If you have ever Googled your symptoms and found yourself reading about both ADHD and anxiety, you are not alone. The two conditions share a striking number of features — difficulty concentrating, restlessness, feeling overwhelmed, and trouble sleeping. They are easy to confuse, and they are frequently misdiagnosed as one another.

Understanding the difference matters — not just academically, but practically. ADHD and anxiety often require different treatment approaches, and treating the wrong condition can leave you feeling worse, not better.

Both ADHD and anxiety can produce:

• Difficulty sustaining focus or concentration
• Restlessness and an inability to relax
• Trouble sleeping
• Irritability and emotional sensitivity
• Avoidance of tasks that feel overwhelming
• Forgetfulness and disorganization

When you are sitting in a clinician's office describing these symptoms, the picture is not immediately clear. That is why a thorough evaluation — not a quick checklist — is essential.

This is often the most revealing question.

In ADHD, inattention is neurological. The brain has difficulty regulating attention regardless of the topic. You may struggle to focus on a boring task, but you can also hyperfocus intensely on something engaging. The inattention is inconsistent and stimulus-dependent — not driven by worry.

In anxiety, inattention is secondary to worry. Your mind is not wandering because it cannot focus — it is occupied. You are mentally rehearsing a difficult conversation, catastrophizing about a deadline, or running through worst-case scenarios. The inattention is a byproduct of an overactive threat-detection system.

Ask yourself: when you cannot concentrate, is your mind blank and drifting — or is it full and racing?

Both conditions produce restlessness, but the quality is different.

ADHD restlessness tends to feel like an internal motor — a need to be doing something, moving, stimulated. It is not necessarily unpleasant; it is just relentless.

Anxiety restlessness is driven by tension and dread. It feels more like being unable to settle because something bad might happen. There is an emotional charge to it — a sense of threat or urgency that ADHD restlessness typically lacks.

Both ADHD and anxiety can lead to avoidance, but the mechanism differs.

In ADHD, avoidance is often about activation — the brain struggles to initiate tasks that feel tedious, complex, or low-reward. It is not that you are afraid of the task; you simply cannot get started.

In anxiety, avoidance is fear-based. You avoid the task because completing it might reveal a mistake, invite criticism, or confirm a fear. The avoidance is protective.

In practice, these can look identical from the outside — and both can be present at the same time.

ADHD often disrupts sleep through racing thoughts at bedtime, difficulty winding down, and a tendency to stay up late (often called "revenge bedtime procrastination" — finally having quiet time when the demands of the day are over).

Anxiety disrupts sleep through worry — lying awake rehearsing tomorrow's challenges, replaying past events, or anticipating problems that may never materialize.

Here is the complication: ADHD and anxiety frequently co-occur. Research suggests that roughly 50% of adults with ADHD also have an anxiety disorder. This is not coincidence — years of struggling with ADHD symptoms, underperforming relative to your potential, and receiving criticism for things you could not control naturally produces anxiety.

When both are present, the picture becomes more complex. Treating only the anxiety may leave the underlying ADHD unaddressed. Treating only the ADHD may not fully resolve the anxiety that has developed around it.

This is why accurate, comprehensive diagnosis is so important. A clinician who specializes in adult ADHD understands how these conditions interact — and can help you understand what is driving what.

Adults with ADHD — particularly women and those with the predominantly inattentive presentation — are frequently diagnosed with anxiety or depression before anyone considers ADHD. The hyperactivity is absent or internal. The struggles look like worry, perfectionism, or emotional sensitivity. The ADHD goes unrecognized for years, sometimes decades.

If you have been treated for anxiety and still feel like something is missing — like the treatment helped but did not fully explain your experience — it may be worth exploring whether ADHD is part of the picture.

A comprehensive psychological evaluation can distinguish between ADHD, anxiety, and the combination of both. It examines your history, your cognitive profile, and the specific nature of your symptoms — not just what they look like on the surface, but what is driving them.

You deserve an accurate explanation for your experience. Sessions are available via telehealth throughout Long Island and New York State.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

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., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (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

Schatz, D. B., & Rostain, A. L. (2006). ADHD with comorbid anxiety: A review of the current literature. Journal of Attention Disorders, 10(2), 141–149. https://doi.org/10.1177/1087054706286698