Can Stress and Anxiety Be Confused for ADD/ADHD?

  Do you have trouble concentrating? Do you feel restless? Do you get tired easily? You (and your healthcare provider) may think these are signs of ADD/ADHD, which affects an estimated 4.4% of American adults. But these same symptoms can also be signs of stress and anxiety, which impact about 40 million Americans aged 18 and older. Getting misdiagnosed or treated for the wrong condition can make things worse. How can you tell if it’s stress and anxiety or ADD/ADHD, or both?   Misdiagnosing ADD/ADHD for anxiety and vice versa can lead physicians to treat the wrong area of the brain.

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WHAT IS ADD/ADHD?

Attention-deficit hyperactivity disorder (ADHD), formerly called attention-deficit disorder (ADD), is a neurodevelopmental disorder that is marked by problems with attention and a range of behavioral issues. It is characterized by unhealthy activity in the brain’s prefrontal cortex (PFC) located just behind the forehead. The prefrontal cortex is involved with forethought, planning, judgment, impulse control, and more. Brain SPECT imaging shows that ADD/ADHD is associated with low activity in the PFC. SPECT measures blood flow and activity in the brain and reveals 3 things: areas with healthy activity, too much activity, or too little activity. On SPECT scans, when people with ADD/ADHD try to concentrate, activity in the PFC decreases. This means the harder they try, the worse it gets. In people who don’t have the condition, PFC activity increases during concentration. One of the biggest myths about ADD/ADHD is that it is a single or simple disorder. In fact, the brain SPECT imaging work at Amen Clinics has helped identify 7 types of ADD/ADHD. The hallmark symptoms seen in all 7 types of the condition are:

• Short attention span
• Distractibility
• Disorganization
• Procrastination
• Poor self-control and impulse control

Note that hyperactivity is not a core symptom, as it is not seen in all 7 types.

WHAT ARE STRESS AND ANXIETY?

Stress and anxiety can develop at any age and are characterized by feelings of anxiousness, nervousness, and overwhelm. On SPECT scans, anxiety is associated with overactivity in the brain, specifically in the basal ganglia and amygdala. The basal ganglia are important structures that are involved in motivation, drive, and setting the body’s anxiety level. The amygdala, an older part of the brain in evolutionary terms, is involved in emotional and fear responses. It plays a role in our fight-or-flight response in the face of danger or threats to our safety. Just like ADD/ADHD, anxiety is not a singular disorder. SPECT scans reveal that there are 7 types of anxiety and depression. Anxiety alone is mainly characterized by:

• Impending sense of doom
• Nervous disposition
• Persistent fears or phobias
• Fast heart rate
• Trembling and sweating
• Constant worry
• Panic attacks

Anxiety can trigger symptoms associated with ADD/ADHD. When the basal ganglia and amygdala are overactive, they can override the higher-functioning skills of the PFC. In particular, the amygdala—part of our so-called “reptilian brain”—operates primarily by instinct to avert threats whether they are real or perceived. To prioritize safety in these instances, the amygdala takes over, shutting down executive functions in the PFC and causing people with anxiety disorder to be unable to focus. When anxiousness and fear are nearly constant, it can lead to many of the symptoms seen in ADD/ADHD.

OVERLAPPING ANXIETY AND ADD/ADHD SYMPTOMS

One of the primary reasons why stress and anxiety may be confused for ADD/ADHD is that they have some similar symptoms. Overlapping symptoms include:

• Trouble concentrating
• Difficulty relaxing
• Feeling restless
• Sleep disturbances
• Easily tired
• Problems with working memory
• Low GABA levels

These symptoms can be a sign of either disorder or may occur when a person has both conditions.

CO-OCCURRING ANXIETY AND ADD/ADHD

There is a strong connection between stress and anxiety and ADD/ADHD. As many as half of all people who have ADD/ADHD have one or more comorbid anxiety disorders, according to a National Institutes of Health study. “Knowledge of the neural pathways underlying the combined presence of ADHD and anxiety may aid in a better understanding of their co-occurrence,” the authors wrote. This is why functional brain imaging with SPECT can be so powerful in helping distinguish anxiety from ADD/ADHD or in identifying co-existing disorders. By seeing the brain patterns of low and/or high activity in different areas of the brain, physicians can make more accurate diagnoses and provide more effective treatments. At Amen Clinics, when these two disorders are co-occurring it is considered one of the 7 types of ADD/ADHD and is called Anxious ADD/ADHD. This type includes the core symptoms of ADD/ADHD in addition to:

• Frequent anxiousness or nervousness
• Physical stress symptoms, such as headaches
• Tendency to freeze in social situations
• Dislikes or gets excessively nervous speaking in public
• Predicts the worst
• Conflict avoidant
• Fear of being judged

THE CONSEQUENCES OF MISDIAGNOSED ANXIETY OR ADD/ADHD

Being misdiagnosed with anxiety when you actually have ADD/ADHD, or vice versa, can worsen your condition. For example, taking stimulant medication or other ADD/ADHD solutions intended to stimulate the brain can be helpful for those with the condition, but these same therapies can exacerbate issues in someone with an overactive, anxious brain. Similarly, treatment protocols intended to calm an overactive brain are generally beneficial for those with anxiety, but in those with ADD/ADHD, they further decrease activity in the PFC and can worsen symptoms.

TREATING ANXIETY AND ADD/ADHD

Given the complexity of teasing out the differences between the disorders, seek out a mental health professional who understands that anxiety disorders and ADD/ADHD are brain-based disorders. And look for someone who is also thoroughly versed in recognizing and working with people who struggle with both conditions. Getting an accurate diagnosis is the key to finding the most effective treatment so you can feel calmer, more focused, and more in control of your life. Anxiety, ADD/ADHD, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.