Is It ADHD or Anxiety? How to tell the difference, and when you can have both.

An expressive, moody painting depicts a person holding their face in their hands with an expression of distress, surrounded by chaotic, swirling brushstrokes in dark muted tones. Written throughout the background surrounding their head are handwritten phrases expressing overwhelm, such as "too much to do," "what am i doing?," "can't focus," "so behind," "never enough," and "stuck again."

Many adults who question whether they may have attention-deficit/hyperactivity disorder (ADHD) or anxiety are asking a reasonable question: can both interfere with executive functioning (i.e., concentration, task initiation, task completion, emotional regulation, etc.), sleep, and daily functioning? A person may describe racing thoughts, procrastination, psychomotor restlessness, avoidance, overwhelm, missed deadlines, or an overall inability to “just get started”. These experiences are real and often impairing, but they do not automatically point to one diagnosis.

The most clinically useful question is not simply, “Do I have trouble focusing?” Rather, it is, “What is driving the difficulty, when did it begin, how consistently does it occur, and in what contexts does it worsen?” ADHD and anxiety can resemble one another, can worsen one another, and frequently co-occur. An accurate formulation requires including developmental history, symptom patterns, functional impairment, and alternative explanations for concentration or regulation difficulties (Alarachi et al., 2024; Torgersen et al., 2022; Zhang et al., 2022).

This article is educational and is not a substitute for a comprehensive diagnostic assessment by a qualified clinician.

Why ADHD and Anxiety Can Be Confused

ADHD is a neurodevelopmental condition characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning. While it is commonly identified in childhood, many people are not assessed until adolescence or adulthood. This is particularly true for individuals whose difficulties were masked by high intelligence, strong external structure, family support, perfectionism, fear of failure, or the ability to perform well in highly interesting or urgent situations (National Institute for Health and Care Excellence [NICE], 2018).

Anxiety disorders are characterised by excessive fear, worry, apprehension, avoidance, and psychological arousal. Anxiety can affect attention because the mind is occupied with possible threats, negative outcomes, uncertainty, self-criticism, or repeated attempts to gain reassurance and control. When the nervous system is activated for danger, it becomes more difficult to remain mentally present with routine tasks, conversations, reading, or decision-making.

The overlap can be significant. Both ADHD and anxiety may involve distractibility, restlessness, difficulty sleeping, irritability, procrastination, forgetfulness, impaired working memory, emotional overwhelm, and problems completing tasks. In clinical settings, these shared features can complicate diagnosis, particularly when adults present with only their current symptoms and do not receive a developmental and psychiatric history (Alarachi et al., 2024; Torgersen et al., 2022).

However, overlap does not mean that ADHD and anxiety are interchangeable. They often differ in their underlying mechanisms. ADHD-related attention problems typically involve dysregulation of attention, motivation, planning, task initiation, time awareness, and impulse control. Anxiety-related concentration problems are more often tied to worry, threat monitoring, avoidance, psychological activation, or repetitive negative thinking.

Worry Versus Distractibility

One of the clearest ways to begin distinguishing ADHD from anxiety is to examine the content and direction of the person’s thoughts.

In anxiety, thoughts often become repetitive and threat-focused. A person may be preoccupied with questions such as: “What if I make a mistake?” “What if I disappoint someone?” “What if I lose my job?” “What if this physical sensation means something is wrong?” “What if I can’t handle what happens next?” The mind may circle around the same concern repeatedly, searching for certainty or attempting to prevent a feared outcome. This process can make concentration difficult because attention is being pulled toward perceived danger rather than the task at hand.

In ADHD, the subjective experience may also be described as racing thoughts, but the pattern is often different. Thoughts may move rapidly from one unrelated topic to another. A person may begin thinking about an unfinished email, then remember a household task, notice an external distraction, consider a new project idea, recall a conversation, and then realize that they have lost the thread of what they were doing. The central problem is not always fear. It may be difficulty filtering competing stimuli, sustaining voluntary attention, holding information in working memory, or returning to the original task after an interruption.

These differences are not absolute. A person with ADHD may become highly anxious after years of missed deadlines, forgotten obligations, financial stress, interpersonal conflict, or inconsistent performance. Likewise, a person with chronic anxiety may become distractible because so much cognitive energy is devoted to worry. Still, asking whether thoughts are primarily fear-based and repetitive or rapid, associated, and easily redirected can provide useful clinical information.

Difficulty Concentrating: What Happens When You Are Calm?

Both ADHD and anxiety can make it hard to pay attention. This difference often becomes clearer when anxiety is lower.

With ADHD, attention challenges frequently persist even during relatively calm or positive periods. The person may be distracted during low-stimulation tasks, lose track of conversations, forget what they intended to do, struggle to read material that is not immediately engaging, underestimate how long projects will take, or have trouble organizing multi-step responsibilities. They may be able to focus intensely on something highly interesting, urgent, novel, or rewarding while remaining unable to begin a routine administrative task. This pattern is sometimes misunderstood as a lack of effort or motivation. More accurately, it reflects inconsistent regulation of attention and activation.

With anxiety, concentration may improve when worry, physiological arousal, or perceived threat decreases. A person may be able to focus adequately when they feel safe, rested, and emotionally settled, but struggle when facing uncertainty, interpersonal conflict, performance demands, financial pressure, health concerns, or situations in which they fear making a mistake. Their difficulty concentrating may be less about the task itself and more about the internal alarm system competing for attention.

For example, an employee with ADHD may repeatedly delay expense reports because the task is tedious, detail-heavy, and difficult to organize, even if there is no particular fear associated with it. An employee with anxiety may delay the same expense report because they worry they will enter something incorrectly, violate a policy, be judged as incompetent, or trigger criticism from a supervisor. The behavior, procrastination, looks similar, but the mechanism differs.

‍Restlessness and Physical Anxiety

Restlessness can also arise from either ADHD or anxiety. In ADHD, restlessness may involve fidgeting, frequent movement, difficulty sitting through long meetings, interrupting, impatience, excessive talking, a tendency to act before thinking, or an internal sense of needing to stay active. Adults with ADHD may describe feeling uncomfortable when understimulated or may seek novelty, movement, multiple simultaneous activities, or urgent deadlines to feel engaged.

In anxiety, restlessness more often occurs alongside physiological arousal. This may include muscle tension, shakiness, stomach discomfort, sweating, rapid heartbeat, chest tightness, shortness of breath, fatigue, sleep disruption, or a persistent sense of being “on edge.” The person may feel compelled to move, check, seek reassurance, overprepare, or leave a situation because their body is signaling danger.

These differences depend partly on function. ADHD-related movement may help a person regulate alertness or sustain focus, while anxiety-related movement may help the person reduce distress, escape uncertainty, or manage a threat response. Of course, these patterns can overlap. A person with ADHD and anxiety may need movement to focus and also experience physical tension related to chronic worry.

Procrastination, Avoidance, and Executive Dysfunction

Procrastination is often treated as a moral failing or a sign that someone does not care enough. In clinical practice, it is more useful to ask what prevents the person from beginning or completing the task.

In ADHD, procrastination is often associated with executive dysfunction. Executive functions are cognitive processes involved in starting tasks, organizing materials, prioritizing, sustaining attention, monitoring progress, regulating emotion, estimating time, remembering future obligations, and shifting flexibly between demands. A person may deeply value a task and still feel unable to initiate it. They may wait until urgency creates enough activation to begin, become overwhelmed by the number of steps involved, lose track of time, or become diverted by other demands before completing the original task.

This internal experience may sound like, “I know exactly what I need to do, but I cannot make myself start”; “The task feels impossibly large”; “I meant to do it all day”; or “I only seem to function when there is a deadline.” These challenges may occur even when the person is not particularly worried or emotionally distressed.

On the other hand, with anxiety, avoidance often functions as an attempt to reduce immediate discomfort. A task may be postponed because it evokes fear of failure, rejection, criticism, uncertainty, conflict, embarrassment, or loss of control. Avoidance brings short-term relief, which unintentionally reinforces it. Over time, the task can become more emotionally charged and more difficult to approach.

A person with anxiety may think, “If I do not open the email, I cannot receive bad news”; “I need to be completely prepared before I begin”; or “I cannot submit this until I am certain it is perfect”. This pattern is particularly common when anxiety is linked to evaluation, responsibility, social judgement, or fear of making mistakes.

Yet ADHD and anxiety can create a self-reinforcing cycle. Someone with ADHD may procrastinate because of difficulty initiating or organizing a task. As deadlines approach, the consequences of delay may create legitimate anxiety. The person may then avoid the task because it has become emotionally overwhelming, which increases both the workload and the anxiety. By adulthood, it can be difficult to identify where one process ends and the other begins.

Perfectionism Is Not Proof of Anxiety

Perfectionism is commonly associated with anxiety, and it can certainly reflect fear of criticism, failure, rejection, or making an irreversible mistake. A person may spend excessive time editing an email, reviewing work repeatedly, delaying submission until every detail feels controlled, or avoiding a project because they do not believe they can complete it flawlessly.

However, perfectionism can also emerge as a compensatory strategy in ADHD. Adults who have spent years being criticized for carelessness, disorganization, missed details, lateness, inconsistent output, or underachievement may become highly vigilant about errors. They may overcheck work, overprepare for meetings, avoid delegating, or hold themselves to impossible standards because they fear confirming others’ negative assumptions about them.

In this sense, perfectionism may be anxiety-driven, ADHD-related, or both. The relevant question is not whether perfectionism is present, but what purpose it serves. Is the person attempting to prevent catastrophe or judgement? Are they trying to compensate for a history of executive function errors? Are they caught in a cycle in which fear of imperfection prevents task completion? These differences matter for treatment planning.

Developmental History Is Essential

Because ADHD is a neurodevelopmental disorder, its symptoms must have begun in childhood, even if the impairment was not recognized at the time. Current diagnostic standards require evidence that ADHD symptoms were present before the age of 12, that symptoms occur across more than one setting, and that they result in clinically significant functional impairment (NICE, 2018).

For an adult considering ADHD, childhood signs may include frequent daydreaming, chronic lateness, forgotten assignments, difficulty following multistep directions, fidgeting, talking excessively, losing belongings, academic inconsistencies, procrastination, messy workspaces, impulsive behavior, or repeated feedback that they were “bright but not applying themselves”. Other people remember working much harder than peers to manage tasks that seemed to come easily to others, relying on last-minute pressure, or becoming intensely focused on only a narrow range of interests.

Not everyone with ADHD has obvious behavioral problems in childhood. Some children internalize their struggles, perform adequately in structured environments, or receive enough support from parents, teachers, or routines that impairment becomes more apparent only in adulthood. This is particularly relevant for people whose presentations were inattentive rather than overtly hyperactive or disruptive.

Anxiety can also begin early in life, but anxiety-related attention problems may have a different developmental pattern. A person might recall being organized, focused, and academically successful until a period of trauma, chronic stress, loss, illness, increased performance demands, or major life transition. Alternatively, they may remember longstanding worry, reassurance seeking, fear of mistakes, physical tension, and avoidance that intensified during particular periods.

A qualified clinician will not rely on a single childhood memory or an online screening result. A comprehensive assessment may include a detailed developmental interview, review of historical school information when available, collateral information from someone familiar with the person’s early history if needed, and an examination of functioning across work, home, relationships, education, finances, and health responsibilities (NICE, 2018; Royal College of Psychiatrists, 2023).

When AdHD and Anxiety Co-Occur

It is entirely possible to have both ADHD and an anxiety disorder. In fact, anxiety disorders are among the most common psychiatric conditions that co-occur with ADHD in adulthood. A systematic review and meta-analysis of psychiatric comorbidity in adults with ADHD found high rates of co-occurring mental-health conditions, with anxiety disorders among the most frequently reported categories (Zhang et al., 2022). Earlier research has also indicated that anxiety disorders are substantially more prevalent among adults with ADHD than in the general population (Kessler et al., 2006; Torgersen et al., 2022).

Co-occurrence can develop for several reasons. ADHD-related difficulties with organization, impulsivity, task completion, financial management, academic performance, employment, and relationships can create repeated experiences of stress and negative feedback. Over time, a person may develop anticipatory worry about forgetting something, disappointing others, missing a deadline, making an error, or being exposed as incompetent.

At the same time, anxiety can intensify ADHD-related challenges. Persistent worry can disrupt sleep, drain working memory, increase avoidance, reduce flexibility, and make it harder to initiate tasks. This means that treating only one condition may not fully resolve the person’s difficulties. Anxiety treatment may reduce physiological arousal and worry while leaving longstanding executive-function impairments unaddressed. Similarly, ADHD-focused support may improve planning and follow-through while leaving severe fear, panic, avoidance, or trauma-related hyperarousal untreated.

The presence of one diagnosis should never be used as a reason to stop considering the other. A careful assessment asks whether the person’s symptoms are best explained by ADHD, anxiety, both conditions, or another factor entirely.

Other Conditions Can Resemble ADHD or Anxiety

ADHD and anxiety are not the only explanations for distractibility, restlessness, fatigue, forgetfulness, procrastination, or emotional overwhelm. Depression, trauma-related disorders, sleep disorders, substance use, learning disorders, autism-spectrum conditions, chronic stress, burnout, medication effects, thyroid conditions, hormonal changes, and other medical concerns can affect attention and executive functioning.

For example, trauma-related hypervigilance can look like distractibility because the person is continually scanning their environment for threat. Depression may create slowed thinking, poor concentration, reduced motivation, and difficulty completing ordinary tasks. Chronic sleep deprivation can produce irritability, impulsivity, poor working memory, and impaired attention. Burnout can reduce cognitive flexibility, motivation, memory, and emotional capacity even in a person without ADHD.

This is why a responsible diagnostic process includes a broad differential assessment rather than assuming that concentration difficulty automatically indicates ADHD. Adult ADHD evaluations should consider co-occurring psychiatric disorders, sleep problems, substance use, medical issues, trauma history, and environmental stressors that may contribute to or complicate the clinical presentation (American Academy of Family Physicians, 2024; NICE, 2018).

Questions to Consider Before an Assessment

It can be useful to reflect on your experiences before meeting with a clinician. The goal is not to self-diagnose, but to identify patterns that may help guide a more productive conversation.

Consider whether your attention problems were present in childhood and whether they have appeared across multiple areas of your life. Ask yourself whether you struggle to focus even when you are calm, safe, interested, and not facing a major stressor. Notice what happens internally when you procrastinate: do you feel unable to organize and initiate the task, or are you avoiding the anxiety the task evokes?

Pay attention to the nature of your thoughts. Are they primarily organized around feared outcomes, criticism, uncertainty, or danger? Or do they move quickly among unrelated topics, stimuli, tasks, and ideas? Consider whether physical symptoms such as tension, rapid heartbeat, nausea, shaking, or panic are central to your experience. Also notice whether highly structured environments, accountability, external deadlines, body doubling, reminders, or breaking tasks into small steps improve your functioning. These details do not establish a diagnosis, but they can help clarify the mechanisms involved.

It is also important to examine impairment. Everyone loses focus occasionally, procrastinates, or becomes anxious under pressure. A clinical evaluation becomes more relevant when the pattern is persistent, difficult to control, and associated with meaningful problems in employment, education, relationships, finances, parenting, health management, driving, household responsibilities, or emotional well-being.

The Bottom Line

ADHD and anxiety can look remarkably similar from the outside. Both can involve racing thoughts, poor concentration, restlessness, procrastination, avoidance, sleep difficulties, overwhelm, and frustration with unfinished tasks. The difference often lies in the pattern beneath the symptom.

ADHD is more likely to involve longstanding and cross-situational difficulty regulating attention, effort, planning, time, working memory, and impulse control. Anxiety is more likely to involve fear-based worry, physical arousal, threat monitoring, avoidance, and difficulty tolerating uncertainty. However, neither description excludes the other. Many adults experience both ADHD-related executive dysfunction and clinically significant anxiety.

If you recognize yourself in either pattern, the most helpful next step is not to decide on a diagnosis alone. It is to seek an assessment that takes your developmental history, present-day functioning, emotional health, and broader life context seriously. A well-formulated diagnosis can reduce self-blame and make it possible to pursue support that addresses the actual drivers of your difficulty.

References

Alarachi, A., Merrifield, C., Rowa, K., & McCabe, R. E. (2024). Are we measuring ADHD or anxiety? Examining the factor structure and discriminant validity of the Adult ADHD Self-Report Scale in an adult anxiety disorder population. Assessment. Advance online publication. https://doi.org/10.1177/10731911231225190

American Academy of Family Physicians. (2024). Attention-deficit/hyperactivity disorder in adults. American Family Physician, 110(2), 153–164.

Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Üstün, T. B., & Walters, E. E. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. https://doi.org/10.1176/ajp.2006.163.4.716

National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: Diagnosis and management (NICE Guideline NG87). Updated 2019. https://www.nice.org.uk/guidance/ng87

Royal College of Psychiatrists. (2023). Attention deficit hyperactivity disorder (ADHD) in adults: Good practice guidance (College Report CR235). https://www.rcpsych.ac.uk

Torgersen, T., Gjervan, B., Lensing, M. B., & Rasmussen, K. (2022). Anxiety disorders in adult attention-deficit/hyperactivity disorder: A frequent comorbidity and a diagnostic challenge. Journal of Affective Disorders, 314, 41–48. https://doi.org/10.1016/j.jad.2022.04.027

Zhang, L., Yao, H., Li, L., Liang, Y., & Yang, S. (2022). The prevalence of psychiatric comorbidities in adult attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. PLOS ONE, 17(11), Article e0277175. https://doi.org/10.1371/journal.pone.0277175

About Dr. Cristina Louk, PhD, LMHC

Dr. Cristina Louk, PhD, LMHC, is a Licensed Mental Health Counselor in Washington State and the founder of Peace Humanistic Therapy, specializing in ADHD, trauma, and neurodivergence in adolescents and adults. She provides psychotherapy and comprehensive ADHD and ASD assessments, with particular expertise in the evaluation of ADHD and autism and in understanding how ADHD can affect executive functioning, emotional regulation, relationships, identity, and daily functioning across the lifespan.

Dr. Louk holds a PhD in Clinical Psychology and has extensive doctoral-level training and clinical experience in psychological assessment and the evaluation of ADHD and related conditions. Her clinical approach integrates research-informed practice with a humanistic, strengths-based perspective that considers both an individual's symptoms and the developmental and environmental factors that influence how those symptoms are experienced.

In addition to her clinical practice, Dr. Louk is an Approved Clinical Supervisor and professional educator for mental health clinicians. She serves as President of the Washington Mental Health Counselors Association (WMHCA) and is actively involved in professional education and advocacy within the mental health field.

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