Can Stress and Anxiety Be Confused for ADD/ADHD?

Anxiety and ADD


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. Click To Tweet


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.


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.


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.


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


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.


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.


  1. Thanks it helped.

    Comment by Stan Roberson — July 28, 2023 @ 4:24 AM

  2. Do you have a facility in or near Columbus Ohio?

    Comment by Maria — July 28, 2023 @ 5:27 AM

  3. In need of a accurate diagnosis.

    Comment by Jackie Toth — July 28, 2023 @ 6:44 AM

  4. This is my 10 year old daughter. We have not found an ADHD medicine that works for her. She is 10 and we adopted her at age 5. I tried to bring her to the clinic over the summer, but she had a total panic attack with the needle, and, we were unable to stay. I don’t know how to help her anymore. The stimulants give her tics the non-stimulants give her suicidal thoughts. She is diagnosed with an anxiety disorder and ADHD. Do you guys ever help without the spec scans?

    Comment by Jenny McCall — July 28, 2023 @ 9:40 AM

  5. You list all the types of categories. Yet I want to see you categorize living conditions into the equation. Would a woman living in a a well organized home surrounded with loving and supportive family members, a maid, a cook, a butler, a gardener, a tax accountant, a chauffeur, a social assistant, and a companion be diagnosed with ADD/ADHD? Take the same woman 10 years later who suffered a concussion, a torn optic nerve in her left eye, and neuropathy setting in, an an imbalance in walking who also lost all her helpers due to bankruptcy, and found herself at age 65 living all alone, and having to cook, clean, garden, drive, organize files that became disorganized when the lateral filing cabinets broke and collapsed. Due to not being able to climb stairs easily, to organize a 4 season wardrobe, and to manage the household tasks, is she suffering from add/ADHD? Or is she overwhelmed with piles of chores mounting in the rooms??? I really need to hear from you. When a neuropsychologist sees a patient for 45 minutes (not the 4 hours promised) and diagnoses her with ADD?ADHD, and that sticks in her medical records, and other doctors go with that LABEL, it snow balls. It's unprofessional. It hurts the patient suffering from a concussion. Look at the whole picture. Mislabeling harms patients.

    Comment by Linda — July 28, 2023 @ 12:18 PM

  6. Do you know of any doctors in Kansas City MO. that use brain imaging to treat anxiety and ADD? Thank you for your time.

    Comment by Brenda — July 30, 2023 @ 4:37 PM

  7. I wish to educate me or a member in the family.. on the Amen method.. but two things leave me asking for considering.
    1. why not always show a sample of a scan to compare with one or another condition..
    helpful for me to, I am a visiual learner..
    2. HOW does the amen clinic (try) to treat any condition, suplements, drugs, therapie? how many visits to the clinic are needed to influence changes in the brain? how long does treatment take to experience changes/improvements?

    A 1.5 year old is (from birth) not using his left hand as he is using his right hand.. similar: he is not using the right foot compared to the other side… when to decide a cross country visit to the Amen Clinic???

    Comment by Jolanda Bassi — July 30, 2023 @ 7:38 PM

  8. Low income adhd treatments and plan 42 years untreated

    Comment by Lindsay Shattock — August 3, 2023 @ 3:54 PM

  9. I’ve been diagnosed with anxiety by my primary doctor, and he prescribed me to take Lexapro. I have not taken any cause I’m afraid of side effects. I’m more of a person that prefers natural remedies. I experienced nervousness, panic attacks, anxious feelings especially going to stores, fast heart rate, heavy breathing episodes. All my lab work came out normal. Currently I purchased anxiety free supplements together with gabatrol at natural health store!!Please help! Are those ok to take?

    Comment by Joanna Brychta — August 24, 2023 @ 9:52 PM

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