For adult women, ADHD and anxiety are commonly evaluated together because they can look remarkably similar, can coexist, and can amplify one another. Importantly, anxiety can sometimes mimic ADHD symptoms, while untreated ADHD can create chronic stress/anxiety from years of feeling overwhelmed, behind, or disorganized.

ADHD vs. Anxiety: why evaluate both?

• Both can cause:
  • Difficulty concentrating
  • Forgetfulness
  • Restlessness/fidgeting
  • Racing thoughts
  • Difficulty completing tasks
  • Sleep problems
  • Irritability
  • Feeling overwhelmed
  • Poor executive functioning
  • Trouble sitting still or relaxing

The key difference:
ADHD = a neurodevelopmental disorder involving persistent problems with attention and/or hyperactivity/impulsivity.
Anxiety = excessive fear, worry, or apprehension that is difficult to control and causes impairment.

ADHD —DSM-5-TR criteria

For adult women, ADHD requires a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning.

Inattention — 5 or more symptoms in adult women:

• Often fails to give close attention to details
• Difficulty sustaining attention
• Doesn’t seem to listen when spoken to directly
• Doesn’t follow through on tasks
• Difficulty organizing tasks
• Avoids tasks requiring sustained mental effort
• Often loses things
• Easily distracted
• Forgetful in daily activities

They can also feed into each other:

Hyperactivity/impulsivity — 5 or more symptoms in adults:

ADHD → missed deadlines, disorganization, unfinished tasks → stress → anxiety

Anxiety → excessive worry/preoccupation → difficulty concentrating → symptoms that resemble ADHD

Some patients genuinely have both conditions, rather than one causing the other.

• Fidgets
• Leaves seat when remaining seated is expected
• Feels restless
• Difficulty engaging in leisure activities quietly
• Often “on the go”
• Talks excessively
• Blurts out answers
• Difficulty waiting their turn
• Interrupts or intrudes on others

Other important ADHD criteria

• Several symptoms must have been present before age 12
• Symptoms must occur in 2 or more settings — e.g., work + home
• Symptoms must cause clinically significant impairment
• Symptoms cannot be better explained by another disorder
• Symptoms aren’t simply a consequence of stress, sleep deprivation, substance use, etc.

Anxiety —There are several anxiety disorders, so the evaluation depends on the patient’s symptoms.

Generalized Anxiety Disorder (GAD)

DSM-5-TR includes:

• Excessive anxiety and worry about multiple areas of life
• More days than not for at least 6 months
• Difficulty controlling the worry
• Associated symptoms such as:
  • Restlessness/on edge
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance
• Symptoms cause clinically significant distress or impairment
• Not better explained by another condition/substance

Why the clinical interview matters more than the questionnaire

A really useful question is:

“When did these symptoms start, and what happens when you’re NOT anxious?”

Clues favoring ADHD

• Symptoms have been present since childhood
• Longstanding disorganization
• Chronic procrastination
• Frequently losing things
• Time blindness
• Difficulty initiating/completing tasks
• Distractibility even when calm
• Hyperfocus on highly interesting activities
• Symptoms occur across multiple environments
• Pattern persists even when life is relatively stable

Clues favoring anxiety

• Concentration problems occur primarily when worrying
• Symptoms began later in life
• Excessive “what if…” thinking
• Physical anxiety symptoms
• Muscle tension
• Feeling constantly on edge
• Avoidance
• Panic symptoms
• Symptoms fluctuate with stressors
• Attention improves when anxiety is controlled

And sometimes…

It’s both.

A patient may have lifelong ADHD and develop significant anxiety because of the functional consequences of ADHD—or have an independent anxiety disorder alongside ADHD.

You don’t want to diagnose “ADHD” simply because someone can’t concentrate—and you don’t want to diagnose “anxiety” simply because someone feels overwhelmed.

The goal is to determine what is driving the symptoms, when they started, where they occur, and how they impair functioning.

For adults especially, ADHD and anxiety should often be considered together because the symptom overlap is substantial—and treating the wrong underlying problem may not resolve the patient’s difficulties.

Think You May Have ADHD? You’re Not Alone.

If you’re a woman struggling with difficulty focusing, forgetfulness, overwhelm, restlessness, or constantly feeling like you’re falling behind, it may be worth exploring whether ADHD could be part of the picture. Because ADHD and anxiety can share many of the same symptoms, getting the right evaluation is an important first step.

EmpowerHER offers ADHD testing for women to help you better understand your symptoms and determine whether ADHD, anxiety, or both may be contributing to your experience. If you’re ready for answers and personalized support, schedule an appointment with Jacquelyn today.