Children with anxiety and children with ADHD (Attention Deficit and Hyperactivity Disorder) can exhibit some of the same characteristics and behaviors so it can be hard to tell the difference. For example, both can have trouble with focusing in class, both can be inefficient, both resort to escapist behavior and both can lead to emotional outbursts or tantrums. All too often, a parent or teacher will seek ADHD treatment for a child, when in reality the child has an anxiety disorder, not an attention disorder. Parents and educators need to understand the subtle differences, so they can get children the right help to contribute to their success.
Symptoms of Anxiety Disorder
Children with anxiety may have trouble focusing on their schoolwork. This can lead teachers to suspect that the child has ADHD, when the underlying problem is actually anxiety. For this reason, professionals need to understand what anxiety looks like in kids.
Kids with Anxiety will exhibit:
- Exaggerated fears or feelings of doom about specific situations, things or persons
- Physiological arousal from moderate to severe that doesn’t fit the situation
- Lack of attention in school because of preoccupation with subject of anxiety
- Desire to escape or avoid things or situations that trigger anxiety
- Need for reassurance that things are safe
A child with anxiety may appear distracted and disorganized, but it is not due to ADHD. Instead, the child’s mind is so preoccupied with his fears that he cannot focus on the routine aspects of the school classroom. The train of apprehensive thoughts just continues to snow ball until the child acts out, and this can lead to disruptive behavior or behaviors that appear as lack of impulse control. Again, the root cause is anxiety, not another disorder. Medicating the child for ADHD will not control the behaviors and, in fact, make the anxiety worse if the medication is a stimulant.
If you are noticing some of these symptoms as well as the attention problems associated with ADHD, you need to look a little more closely at anxiety. Getting help for anxiety may help solve the attention and other behavior issues.
Signs and Symptoms of ADHD
So what does a child with ADHD look like? How can a parent or teacher differentiate between the two?
A child with ADHD may:
- Appear inattentive in variety of settings especially with low stimulus activities
- Exhibit chronic procrastination and inefficiency
- Be fidgety or restless without accompanying object of anxiety
- Display routine and surprising forgetfulness. May seem like complete disregard for consequences
- Start but doesn’t finish tasks, trouble with sustaining attention, and jumping from one thing to the next. Needs lots of feedback and direction to keep on task.
To an observer the disorders can be difficult to distinguish because of apparent behavioral similarities like restlessness and requiring lots of direction or feedback. Understanding the root cause of the outward behavior is essential to finding a right treatment to help your child. This is further complicated by the different types of anxiety and ADHD. Nevertheless, some ways to help tell them apart are as follows.
How to Tell the Difference Between Anxiety and ADHD
(There are exceptions to every rule and both anxiety and ADHD have various subtypes so please consider these as general guides and not clear diagnostic measures.)
Anxiety disorders usually have some specific and “stable” feared situations, objects or people. If a child has test-taking anxiety then it tends to be consistent and is triggered by a testing situation. When there is a trigger present your child will always experience fear, distress, anxiety and/or sometimes anger. It will be a fight or flight response. Look for both the experience of anxiety and one or more specific things that are the reasons for the fear.
Attention disorders may produce anxiety but it is usually less focused and tends to be transitory. It may be hard to define and has more to do with the consequences of inattentiveness or forgetfulness rather than a specific person, place or thing. For example, your child may feel anxious because he or she is worried they are forgetting something but it is non-specific. Your child will feel unmotivated, bored, and uninterested frequently. Discipline will typically evoke more anger than anxiety.
Differences in Inattentiveness
Kids with anxiety may be inattentive but it will be because he or she is preoccupied with something that is causing anxiety. In fact, your child will be very focused on the anxiety problem and can’t switch attention to other things. It is a problem with excluding the worry or fear.
Kids with attention problems may be inattentive because there is nothing interesting enough to occupy their thinking. They have trouble sustaining attention even though he or she may know it is important. For example, if you ask an ADHD child why they didn’t do their homework there may not be a known reason. It simply just “dropped” right out of his or her mind and wasn’t recalled in time.
Anxiety disorders tend to get worse if the environment is highly stimulating with potential triggers. The more important or demanding the situation the more likely it will trigger anxiety. For example, the closer the test the more anxious a child becomes. For a socially anxious child, a group of people will evoke more anxiety than one friend. For someone afraid of contamination a public place will feel much more dangerous. More potential triggers in the environment=more anxiety.
Attention disorders are often less symptomatic if the environment is more stimulating and interesting. Basically if a child’s brain “wakes up” her focus is better. People with attention problems often do great during a crisis. A “demand” in the environment makes attention easier and so reduces any anxiety caused by too many things to focus upon. Kids with ADHD can focus wonderfully on games that are like sensory fire hoses. Conversely, a noisy or busy environment (chaotic not stimulating) may make symptoms worse because there are too many things competing for attention and nothing is interesting enough to capture the attention and keep it.
Differences in the Purpose behind the Symptoms
Anxiety disorders have the purpose of reducing threat. It is always about escaping or fixing a feared problem. Behind the symptoms, even if they seem peculiar, is the clear purpose of trying to make something safer. When a child feels safer, the symptoms significantly improve (although only temporarily).
Attention disorder symptoms have the purpose of waking up the brain. If something is interesting, novel, exciting or even anxiety provoking the attention improves. If it is mundane, routine or boring then the symptoms are worse. The content isn’t the guide, rather it is the stimulation. For example, your child may have impending consequences if he doesn’t do his chores but ends up on the porch changing the laces from one shoe to the next. From your point of view it looks like laces are more important than consequences. Nope, the laces were relatively interesting and the chores were boring.
Differences in Your Experience as a Parent
With anxiety disorders parents are routinely trying to “pull or push” their child along. “It is okay, you will be fine, it isn’t dangerous, you have to go to school.” It is about overcoming resistance or avoidance that is the focus. You can think of it as “expanding” your child’s behaviors. Anxiety makes people do less and you will find yourself trying to get your child to do more. You will try to reduce anxiety and may end up walking on eggshells.
With attention disorders parents are trying to “contain or direct” their child. “Pay attention, finish your chores, clean your room, did you do your homework?” It is about directing and motivating your child. You can think of it as “containing or limiting” your child’s behavior to what is important. You will try to eliminate or stop unimportant behavior. You will try to increase motivation and find yourself critiquing a lot.
So what is a concerned parent or educator to do when two issues seem to have mirror symptoms? Consider finding various checklists of symptoms for both anxiety and ADHD and get various people to score them and see how they compare. Your Pediatrician will be very helpful. Your child’s teacher will have great feedback. (Keep in mind that ADHD is likely to be noticed but not ADD. The “hyperactivity” part is hard to miss.) The key to getting the right help for a child is to dig deeply before diagnosing a condition. Before treating a child for supposed ADHD, parents and teachers should consider whether or not the child has an anxiety condition or vice-versa with the help of a qualified behavior professional.
Do you suspect your child may have an anxiety condition? Look at this checklist for childhood anxiety and see where your child’s symptoms rank. If you have a child that ranks high for anxiety, consider Turnaround, a proven and award-winning audio program that helps teach children ages 6 through 12 to overcome their anxiety. In just 10 lessons, you can see a decided change in your child’s behaviors.