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Treating ADHD & Anxiety: A Clinical Pitfall

June 20th, 2019

Why are so many neuropsychologists, psychiatrists, and therapists seeing such a spike in anxiety disorders and general anxiety among the children, adolescents and young adults who come calling?

Even if mental health professionals are that much better at accurately identifying anxiety disorders, it sure feels like anxiety continues to plague all too many. While we can bemoan the rise of social media and tech in the digital age as two likely drivers, the clinical picture is inevitably far more complex.
 

Further complicating the issue is that 25-50% of kids with anxiety also have ADHD. Aside from treating this comorbidity, clinicians must decide whether to address the anxiety and/or the possibility of ADHD. In this case, the clinician looks at clues that differentiate anxiety disorders from ADHD: family history, recurrent somatic systems, sleep onset problems, headaches, recent social upheaval, excessive screen time or other socially isolating behavior, and fatigue. Comprehensive testing by developmental pediatricians, neuropsychologists, or child psychiatrists can help clarify the problem.

What we do know:

  1. Many parents and teachers are not particularly accurate in reporting anxiety symptoms in children and adolescents.

  2. Children and teens are not necessarily predisposed to verbalize the depth and frequency of their worries and fears.

  3. It’s all too easy to conflate strictly physical complaints with potentially psychosomatic causes, which tend to commingle anyway.

Let’s consider the population of those diagnosed, sometimes inaccurately, with ADHD. While there are a few conditions that can masquerade as ADHD, anxiety is by far the most common disguise. Many of the symptoms experienced by individuals with anxiety look all too similar in someone with ADHD—even if the root cause proves utterly different.

  • Forgetfulness and Focus

  • Disorganization

  • Poor task initiation and prioritization

  • Distractibility

When anxiety is mistaken for ADHD, that misconception can lead to even more issues when medication is part of the treatment plan. What’s the number one class of drugs most favored for treatment of moderate to severe ADHD?

What happens when patients with undiagnosed anxiety disorders go on a course of stimulant medication for ADHD?
 

They tend to get really, really anxious.

Fortunately, many treating physicians and psychiatrists are working with non-stimulants, including SSRIs (antidepressants) and guanfacine. No one can expect to douse a fire with gasoline.
 

There are also many other viable ways to reduce anxiety. Nutrition, mindfulness, exercise, sleep hygiene, cognitive behavioral therapy (CBT), and other forms of therapy are go-to methods, but medication remains king for more severe cases.

We all hope that more alternatives to stimulants prove helpful to our friends and loved ones afflicted with significant anxiety. While many general pediatricians and family medicine physicians don’t always have a lot of clinical experience with CBT and SSRIs than those who do have seen an 80% improvement in reduced anxiety with a combined therapeutic and pharmacological approach (Brown 125-161).
 

Anxiety in the digital age clearly isn’t going anywhere, but at least we’re empowered with more treatment options than ever before.

 

~Jim Varga, M.D., F.A.A.P. and Matthew Hayutin, M. Ed

 
Posted in the category Parenting Tips.
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