How can anxiety mask ADHD in adults?

PostedNovember 19, 2025

UpdatedNovember 21, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Anxiety and ADHD often occur together in adults, making it difficult to tell one condition from the other. Both can cause restlessness, poor concentration, and disturbed sleep, which may lead to confusion during assessment and diagnosis. According to NHS guidance on adult ADHD, adults living with anxiety may be misdiagnosed because their symptoms can closely resemble ADHD. This overlap can delay accurate diagnosis and treatment, meaning many people go years without understanding the full cause of their difficulties.

The NICE NG87 guideline on ADHD advises that clinicians should always consider coexisting mental health conditions such as anxiety during assessment. Understanding how anxiety can mask ADHD helps ensure adults receive accurate diagnosis and holistic, evidence-based care that addresses both conditions.

Understanding the overlap between anxiety and ADHD

Anxiety and ADHD share many core features. Restlessness, irritability, concentration problems, and sleep difficulties are common in both conditions. According to research published in ScienceDirect, around half of adults with ADHD also experience an anxiety disorder. Evidence from PubMed shows that this overlap is linked to more severe emotional distress and reduced daily functioning.

For some adults, anxiety develops because unmanaged ADHD symptoms create long-term stress and worry. For others, anxiety may appear first and mask the underlying signs of ADHD, making clinical assessment more complicated.

Overlapping symptoms

Adults with both anxiety and ADHD often experience similar challenges, including trouble relaxing, constant restlessness, and disrupted sleep. NICE guidance explains that inattentiveness caused by anxiety, such as excessive worry or mental overactivity, can look very similar to the distractibility seen in ADHD (NICE NG87, updated 2025). This similarity makes it essential for clinicians to take a full developmental and psychiatric history rather than focusing only on current symptoms.

Structured screening tools such as the Adult ADHD Self-Report Scale (ASRS) and the Generalised Anxiety Disorder scale (GAD-7) can help determine whether symptoms stem from ADHD, anxiety, or both. Combining these tools with detailed background information helps improve diagnostic accuracy.

Impact on diagnosis and management

When anxiety dominates, ADHD symptoms can be overlooked. Many adults seek help for anxiety without realising that undiagnosed ADHD might be contributing to their struggles. NICE and NHS experts recommend that every ADHD assessment includes screening for coexisting conditions, since treating anxiety alone may not fully address the root causes of concentration or motivation problems.

Effective management often involves a combination of psychoeducation, cognitive behavioural therapy (CBT), and, where appropriate, medication for both ADHD and anxiety. Clinicians usually focus first on whichever condition causes the greatest impairment while continuing to monitor the other. This combined approach helps adults manage symptoms more effectively and improve overall wellbeing.

Key takeaway

Anxiety can mask ADHD in adults because both conditions share many overlapping symptoms. NICE and NHS guidance highlight the importance of comprehensive, specialist-led assessment to identify each condition accurately. When both are recognised and treated together, adults can gain better control of their focus, mood, and daily life.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.