Anxiety on the Surface. ADHD beneath.

Anxiety is a form of psychic pain. Worse, its presence is often looked down upon as a moral failing, a lack of faith and perspective, while its absence is considered a mark of life well-lived.

“Be not anxious for the morrow,” —Jesus.

“Our anxiety does not come from thinking about the future, but from wanting to control it.” —Kahlil Gibran

Anxiety can obscure underlying ADHD. It is very common in my practice to meet adults whose anxiety was diagnosed years ago, often within weeks or months of its appearance, but whose ADHD has been missed for their entire lives. Almost 40% of the people sent to a specialty anxiety clinic also had ADHD when their cases were carefully reviewed. Up to 60% of those with ADHD also have anxiety. The two seem to foster each other.

It’s widely assumed that those of us with ADHD bring anxiety onto ourselves from procrastination’s logjams and the clutter that surrounds us. There is some truth to that, but not enough to explain such numbers.

I think it’s more likely that people with ADHD cultivate anxiety to serve as motivational energy. What is procrastination, but the decision to schedule a task at the precise, final moment that fear of failure makes it engaging? Anxiety and desperation not to fail may be the only useful way for someone with ADHD to get things done.



From ABC News ‘12 Signs You May Have Anxiety

Melissa is a busy mother of four children who has plenty of reason to be anxious if you are feeling dismissive and judgmental. Her kids are 4, 6, 8 and 9. They are rambunctious, energetic and loud. Their backyard is a magnet for their neighborhood friends, and neighborhood moms take some advantage of that. Melissa’s husband, Bill, travels several days each week, so homework and bedtime routine is often hers alone. The kitchen and family room clutter depress her, and an hour of cleaning hardly makes a dent. She is dead-tired when she collapses into bed each night.

If anyone deserves to sleep, it is Melissa, but no sleep comes. Her mind whirls. Is there bread for school lunches? Did I tell Jordan’s teacher that he has a doctor’s appointment? Was that Bill who called when I was too busy to check? Is he still up? Will he be angry that I didn’t call back? Why was Evelyn yelling at her playmates? Should I have intervened? She hasn’t been invited anywhere in a while; why can’t she keep friends? Should I find a therapist? Talk to her teacher?

Melissa’s heart pounds and her throat burns. She gets up to drink an unmeasured slug of antacid straight from the bottle. She checks the bread supply—almost gone. The kids can have school pizza. They won’t mind, but she had much higher aspirations for the nutrition she would provide them when they were conceived. Will’s math worksheet is on the floor. She puts it on the kitchen table. He didn’t finish it.

Explaining her insomnia to the nurse practitioner, she bursts into tears. No, she’s not depressed, just never far from panic. She is given an anti-depressant (“It’s for anxiety, too”) and referred to a therapist. The appointment is over before she can protest that she doesn’t have time to lavish on herself.

The therapist tells her to take more walks, try yoga, lean on Bill sometimes. With less anxiety, she should have more energy for her family.

The anti-depressant helps—less panic, better sleep, fewer antacids. Her heart doesn’t race when she forgets the appointment with Evelyn’s school counselor. She takes a prescribed walk and loves escaping the mess at home, so she takes a few more. One walk stretches so long she forgets to pick up the kids at the bus stop.

The therapist encourages her to write down her priorities, forgive herself, lower her expectations. It sounds wonderful. And impossible. She asks if things are getting better—less chaos, less frustration with the kids, better time with Bill?

“This medicine relaxes me, but now I’m useless,” blurts Melissa. It is meant to be a joke, except that it’s true. “I feel better, but I’m not getting anything done. Jordan’s inhaler is empty and it never crossed my mind until this second.”

Melissa is overwhelmed again, not by anxiety, but guilt. She still hasn’t talked to anyone about Evelyn, the house is still a mess and Will is now failing math. Without anxiety, she’s a worse wife and mother than with it.

She stops her medication, because she loves her family and accepts the psychic pain of anxiety as the cost of caring for them. Anxiety is not an unbidden, invader in Melissa’s life, but the only energy she can muster to fuel the endless repetition of raising a family.

It will be two more years until Evelyn’s teacher recommends ADHD testing. Melissa will see Evelyn’s inattention and forgetfulness and remember it in herself at that age. Evelyn’s doctor will urge her to undergo diagnosis, too. “Girls with ADD need attentive moms,” he will say. ADHD medication and therapy will bring mental clarity, and daily tasks won’t overwhelm her. The anxiety will fade away, unneeded.

Until then, Melissa needs the anxiety to keep her going.

She meets her friend for coffee and orders chai so she won’t feel more jangled. The friend has been meditating and wants Melissa to try. And there’s a new yoga studio. And she discovered aromatherapy which is also life-changing.

Melissa pulls an envelope out of her purse to jot some notes and pretend for a second that she could do so much for herself. The envelope is a cable bill she meant to pay last week. She forgot it was in there, It’s overdue, and her heart races. She writes ‘meditation’ at the top, then ‘PAY COMCAST’, then ‘INHALER!!!’, then ‘start laundry’. Her mind has left the coffee shop and she can’t sit there one more second.  “Gotta go,” she interrupts. “Let’s do this again,” she lies and rushes out.

For Melissa, anxiety is a solution more than a problem. Fear of failure is the energy behind every task. She never feels accomplishment—only relief at the disasters averted.

Sometimes, anxiety is ADHD, love and the desperation not to fail.

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

Posted in ADHD, anxiety, treatment
14 comments on “Anxiety on the Surface. ADHD beneath.
  1. Karen Greenland says:

    So true! Thanks for posting this Dr. Mason! 🙂


  2. Elizabeth Faught says:

    I am in the same conundrum and desperately seeking for answers.


    • Finding whether ADHD underlies anxiety requires a skilled therapist or physician. Screeners such as the ASRS (link below) can begin the process. Answer the questions in the screener and ask your doctor to begin diagnosis or else to refer you to someone who has diagnosed hundreds of cases of ADHD. Consider books such as “More Attention, Less Deficit” by Ari Tuckman or my book–“Reaching For A New Potential”. Stick with the process. It can take multiple trials to find the right combination of medication, therapy, mindfulness training, exercise, support people. I wish you peace and blessing in the journey.

      Click to access adhd-questionnaire-ASRS111.pdf


  3. Cyn says:

    Yup. That is me to a T!! I love not constantly panicking on anti-depressant, but it’s true that I am useless on them. Eurgh!!


  4. Cathy Evans says:

    This is me also! Always ADHD, looking back since I was a kid. The anxiety on the surface has become a reality for me the past two years. AHA Moment for me….”anxiety is a solution more than a problem. Fear of failure is the energy behind every task. She never feels accomplishment—only relief at the disasters averted”. Definitely food for thought.

    Liked by 1 person

  5. Cass says:

    The last sentence brought tears to my eyes!

    Liked by 2 people

  6. Theresa says:

    I have nothing more to offer tonight… Other than that I am right there with you😀. Hang in there!!


  7. Christi says:

    This article is too long.


  8. Avo says:

    Melissa needs Bill. Bill needs Melissa. That simple. 4 kids. That close in age and Bill’s job takes him away several days. …Melissa has anxiety? Duh! Doc….you take care of 4 kids with no help. See who has anxiety then! Melissa needs physical help and support at home. She and Bill have 4 kids. What is so difficult to understand? Bill….you’re a husband too….don’t forget that when you’re out earning a living. Melissa’s family. ….if they exist….are they helping? All the pills in the world won’t fold laundry pack lunches do dishes scrub toilets bathe babies. ….oh yeah….and hug Bill and the kids! Hmmmm….anxiety. ….adhd…..who wouldn’t have that if you’re ALONE like Melissa!


    • Your sympathy for Melissa is admirable. ADHD and anxiety don’t come from being alone or else all single moms would suffer them. ADHD and anxiety worsen the stress that even the most capable parents have when they are in Melissa’s shoes.

      Liked by 1 person

  9. BK says:

    Doc, I see you using ADHD to describe what Melissa is struggling with, but am wondering why Attention Deficit/Hyperactivity Disorder instead of Attention Deficit Disorder (ADD)? What are you seeing in Melissa that indicates the “Hyperactivity” aspect of things?


    • Melissa is a composite with details pulled from probably several dozen patients I thought of as I wrote this. There aren’t enough details in this story to make an official diagnosis. We don’t know if she is restless when sitting, impulsive in decisions, etc. .

      ADHD is the name used in the official diagnostic manual–DSM-5–for both ADD and ADHD. ADD is a popular term, but unofficial. Actually, I used it in my book, Reaching For A New Potential, rather than ADHD, but was able to point out at the start of the book that it referred to both ADD and ADHD.

      The distinction is useful at the point of diagnosis, but not that important for treatment. Both forms of ADHD are lurking behind the persistent anxiety of many women and men whose anxiety has been diagnosed, but whose ADHD has been overlooked. That was the singular point of this story.

      Liked by 1 person

  10. Lori says:

    I’ve known my anxiety was both a problem and a solution for years. I refuse meds to treat it because I do become useless. I’m a single woman and no one will pay the bills for me if I can’t work.

    I remember arguing with my doc about anxiety meds and how if I take them I become unable to function. His response? Well everyone feels worse on medication for mental health. Sadly, there may be a lot of truth in that, possibly. It was a real eye opener for me that a doc would treat anxiety to the point of ruining my life. I didn’t get it then and don’t now.

    When it comes to adhd a lot of maladaptive behaviours are also ironically, successful strategies.

    The more I’ve learned about my adhd, the more I realise how counter-intuitive it is. A surface look is useless.

    Liked by 1 person

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Oren Mason MD
Oren Mason MD

Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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