Anxiety Masquerading as ADHD: A Clinician's Perspective

I’ve noticed a troubling trend in my psychiatry practice: many clients arrive convinced they have attention-deficit/hyperactivity disorder (ADHD), often self-diagnosed, and insist on medication to address their struggles with focus, restlessness, or disorganization. Yet, after thorough evaluation, I frequently find that the root of their symptoms isn’t ADHD at all—it’s unmanaged anxiety. This observation aligns with emerging research and clinical discussions, and it raises critical questions about diagnostic accuracy and the risks of misprescribing medications. I'd like to discuss the overlap between anxiety and ADHD, and discuss why mistaking one for the other can lead to ineffective or even harmful treatment.

The Overlap Between Anxiety and ADHD

In my practice, patients often describe symptoms like difficulty concentrating, feeling overwhelmed, or being unable to complete tasks—hallmarks they associate with ADHD. However, these same symptoms frequently stem from anxiety disorders, which can mimic ADHD’s presentation. Research supports this overlap. For instance, a study found that anxiety disorders are highly comorbid with ADHD, with up to 33% of ADHD patients also meeting criteria for an anxiety disorder (Jensen et al., 2001). The shared neurobiological pathways, including dysregulation in the prefrontal cortex and heightened arousal states, can make differentiation challenging (Schatz & Rostain, 2006).

Above: Anxiety disorders can mimic ADHD with up to 33% of ADHD patients also meeting criteria for an anxiety disorder.

I’ve seen patients who, after browsing social media or online forums, latch onto ADHD as an explanation for their struggles. The accessibility of ADHD-related content—think viral videos listing “10 Signs You Have ADHD”—makes it an appealing self-diagnosis. ADHD seems concrete, with clear diagnostic criteria and widely discussed treatments like stimulants. Anxiety, by contrast, feels amorphous, tied to complex emotional or environmental triggers that patients may be reluctant to explore. A 2024 review noted that the rise in ADHD diagnoses may partly reflect societal pressures and increased awareness, but also misattribution of symptoms like inattention to ADHD when anxiety or other conditions are at play (Banaschewski et al., 2024).

Why Patients Gravitate Toward ADHD

Why do so many patients arrive at my office fixated on ADHD? I suspect that one reason is because ADHD feels more manageable to address. The narrative around ADHD is often empowering: it’s a neurodevelopmental condition, not a personal failing, and medications like methylphenidate or amphetamines promise quick relief. In contrast, confronting anxiety can feel daunting. Anxiety often ties to deeper issues—trauma, chronic stress, or interpersonal conflicts—that require introspection and, frequently, therapy. As I discuss with patients, therapy for anxiety, such as cognitive-behavioral therapy (CBT), demands time and emotional work, with studies showing significant benefits but slower onset compared to medication (Hofmann & Smits, 2008).

Moreover, ADHD carries less stigma in some circles. Patients tell me they’d rather have a “brain wiring issue” than admit to anxiety, which some perceive as weakness. This aligns with findings that mental health stigma persists, particularly for internalizing disorders like anxiety (Clement et al., 2015). The ease of pursuing an ADHD diagnosis—bolstered by online symptom checklists and telehealth platforms—further tilts the scales. A 2025 study highlighted that telehealth has increased ADHD diagnoses, sometimes without comprehensive assessments, potentially overlooking conditions like anxiety (Staley et al., 2025).

The Risks of Misdiagnosis and Misprescribing

When patients insist on ADHD medication without a thorough evaluation, I worry about the consequences. Stimulants, the first-line treatment for ADHD, can exacerbate anxiety symptoms. In my practice, I’ve seen patients prescribed stimulants elsewhere return with worsened restlessness, racing thoughts, or even panic attacks. Research backs this up: a meta-analysis found that stimulants can increase anxiety in some patients, particularly those with undiagnosed anxiety disorders (Cortese et al., 2018). This isn’t surprising—stimulants boost dopamine and norepinephrine, which can heighten arousal in an already anxious brain (Volkow et al., 2003).

Beyond worsening symptoms, prescribing ADHD medications for anxiety misses the root cause. As I write this, I recall a client, a 32-year-old professional, who was certain he had ADHD due to his inability to focus at work. After a detailed history, it became clear his symptoms stemmed from generalized anxiety disorder, triggered by a high-pressure job and unresolved family stress. Instead of stimulants, we started psychotherapy and a selective serotonin reuptake inhibitor (SSRI). Weeks later, his focus improved dramatically—not because we “treated ADHD,” but because we addressed his anxiety. Studies support this approach, showing SSRIs and therapy as effective for anxiety, with lasting benefits compared to stimulants’ temporary symptom relief (Bandelow et al., 2015).

Misprescribing also risks reinforcing a cycle of avoidance. Patients who receive ADHD medication for anxiety may feel temporary relief from heightened focus, but without addressing the underlying emotional drivers, their symptoms often resurface, sometimes worse. A 2024 study warned that over-reliance on pharmacotherapy for misdiagnosed ADHD can delay proper treatment for conditions like anxiety, leading to poorer outcomes (Banaschewski et al., 2024).

A Call for Careful Consideration

For patients, I encourage openness to exploring anxiety as a possible driver. It’s not an easy conversation—acknowledging anxiety can feel like opening a Pandora’s box. But as I tell my clients, understanding the true source of their struggles is the first step to meaningful relief. In Scottsdale, where fast-paced lifestyles and high expectations amplify stress, I’m seeing more patients whose “ADHD” is really anxiety in disguise. By addressing this head-on, we can move beyond quick fixes and toward lasting solutions.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: A meta-analysis. International Clinical Psychopharmacology, 30(4), 183–192. https://doi.org/10.1097/YIC.0000000000000078

Banaschewski, T., Häge, A., Hohmann, S., & Mechler, K. (2024). Perspectives on ADHD in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use. Frontiers in Psychiatry, 14, 1289157. https://doi.org/10.3389/fpsyt.2023.1289157[](

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Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129

Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., ... & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(8), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632. https://doi.org/10.4088/JCP.v69n0415

Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., ... & Vitiello, B. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 147–158. https://doi.org/10.1097/00004583-200102000-00009

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

Staley, S. B., Robinson, L. R., Claussen, A. H., Danielson, M. L., Wolicki, S. B., & Bitsko, R. H. (2025). Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults—National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. Morbidity and Mortality Weekly Report, 73(40), 885–892.

Volkow, N. D., Wang, G. J., Fowler, J. S., Gatley, S. J., Logan, J., Ding, Y. S., ... & Pappas, N. (2003). Evidence that methylphenidate enhances the saliency of a mathematical task in attention deficit hyperactivity disorder. American Journal of Psychiatry, 160(9), 1630–1636. https://doi.org/10.1176/appi.ajp.160.9.1630