a situation that feels very uncomfortable.


Why Does the ADHD vs Anxiety Diagnostic Difference Matter?


The treatment approaches for ADHD and anxiety are different. A child with anxiety will not necessarily benefit from psychostimulants, for example.

Also, cognitive and behavioral coping skills for each disorder are unique to each.

Therefore it is important to understand the distinction before embarking on a treatment plan.