ADHD Questions
Does anxiety affect the way you think in ADHD?
Charles Li, MD
April 25, 2023
🧠
Having anxiety has been shown to affect how ADHD alters our thinking and cognition.
🔥
Compared to those with only ADHD, those with anxiety and ADHD have less impulsivity and hyperactivity. However, they also have more difficulties with working memory.
👩⚕️
Anxiety affects how we respond to ADHD treatment. Those with anxiety and ADHD tend to respond better to therapy.
How anxiety affects cognition in ADHD
One of the most significant ways anxiety affects our thinking in ADHD is our working memory.
Our working memory keeps things in our mind as we perform tasks, similar to RAM in a computer. When we play card games, our working memory helps us track the game and our opponents.
What is working memory?
The study below found that those with ADHD and anxiety had the most difficulty with working memory.
On a standardized test of working memory, researchers found that those with either ADHD or anxiety had significant difficulties with their working memory. Those with both disorders had the greatest difficulties.
What does ADHD + Anxiety look like in children?
Other experts in the field have come to similar conclusions. Interestingly, those with ADHD and anxiety may be less likely to experience challenges with inhibition, another key effect of ADHD:
“
Children with ADHD and anxiety do better on stop signal paradigms that measure response inhibition (Brown, 2000, p. 141). On the other hand, working memory tasks and serial addition tasks are particularly challenging for patients with comorbid ADHD and anxiety (Brown, 2000, p. 141).
Brown, 2000
Some experts theorize that the link between working memory and ADHD may come from our brains becoming overworked from dealing with anxiety. Having anxiety is tiring and consumes mental resources. Some of these mental resources are shared with working memory. When we’re dealing with anxiety, it may lead to us having less mental bandwidth to remember small details of our task at hand:
“
Worry is the cognitive component of anxiety and according to processing efficiency theory, its effect is to preempt some processing and storage resources of the working memory system (Eysenck and Calvo, 1992). As a consequence, worry tends to impair performance on tasks with high demands on working memory.
Eysenck and Calvo. 1992
How anxiety and ADHD respond to therapy
A comprehensive study on ADHD and anxiety found that those with ADHD and anxiety tended to respond the best to therapy, particularly compared to those with ADHD and no anxiety.
Medications work as well. The best results, however, came from a combination of medication and behavioral therapy:
A clinical trial found that anxiety affected treatment response to ADHD. While all three treatment types studied were effective, a combination of medication and behavioral therapy worked the best. The p-values below represent the differences between the therapy and the next-ranked therapy.
How anxiety affects medication response in ADHD
ADHD, in general, responds well to medication, and many of those with ADHD are actively treated with medication, most commonly with stimulants.
Because of the importance of medication in ADHD, studies have been conducted on how anxiety affects ADHD treatment.
One study found that those with anxiety were less likely to respond to Ritalin than those without anxiety:
A second study found that Ritalin did not improve working memory for those with ADHD and anxiety but did help those without anxiety:
Differential Effects of Methylphenidate on Working Memory in ADHD Children with and without Comorbid Anxiety
However, Ritalin showed similar benefits in reducing hyperactivity in children with and without anxiety.
The benefits of medication on anxiety in ADHD
While stimulants are not approved as anxiety treatments, there is some evidence that they can affect anxiety.
A small study tested those with and without ADHD with a standardized cognitive test. They measured anxiety levels during the test, along with test performance.
The results showed that those with ADHD experienced less anxiety during the test when provided with Ritalin.
Methylphenidate Reduces State Anxiety During a Continuous Performance Test That Distinguishes Adult ADHD Patients From Controls
Key takeaways
Anxiety changes the way we experience ADHD. It affects our symptoms and how we respond to treatment.
It can potentially improve impulsivity and hyperactivity while worsening working memory.
It can also change how our minds respond to medication. Fortunately, it is treatable with therapy. Studies have linked ADHD and anxiety with better responses to behavioral therapy.
If you or your loved one has anxiety with ADHD, be sure to talk to your doctor about treatment options.