What is anxiety?

Anxiety is the feeling of worry, apprehension or dread that something bad is going to happen or that you can’t cope with a situation. It’s also the physical reactions that go with the feeling, like ‘butterflies in the stomach’, increased heart rate, tension or tightness in the body, shakiness, nausea and sweatiness. And it’s behaviour like avoiding what’s causing the anxiety or wanting a lot of reassurance.

Anxiety can happen in response to a specific situation or event. It can happen without a specific situation or event too.

Anxiety is a common and natural part of life. Everyone feels anxious sometimes.

About ADHD and anxiety in children and teenagers

Children and teenagers with attention deficit hyperactivity disorder (ADHD) feel the same worries and fears as their peers.

But children and teenagers with ADHD are more likely to develop anxiety. And if they have anxiety, they often have quite high levels. This can be because the challenges of ADHD mean they feel worried about:

• forgetting everyday things
• not finishing their homework on time
• making ‘careless’ mistakes
• getting distracted and finding it hard to pay attention
• getting negative feedback from parents, teachers or friends
• falling behind their friends and peers academically.

Children and teenagers with ADHD who feel anxious can find everyday situations challenging. This is because it can be hard for them to ignore worrying or intrusive thoughts and to manage emotions like anger and frustration. For example, if your child is worried about the start of the school year, they might have an angry outburst about packing their school bag. Their anxiety can grow over time.

And if children and teenagers with ADHD feel highly anxious, stressful situations can become even harder. For example, if your child is anxious about doing well at school, their anxiety might increase when the teacher asks them a question in front of the class. Then it’s hard for them to concentrate or recall information.

Signs of anxiety in children and teenagers with ADHD

When children and teenagers with ADHD get worried or anxious, the way they show anxiety can look like common characteristics of ADHD. This can make it hard to work out what’s ADHD and what’s anxiety.

For example, if your child with ADHD is feeling anxious, they might:

• fidget or be restless
• have difficulty concentrating
• say their mind is racing
• have trouble sleeping.

ADHD or anxiety?

You’ll probably see your child’s ADHD characteristics in most situations.

Their anxiety signs might appear less often. And these signs might appear before or during situations that your child is worried about, like before they go to school or give a speech in class.

In these situations, you might be able to work out whether it’s ADHD or anxiety by asking your child how they’re feeling and what they’re thinking about:

• A busy ADHD mind will probably be jumping from topic to topic or thinking deeply about something interesting.
• An anxious mind might be thinking about something scary or something bad that could happen in the future.

If you’re not sure whether it’s ADHD or anxiety but you’re worried that any of these signs are interfering with your child’s everyday activities, it’s a good idea to talk to a professional. Your GP is a good place to start.

Helping your child with ADHD recognise anxious feelings

Your child might need help to learn what anxiety feels like in their body.

For example, if your child is anxious, their physical reactions might include:

• sweaty palms
• a sick feeling or butterflies in their stomach
• a fast heartbeat.

Supporting your child with ADHD and anxious feelings

Helping with anxiety usually involves supporting your child with both anxiety and ADHD. Here are ideas.

Routines, tasks and goals

• Establish daily routines. Routines let your child know what’s happening in their day, which can reduce anxiety.
• Break up big tasks. For example, your child might feel anxious or overwhelmed about tidying their room. Your child could break this big task into smaller tasks like picking up clothes, tidying the desk, dusting and vacuuming. This can help your child manage the task, which might reduce their anxiety.
• Set small goals for things your child feels anxious about. When your child feels they can manage these things, they’ll feel more in control of anxious feelings. But avoid pushing your child to face situations they’re not ready for. For example, if your child is anxious about giving a speech in class, they could start by practising at home.

Physical health

• Encourage your child to be physically active. Physical activity can help to clear your child’s mind. Physical activity can become part of your child’s daily routine. Read more about physical activity for children aged 5-8 years and physical activity for pre-teens and teenagers.
• Help your child to get enough sleep. When your child is well-rested, they’re better able to manage strong emotions like anxiety. Making sleep and rest part of a daily routine can help with this, as can a bedtime routine.

Emotional wellbeing

• Help your child to understand their feelings. When your child can notice early signs of strong emotions, it’s a step towards managing anxiety and other emotions.
• Suggest breathing exercises, muscle relaxation exercises or mindfulness exercises for your child. These exercises can help your child feel calmer and more relaxed.
• Be a role model for your child by managing your own anxiety. You can also help your child see that anxiety in itself isn’t bad. It’s only when it stops us from doing what we want or need to do that it becomes a problem.

School

• Talk to teachers if your child’s anxiety is related to school. For example, your child might be anxious about asking for help from the teacher. The teacher might sometimes be able to check in with your child individually.
• Talk to teachers and other school staff about school adjustments that could help your child manage their anxiety at school. This might include a quiet area they can go to or a member of staff they can talk to if they’re feeling overwhelmed.

Your child might need support to manage energy, learn, make friends and do everyday tasks. You can read more in our articles on supporting children and pre-teens with ADHD, supporting teenagers with ADHD, friendships for children and pre-teens with ADHD and friendships for teenagers with ADHD.

When to be concerned about anxiety in your child with ADHD

If your child with ADHD also has anxiety, you might be concerned if your child:

• constantly feels nervous, anxious or on edge, or can’t stop or control worrying
• has anxious feelings that go on for weeks, months or even longer
• has anxious feelings that interfere with schoolwork, socialising and everyday activities.

When anxiety is severe and long lasting, it might be an anxiety disorder. Around a quarter to a half of children and teenagers with ADHD experience anxiety disorders. Anxiety disorders usually respond well to professional treatment. And the earlier anxiety disorders are treated, the easier it is for children and teenagers to recover. It’s also less likely that anxiety disorders will affect mental health and development in the long term.

Many health and other professionals can help your child with ADHD and anxiety. They include GPs, paediatricians, psychologists, psychiatrists, occupational therapists, school counsellors and other school support, health and wellbeing staff.

Therapies and medicine to help with ADHD and anxiety

Psychological therapies

A psychologist can work directly with your child and family on strategies for reducing anxiety. They can suggest and adjust therapies to support your child with ADHD.

Psychologists use a range of therapies for anxiety, including the following:

• Cognitive behaviour therapy – this can help your child develop skills to change their thinking in situations that make them anxious.
• Therapies and supports that use gradual exposure to help your child face their fears – this might include the stepladder approach.
• Relaxation training – this can help your child learn to relax.

Medicine

Stimulant medicines can be prescribed to help children and teenagers with ADHD.

These reduce anxiety in some children and teenagers with ADHD. But they might increase anxiety in others. In this situation, doctors will prescribe a non-stimulant ADHD medicine or treat the anxiety separately with anti-anxiety medicine.

Your child’s paediatrician or psychiatrist will be able to work out which drug and dose will be best for your child.

Methylphenidate is the most common stimulant medicine. It’s sold under brand names including Ritalin 10, Ritalin LA and Concerta. Other stimulant medicines are dexamphetamine or lisdexamfetamine. Lisdexamfetamine is sold under the brand name Vyvanse.

If your child is taking ADHD medicine, they should be closely monitored by a health professional. This is because ADHD medicines can cause side effects. Most side effects are mild and don’t last long. If there are side effects that don’t go away, your health professional might change the dose or timing of the medicine or suggest a different medicine.

Your child might be able to get Medicare rebates for up to 10 mental health sessions with a mental health professional each calendar year. To get these rebates, your child will need a mental health treatment plan from a GP or a referral from a psychiatrist or paediatrician.