Impulsivity
Evidence Based Answers
How does anxiety affect impulsivity and hyperactivity in ADHD?
Charles Li, MD
October 9, 2023
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ADHD and anxiety have a complex relationship. Those with ADHD tend to have a higher risk of developing an anxiety disorder.
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Studies have linked anxiety with less severe hyperactivity and impulsivity, two key effects of ADHD.
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However, anxiety is also linked with more severe ADHD symptoms, particularly in working memory.
ADHD is generally defined by symptoms involving inattention and hyperactivity.
While it’s not an ADHD symptom, anxiety is also quite common among those with ADHD. Studies have consistently shown that those with ADHD have a higher risk of anxiety.
Some studies have shown that anxiety may affect how we experience ADHD as well.
Children with anxiety and ADHD may be less hyperactive than children with only ADHD:
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Two recent texts on comorbid conditions seen in ADHD (Brown, 2000; Pliszka et al., 1999) have posited that anxiety may inhibit impulsivity while making attentional tasks worse. Pliszka et al. (1999, p. 155) reviewed their own studies showing that children with ADHD and anxiety are less likely to display off-task and hyperactive behavior and have longer reaction times than pure ADHD children.
Pliszka et al. 1999
Brown, 2000
There’s also evidence that anxiety can also reduce impulsiveness, a key effect of ADHD:
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In summary, the presence of anxiety may partially inhibit the impulsivity and response inhibition deficits seen in ADHD. It may also, however, make working memory and other cognitive deficits worse.
It is important to note, however, that studies have also linked anxiety with stronger ADHD symptoms overall:
Study on anxiety and impulsivity in ADHD
One study that examined the link between anxiety and ADHD shows just how complex this link can be. The study below found that among those with ADHD, those with anxiety were less impulsive but had slower response times when tested.
They were also less likely to respond to Ritalin:
Ritalin, ADHD, and anxiety in Children
A similar trial in children found differences in how we respond to medication if we have ADHD and anxiety. Children with ADHD and anxiety saw improvements in their hyperactivity on Ritalin but did not experience improvements in their working memory:
Differential Effects of Methylphenidate on Working Memory in ADHD Children with and without Comorbid Anxiety
Key takeaways
As the data above shows, anxiety is generally linked with lower levels of hyperactivity and impulsivity in ADHD.
However, it’s a complicated relationship. There’s also evidence of more severe ADHD symptoms overall and worsened working memory.
More research is needed to understand this link better. What we know for now is that ADHD and anxiety are closely linked conditions. ADHD affects our anxiety risk, and anxiety affects our ADHD symptoms.