ADHD or Anxiety? Telling Them Apart

Before my diagnosis, the thing I was told most often was that I was anxious. I believed it too, because it was true; I was anxious.

What I did not understand was this: when my anxiety passed, I still could not focus. On a calm day, on a morning when I was worrying about nothing, I would read a page and understand nothing. For a long time that gap stayed unanswered for me.

These two conditions are one of the pairs most often confused in the clinic, and the reason is obvious: both disrupt focus, both cause restlessness, both delay sleep.

Three signs that tell them apart

1. How attention is disrupted.

This is the most useful question and one you can ask yourself.

In ADHD attention settles nowhere: it jumps from one subject to another, the page is read but does not go in, and by the time you reach the end of the sentence its beginning is lost.

In anxiety, attention locks. You cannot leave the subject of the worry and no room is left for anything else. The page you read does not go in either, but the reason is clear: your mind is somewhere else and insists on staying there.

The question is this: does my mind go everywhere, or always to the same place?

2. When it started.

ADHD is a developmental condition; it is required that the symptoms were present in childhood too. Anxiety often begins in a particular period, and what came before can be remembered.

The difference between "I've always been like this" and "I've been like this for three years" is a strong clue in an assessment. That is why childhood is asked about so much in an assessment, and that is why old report cards help.

3. What the restlessness depends on.

The restlessness in ADHD is bodily and constant; it is there even on a calm day. The restlessness in anxiety rises and falls depending on a trigger.

This was exactly the point that confused me. I thought the stirring inside me had a reason, I looked for a reason, and each time I found one. In fact the stirring was there before the reason. I wrote in detail about what it is in the article on hyperactivity and inner restlessness in adults.

In ADHD, procrastination comes from being unable to start. In anxiety, from avoidance. From outside the two look the same.

Overlapping symptoms

It has to be said that these distinctions are not easy. The picture, which appears in the glossary as symptom overlap, goes like this:

Symptom	In ADHD	In anxiety
Being unable to focus	Attention does not settle	Attention is locked on the worry
Restlessness	Constant, bodily	Tied to a trigger
Being unable to fall asleep	The mind jumps from subject to subject	The mind goes round on the same subject
Procrastination	Being unable to start	Avoidance
Forgetfulness	Working memory	Attention being on the worry

While making this table I noticed: the right and the left columns are described with the same sentences. That is why no internet test can make this distinction.

The third possibility: both

This is one of the most likely scenarios. The community-sample study by Kessler and colleagues (2006) shows that anxiety disorders are markedly more common in adults with ADHD. Katzman and colleagues (2017) stress that this co-occurrence is almost an expected situation in the clinic.

Part of the anxiety can also develop as a result of ADHD. For someone who has forgotten, been late and left things half-finished for years, becoming anxious is a reasonable thing to learn. This is called anticipatory anxiety and its content is very concrete: I'll forget again, I won't keep up again, it'll be noticed again.

In this kind of anxiety, when ADHD is treated part of the anxiety eases by itself, because the cause underneath has decreased.

But the reverse can happen too: a picture explained for a long time as anxiety delays the ADHD diagnosis for years. In women this is especially common; anxiety and depression diagnoses are made first and ADHD is noticed much later.

How the two feed each other

I want to describe this cycle, because it is what makes the picture heaviest.

Attention drifts, work does not get done. When work does not get done, anxiety rises. When anxiety rises, attention is disrupted even more. Procrastination is piled on top, because approaching the work now triggers the anxiety. As the postponed work grows, the anxiety grows too.

Inside this cycle a person can no longer tell which came first. I could not either. What I learned afterwards was this: finding which came first is not my job, but finding at what point I can break the cycle is.

For me the point that broke most easily was the work side. When I made the job small enough, the anxiety fell too. With emotionally loaded jobs this is not enough, and there the distinction I described in the article procrastination or avoidance comes into play.

A two-column note. In a moment of difficulty, open two columns in your notebook. On the left write "where did my mind go," on the right "what did I feel at that moment." After two weeks, if the left column is full and scattered the picture points in one direction; if the right column repeats the same sentence it points in another. This is not a test; it is an observation to take to the doctor.

Why the distinction matters

Because the order of treatment changes.

The European consensus statement (Kooij et al., 2019) recommends that, in co-occurring conditions, the problem causing the most loss of function at that moment be addressed first. When there is severe anxiety, an ADHD assessment does not give reliable results, because anxiety disrupts attention anyway.

This is a decision the doctor will make together with your history. The decision about diagnosis and treatment is the doctor's.

What you can do yourself

You will not make the distinction. But you can make the assessment considerably easier.

• Take notes for two weeks. In moments when your attention drifts, where did your mind go: everywhere, or to one subject? One line a day is enough.
• Mark the calm days. If you cannot focus even on a day when you are worrying about nothing, that information is very valuable. For me it was the real clue.
• Ask about your childhood. Ask someone who knew you as a child: was I like this then too?
• Write down the content of the worry. If the content is concrete and tied to ADHD, that is, if it revolves around forgetting and not keeping up, that information is valuable for the doctor.
• Keep other causes in mind. Sleep disorders, thyroid dysfunction, B12 and iron deficiency can also produce a similar picture. A good assessment screens for these too.

When to go without waiting

• If the anxiety is really disrupting your work, school or relationships
• If you have panic attacks
• If avoidance has begun to narrow your life: places you do not go, phones you do not pick up, postponed health appointments
• If your sleep pattern has collapsed

If thoughts of harming yourself come during a hard period, do not carry them alone. In Turkey you can call the 112 Emergency line and ask for referral from the ALO 183 Social Support Line.

The sentence I am left with

I covered the intersection of the two and how they are managed together in detail in the article ADHD and anxiety.

The most practical thing to take from this is knowing that the answer does not have to be "one of the two." For years I looked for the right box, and the box was not there on its own. Getting two diagnoses is not a failure; it is the picture finally being seen in full.