Can anxiety, depression or bipolar mask ADHD?

PostedNovember 20, 2025

UpdatedNovember 21, 2025

ByMy Patient Advice

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

Anxiety, depression, and bipolar disorder can sometimes hide or “mask” the core signs of ADHD, leading to diagnostic confusion and delayed recognition. Many of the shared symptoms, including poor concentration, emotional dysregulation, and sleep problems, can appear identical across these conditions. According to NICE guidance on ADHD (NG87), accurate diagnosis depends on assessing developmental history, persistence of symptoms, and functional impact across different areas of life.

Why mood disorders can mask ADHD

Mood and anxiety disorders often dominate the clinical picture, making ADHD harder to identify. The Royal College of Psychiatrists’ Adult ADHD guidance (CR235) highlights that overlapping symptoms can cause diagnostic overshadowing, particularly among females and older adults who may compensate or “mask” ADHD traits. NICE advises clinicians to look for lifelong attention and impulsivity issues, even when anxiety or depression appears more prominent.

NHS and NICE clinical perspective

The NHS ADHD overview and the NHS ADHD Taskforce report (2025) confirm that anxiety and depression frequently mimic ADHD symptoms, such as restlessness, irritability, and poor concentration. Clinicians are encouraged to differentiate between episodic mood changes and persistent attention problems through thorough histories and validated screening tools, as set out in both NHS and NICE guidance.

Research and clinical evidence

A 2025 meta-analysis published in PubMed found that up to 60% of adults with ADHD also have anxiety or depression, which can mask underlying attention difficulties. Likewise, The Lancet Psychiatry review (2024) reported that mood instability and sleep disturbance often lead to ADHD being mistaken for bipolar disorder or generalised anxiety. The review emphasised the importance of longitudinal assessment and gender-sensitive diagnostic practices to improve accuracy.

Masking and late diagnosis

Masking, or consciously hiding neurodevelopmental traits, is especially common in females and adults with strong coping mechanisms. This often results in delayed diagnosis and prolonged emotional strain. The RCPsych recommends exploring early life patterns, coping strategies, and the persistence of functional difficulties to avoid misdiagnosis.

Key takeaway

Anxiety, depression, and bipolar disorder can easily overshadow ADHD symptoms, leading to missed or delayed diagnoses. However, applying NICE and NHS frameworks alongside evidence from The Lancet Psychiatry helps clinicians recognise the full picture. A multidisciplinary, gender-aware approach remains essential for uncovering underlying ADHD and ensuring timely, accurate care.

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.