When Anxiety Looks Like ADHD

I can’t tell you how many first visits begin with, “I’m having attention issues.” It’s a real and exhausting feeling. But difficulty concentrating is a symptom, not a diagnosis. Fatigue, mood changes, hormones, depression, or anxiety can all drain focus. When anxiety is running the show, the mind races, the body is on alert, attention often looks scattered, and motivation is flat, even in people who’ve never had ADHD.

How Anxiety Can Look Like ADHD

When your nervous system is stuck in “go,” the brain prioritizes scanning for threats over deep work. That can feel like distractibility, poor follow-through, and mental fog. Physical cues like restlessness, muscle tension, shallow breathing, and poor sleep often ride along and make focus worse. In high-pressure, competitive environments, people start to feel “not present” and wonder if they’ve had ADHD all along. Sometimes it’s anxiety crowding out attention. 

Hormonal shifts can add fuel. During perimenopause, for example, sleep and cognitive changes are common, and anxiety or depression may flare. This creates another pathway to ‘brain fog’ that can mimic ADHD.

What Truly Points to ADHD

ADHD is a neurodevelopmental condition. For a true diagnosis, symptoms typically begin in childhood, show up in two or more settings (home/school/work), impair functioning, and aren’t better explained by something else (like an anxiety or mood disorder). That “across time and settings” piece matters.

Yes, Both Can Co-Exist

Plenty of adults have both ADHD and an anxiety disorder, which is one reason the picture can get muddy. Careful history-taking, not quick labels, keeps us honest and guides treatment.

Why Getting the Name Right Matters

Treatment plans diverge. If anxiety is central, easing the worry and calming the body often brings focus back, even without ADHD meds. If ADHD is primary, stimulants or non-stimulants can help attention and executive function. (Worth noting: in some people, stimulants can heighten anxiety, so we choose thoughtfully and monitor closely.) 

How I Sort This Out (My Approach)

Our first visit is your story: where symptoms started, how they show up across work, home, and relationships, and what’s changed recently (stress, sleep, grief, hormones). I’m listening for timeline (since when?), pattern (everywhere or situational?), and contributors (anxiety, depression, burnout, medical issues).

Sometimes I use brief screeners to add structure to the conversation, like the ASRS for adult ADHD and the GAD-7 for anxiety, along with collateral when it helps (old report cards, a partner’s perspective). They don’t replace a clinical interview, but they keep us anchored.

The Takeaway

If you’re struggling to focus, you’re not “lazy”- your brain is signaling something. Sometimes that something is ADHD. Sometimes it’s anxiety wearing an ADHD mask. Often, it’s a bit of both. My job is to untangle the threads and build a plan with medication when useful, therapy, and practical habits that help you feel clear and present again.

References & further reading

• CDC: Diagnosing ADHD (childhood onset; multiple settings; impairment; rule-outs). 

• DSM-5 overview of ADHD criteria (childhood onset emphasis). 

• NIMH: Generalized Anxiety Disorder (symptoms include trouble concentrating and physiologic arousal). 

• MGH Center for Women’s Mental Health: Menopausal transition & cognition/mood. 

• Cleveland Clinic: ADHD medications overview (stimulants, neurotransmitters, cautions). 

• Adult ADHD ASRS (screening tool); GAD-7 (anxiety screener).