Anxiety or ADHD? How the two can look the same in children

The short answer

Anxiety and ADHD can look surprisingly alike. A worried child may seem distracted, restless or forgetful because their mind is busy with "what ifs". A child with ADHD may become anxious because school keeps feeling hard. The key difference is usually why the attention slips: with anxiety, worry pulls the attention away; with ADHD, attention drifts even when the child is calm and interested. The two also often happen together, so only a full professional assessment can say for sure.

Why they get confused

Child and adolescent psychiatrist Dr Candida Fink puts it simply: "Trouble focusing is a symptom of various medical and psychiatric conditions." Both anxiety and ADHD can show up as:

• Not listening or seeming "away with the fairies"
• Fidgeting and finding it hard to sit still
• Trouble starting or finishing homework
• Irritability and big reactions
• Poor sleep
• Avoiding tasks

From the outside, these behaviours can look identical. The difference lies in what is driving them.

Clues that point more towards anxiety

• The focus problems appear in particular situations (tests, new places, separation) and ease when the child feels safe.
• You can see or hear worry: lots of "what if" questions, reassurance seeking, fear of getting things wrong.
• Body signs: tummy aches, headaches, a racing heart, feeling sick before school.
• The difficulties started or got worse after a change or stressful event.
• Perfectionism: the child avoids work because it might not be perfect, rather than because they can't settle to it.

Clues that point more towards ADHD

• Attention, impulsivity or restlessness have been there since early childhood, across many settings: home, school, clubs and holidays.
• Focus slips even during calm, low-pressure, enjoyable tasks (apart from things they find intensely interesting).
• Frequent losing of belongings, interrupting, acting before thinking.
• The child often isn't worried at all about the things they forget.

When it's both

Many children have both. ADHD can make daily life feel unpredictable, which feeds anxiety, and anxiety can make ADHD traits harder to manage. Dr Fink also warns against stopping the assessment process too early. In one case she describes, supporting a teenager's anxiety first with CBT and parent support improved her concentration, and only then could ADHD be properly assessed.

What to note down before you speak to a professional

A simple two-week record makes appointments far more useful:

• When does the focus problem happen? (Time of day, place, task)
• What happened just before? (A change, a worry, a transition)
• Is your child calm or worried when it happens?
• How long have you noticed it? Was it there in nursery or early primary?
• What do teachers see? Ask for a short note.
• Any family history of anxiety or ADHD?

Take this to your GP or your child's school (the SENCo is a good starting point). In many areas, waiting lists for ADHD assessment are long, so starting early and keeping notes is worth it.

What helps either way

Whatever the cause, these support both anxious and ADHD brains:

• Predictable routines and visual plans
• Breaking tasks into small chunks with movement breaks
• Calm, short instructions, one at a time
• Naming feelings and co-regulating before problem-solving
• Plenty of sleep, food and downtime

How Hearth can help

Hearth's free Waiting Room Plan gives you a gentle week-by-week plan for the time while you wait for an assessment, including a simple record you can share with professionals. You'll also find calm scripts and printable visual routines at hearthwellbeinghub.com.

This article is wellbeing self-help and cannot diagnose anxiety or ADHD. Please speak to a qualified professional about any concerns.

Source: Candida Fink MD, "Maybe It's Not ADHD, Maybe It's Anxiety", Psychology Today (June 2025).