Anxiety disorders and ADHD are among two of the most common childhood mental health issues. Approximately 10% of children are currently diagnosed with ADHD, and the prevalence rate of anxiety disorders in children ranges from 4-20%. Aside from their importance in the world of children’s mental health, these two conditions have unexpected overlap in the way that they impact children’s functioning, particularly in school settings.
What is Generalized Anxiety Disorder?
Everyone experiences feelings of worry and stress; this is an adaptive trait that helps us to achieve our goals and stay on top of day-to-day responsibilities. However, for some, anxiety can be an ever-constant feeling that is difficult to control. Children with Generalized Anxiety Disorder worry excessively about various events, and their worry is often disproportionate to the situation. They experience a constant state of stress, which is disruptive to their functioning at home, in school, and across other environments.
What is AD/HD?
Attention-Deficit Hyperactivity Disorder is a neurological disorder that is characterized by difficulties with sustained focus or mental effort over a long period of time. Some children with ADHD may be impulsive, and exhibit disruptive behaviors such as difficulty staying seated during class, waiting their turn, interrupting others, and excessive fidgeting or physical movement. Recent research has suggested an expanded model of ADHD to include deficits in executive functioning. Executive functioning is the ‘cognitive management system’ of the brain, and it refers to specific skills such as planning, organization, working memory, and emotional/behavioral regulation.
How are ADHD and Anxiety related?
Although they are two distinct conditions, ADHD and anxiety share many commonalities in the way they can impact children in school settings. The following are some common challenges that such students face:
Distractibility: Students with ADHD can often focus intensely and for long periods on things they enjoy; however in class, they are easily distracted by their environment, exhibit off task behaviors such as chatting with peers, and tend to stare off or daydream. This is not an issue of willpower or “laziness,” but rather explained by inherited problems with the wiring of the brain. On the other hand, children with anxiety often exhibit problems with focus, although for a different reason. They are preoccupied with their own thoughts, such as anticipation of an upcoming test, ruminating on a social conflict, or worrying about the safety of their family. In this sense, their emotional state interferes with their ability to “tune in” to their environment since their cognitive resources are being used up by persistent worry.
Memory: In addition to distractibility, both ADHD and anxiety can interfere with students’ ability to remember things that have just heard or seen. Often, this is seen in difficulties following multi-step instructions, such as “get out your algebra workbook, turn to page 46, and do the first 10 problems.” This difficulty with keeping information “online” can also create challenges with remembering what was just read (i.e., reading comprehension), or with formulating ideas for an essay. In addition, problems with focus and anxiety can lead to difficulties retrieving information students have heard before, such as classroom discussions and concepts. This difficulty with “pulling out” information when it’s needed it can create barriers to the learning process.
Speed and efficiency: A subset of anxious children and those with ADHD tend to have slower speed of information processing. This means that they take longer to complete assignments compared to their peers, they run out of time on tests, and are generally less efficient with tasks. This can make studying more laborious and time consuming, thereby exacerbating feelings of stress and worry, and sometimes engendering feelings of inefficacy.
In some cases, specific challenges discussed here can signal other problems, such as learning delays or other social-emotional difficulties. Therefore, when children struggle, it is important to differentiate between mood, inattention, or other factors given that conditions can mimic one another. Accurate identification of the problem is essential in order to inform treatment, and involves check-ins with teachers and providers, monitoring of symptoms (frequency and duration) and seeking consultation for a comprehensive evaluation if symptoms persistent. It is also important to note that ADHD frequently co-occurs with other psychiatric disorders such as mood disorders, behavioral problems, and learning disorders, putting children with ADHD at greater risk for other issues.
Dr. Nicole Michaeli is a clinical psychologist who specializes in comprehensive psychoeducational evaluations of children, adolescents, and emerging adults. Her work focuses on the assessment and treatment of individuals with ADHD and executive functioning deficits, learning differences, processing disorders, social-emotional difficulties, and a wide variety of other developmental disorders. Dr. Michaeli is also trained as a psychotherapist, and she has provided play and individual therapies to children and families using a psychodynamic/ object relations approach.
https://www.childnexus.com/provider-profile/nicole-michaeli