Hidden anxiety in teens with ADHD

Adolescence is tough. It's easy now, as adults, to look back to our teen years and reminisce about how "easy" it was—but that's only in comparison to our busy lives now. At the time, though, being a teenager came with more than enough struggle. Fitting in with peers, keeping up with schoolwork, potentially on top of your first job and extracurriculars, all at a time when the brain and body is still developing…it's a lot.

Now, imagine navigating all of that with a brain that's constantly in overdrive. Picture trying to focus on a math problem while a dozen different thoughts compete for your attention, like a crowded party in your mind where everyone's shouting at once. This is the reality for many teens with ADHD.

But what if, on top of this mental chaos, there's also a constant undercurrent of worry and fear? Remember that pit in your stomach on the first day of high school? That flutter in your chest before a big presentation? Now, imagine feeling that way almost all the time—even when there's no clear reason.

This is where anxiety enters the picture.

You may see your teen struggling and wonder, is this just typical teenage angst, or is there something more going on? Could the restlessness we attribute to ADHD actually be a sign of underlying anxiety? And how can we tell the difference?

In this post, we'll cover the often subtle, yet crucial connection between ADHD and anxiety in teenagers, and most importantly, what you can do to help.

Are teens with ADHD more likely to experience anxiety?

Teens with ADHD are significantly more likely to experience anxiety compared to their neurotypical peers. In fact, ADHD and anxiety often go hand-in-hand, with around a third of kids experiencing both and girls more likely to be affected. Additionally, nearly 50% of individuals with ADHD experience anxiety.

For teenagers, the pressures of social and academic life demand sustained focus and attention - the exact areas where individuals with ADHD often face significant challenges. As a result, stress and anxiety can intensify, particularly when struggles with task management become overwhelming.

Without the right support systems—whether through therapy, medication, or personalized learning strategies—managing both ADHD and anxiety can feel frustrating.

Why are teens with ADHD more likely to experience anxiety?

Anxiety is more common among teens with ADHD for a number of reasons, including;

• Brain Chemistry: Teens with ADHD have brains that work differently, which affects how they regulate emotions, leading to increased anxiety.
• Difficulty in emotional regulation: Emotional regulation difficulties can cause heightened stress levels, making academic and social challenges more difficult.
• Sensitivity to stress: Teens with ADHD are more sensitive to stress, which can increase their risk of sleep related disorders and trauma.
• Stress-Trauma Cycle: Stress, sleep disorders, and trauma can amplify each other, further increasing anxiety levels in teens with ADHD.
• Overwhelm Response: The demands of schoolwork, social relationships, and extracurricular activities can feel overwhelming, contributing to anxiety.
• Specific responses: Anxiety in teens with ADHD may appear in specific situations, such as public speaking or test taking, or as generalized worry and nervousness.

How does combined ADHD & anxiety impact teens?

ADHD and anxiety often feed into each other, creating a feedback loop that's hard to break. For instance, ADHD symptoms like disorganization and trouble managing time can make anxiety worse, leading to additional stress and overwhelm. That additional anxiety, in turn, can make ADHD symptoms in teens more intense because stress and anxiety deplete the level of brain chemicals responsible for executive function.

Together, ADHD and anxiety can create unique challenges that impact relationships, school performance, and overall well-being, especially for young adults. Here are some key effects:

• New ADHD symptoms: Not everyone with ADHD experiences the same symptoms; there may be some stereotypical signs of ADHD that you’ve never seen your teen struggle with before, which suddenly seem to come out of nowhere.
• Increased stress and overwhelm: Combined ADHD and anxiety increases feelings of stress and overwhelm. When ADHD kicks in, everything feels more frantic and unmanageable, making your brain race with anxious thoughts.
• Emotional dysregulation: ADHD and anxiety make it tough for teens to keep their feelings and check. It feels like their emotions are already on high alert, making mood swings and outbursts more frequent and/or more intense.
• Social challenges: When teenagers with ADHD face social anxiety, it can be tough to connect with others.
• Physical symptoms: headaches, trouble sleeping, stomach aches, or extreme fatigue can also be more frequent.
• Academic struggles: Having both ADHD and anxiety can be a recipe for academic struggles, leading to subpar grades, missed deadlines, and added stress.
• Self-esteem and confidence issues: Living with ADHD and anxiety can be a real blow to a teen's self-esteem. They may struggle more with self-doubt and mask their ADHD as a result of confidence issues.
• Insomnia: Anxiety and ADHD can both make it difficult to “turn off” your brain at night, leading to decreased or more restless sleep. That lack of sleep is detrimental for emotional regulation, memory, and executive functioning.
• Increased risk of mental health issues: ADHD and anxiety can be a perfect storm that raises the risk of developing other mental health issues, like depression or substance abuse.
• Difficulty with time management and organization: Anxiety can make ADHD-related struggles with planning, organization, and time management even worse, making it even harder to stay on top of things and feel in control.

Since ADHD and anxiety have many symptoms in common, these overlapping symptoms may be more intense or trickier to manage.

What are the most effective treatments for teens with both ADHD and anxiety?

When it comes to treating teens with both ADHD and anxiety, a single approach often falls short. Instead, research shows that effective treatment typically involves a combination of therapy and treatment strategies that targets both conditions together.

• Therapy: Therapy is a great first step for managing ADHD and anxiety. One of the most effective approaches for anxiety is Cognitive Behavioral Therapy (CBT), which helps individuals identify and change negative thought patterns and behaviors that make things tougher. CBT can also be effective for some ADHD-related challenges. No matter the approach, therapy can help teens build emotional strength, boost self-confidence, and improve relationships.
• Medication: Medication can be a big help with both anxiety and ADHD management. It works by tweaking the brain's chemistry to ease symptoms. For ADHD, stimulants like Ritalin can improve focus and impulse control by boosting dopamine. For anxiety, SSRIs like Prozac can calm worries and tensions by regulating serotonin and GABA. Especially when paired with therapy, medication can make a real difference in how you feel and function in the long run.
• School-Based Interventions: Hands-on support right in the classroom helps to manage symptoms and boost academic performance. Common accommodations for students with ADHD include extra time to complete assignments, quiet spaces to focus, and structured routines, all of which can make a big difference. Teachers can also use strategies like frequent breaks, positive reinforcement, and clear instructions to minimize distractions and anxiety triggers. If your ADHD teen doesn’t yet have an IEP or accommodations, you can approach their teachers, counselor, or principal to ask about an evaluation.
• Lifestyle Modifications: Making some simple lifestyle changes can help manage ADHD and anxiety. Building healthy habits that can improve symptoms, such as regular exercise, healthy eating, and getting enough sleep, are essential lifestyle modifications. These simple lifestyle tweaks can create a solid foundation for managing ADHD and anxiety, and make teens with ADHD feel more in control and confident in their daily life.
• Parent Education and Support: Parent education and support are vital for managing ADHD and anxiety in children. When parents understand their child's needs, they can create a structured and supportive home environment that promotes emotional regulation and positive behavior. With guidance from support groups or an ADHD coach, parents can manage their own stress, communicate effectively with their child, and help them build self-esteem and thrive at home and in school.
• ADHD Coaching: ADHD coaching is a highly effective treatment approach for teens with both ADHD and anxiety. Often, the challenges that come along with ADHD cause or exacerbate anxiety. Coaching helps them develop essential skills like time management, organization, and problem-solving, reducing feelings of overwhelm and enabling them to manage tasks more efficiently. ADHD coaching ultimately minimizes anxiety in teens with ADHD by setting them up for success and well-being.

Bottom Line

Managing anxiety and ADHD in teens can be challenging, and often requires a proactive, combined treatment strategy. If you’re not sure where to start, ADHD coaching for teens can offer personalized guidance and strategies to help them find coping skills for ADHD in school, social situations, and more. So why wait? Take the first step towards helping your teen thrive. Consult with a teen ADHD coach today to create a personalized plan for success!

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