When ADHD and Anxiety Happen Together in Children

How often they go together

ADHD rarely travels alone in childhood. Recent national survey data describe high rates of co-occurring behavioral and anxiety disorders among U.S. children with ADHD 2Ref 2Danielson ML, Claussen AH, Bitsko RH, Katz SM, Newsome K, Blumberg SJ, Kogan MD, Ghandour R (2024).ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment.2022 national survey data report high rates of co-occurring behavioral and anxiety disorders among children with ADHD., and CDC reports that nearly 78% of children with ADHD have at least one co-occurring condition 1Ref 1Centers for Disease Control and Prevention (CDC) (2024).Data and Statistics on ADHD.Nearly 78% of U.S. children with ADHD have at least one co-occurring condition.. Anxiety is one of the most common companions. So if your child shows signs of both, that pattern is well recognized, not unusual.

How ADHD and anxiety can feed each other

ADHD is an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning 3Ref 3National Institute of Mental Health (NIMH) (2025).Attention-Deficit/Hyperactivity Disorder (ADHD).NIMH defines ADHD and notes medication and therapy are the most effective treatments.. Anxiety is persistent, outsized worry or fear. When they coexist, they tend to amplify one another:

• A child who forgets assignments or runs late may start to dread school, and that worry then makes it even harder to focus.
• The mental effort of managing worry drains attention, so anxiety can *look* like inattention.
• Restlessness can come from hyperactivity, from anxiety, or from both.
• Bedtime resistance and trouble sleeping can stem from either.

Because the surface behaviors overlap, it's easy to treat one and miss the other.

Signs that point more toward anxiety

Some clues lean toward anxiety as a driver rather than ADHD alone:

• Worry that is specific and persistent (about safety, separation, performance, or social situations).
• Physical complaints, stomachaches, headaches, racing heart, especially before stressful events.
• Avoidance of feared situations rather than general distractibility.
• Reassurance-seeking and difficulty settling at bedtime.

These aren't a substitute for evaluation, but they're worth noting and sharing with your child's clinician.

When a clinician helps

Because ADHD and anxiety overlap but respond to different supports, a clinician's evaluation is the reliable way to sort them out. A pediatrician, therapist, or psychiatric clinician can:

• Screen specifically for co-occurring conditions during the ADHD work-up, which professional guidelines recommend so anxiety isn't overlooked 4Ref 4Pliszka S; AACAP Work Group on Quality Issues (2007).Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.AACAP recommends evaluating for common comorbid conditions during ADHD assessment..
• Use validated rating scales such as the NICHQ Vanderbilt parent and teacher forms, which include screens for anxiety alongside the core ADHD items 5Ref 5National Institute for Children's Health Quality (NICHQ) (2002).NICHQ Vanderbilt Assessment Scales.NICHQ Vanderbilt parent and teacher scales screen for and monitor ADHD and include co-occurring symptom screens.6Ref 6Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K (2003).Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Referred Population.The Vanderbilt parent rating scale is a validated ADHD screening tool..
• Apply DSM-5 criteria with input from both parents and teachers to see how symptoms show up across home and school 7Ref 7Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W; AAP Subcommittee on Children and Adolescents with ADHD (2019).Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.AAP recommends DSM-5 criteria with parent and teacher information when evaluating a child for ADHD..
• Recommend evidence-based treatment matched to the picture: cognitive behavioral therapy (CBT) for anxiety, behavior therapy and, when indicated, medication for ADHD 3Ref 3National Institute of Mental Health (NIMH) (2025).Attention-Deficit/Hyperactivity Disorder (ADHD).NIMH defines ADHD and notes medication and therapy are the most effective treatments..
• Coordinate with the school so accommodations address both the attention and the anxiety load.

Getting both conditions named matters, because treating only one can leave a child still struggling.