Understanding ADHD and Social Anxiety

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral condition that causes people to exhibit patterns of hyperactivity, inattention, and impulsivity. It is not uncommon for people with ADHD to have a co-occurring anxiety condition, including social anxiety. Social anxiety is characterized by an intense fear of social situations.

Though any anxiety disorder can coexist with ADHD, social anxiety disorder (SAD) is one of the most common. While estimates vary, research suggests that 60 to 70% of people with ADHD also experience social anxiety disorder.

Learning the differences between the two conditions is important in the management and treatment of both. In this article, we discuss the connection between ADHD and social anxiety disorder, including how one condition affects the diagnosis and treatment of the other.

The Connection Between ADHD and Social Anxiety

It's entirely possible that anxiety disorders occur much more frequently in people with ADHD than they do in the general population. However, more research is needed to understand why ADHD and SAD co-occur in some people and not in others.

Still, others believe that ADHD symptoms, themselves, contribute to anxiety. Often, ADHD symptoms—such as inattention, hyperactivity, and impulsivity—put a person at greater risk of being teased, bullied, or otherwise socially rejected. Fearing further rejection, many withdraw into themselves, avoiding any social setting that they find threatening.

A person with ADHD might be more likely to develop social anxiety if:

• They have a family history of anxiety disorders
• They have negative social experiences such as peer rejection, bullying, or other interpersonal conflicts
• They have a shy, reserved, or inhibited temperament
• They experience sudden social changes such as starting a new job
  

Complications of ADHD and Social Anxiety

When ADHD and social anxiety occur together, a number of complications may result.

Overlapping Symptoms

On the surface, SAD and ADHD can sometimes look alike. The following are just a few ways symptoms of ADHD and SAD overlap:

• Difficulty socializing: People with SAD may struggle to make and maintain friendships due to fears about rejection. Someone with ADHD is likely to have low impulse control and trouble picking up on social cues, making it difficult to sustain friendships.
• Inattention: A person with SAD may seem tuned out, but they are really just distracted by worries. Those with ADHD are inattentive because of differences in the brain that affect focus.
• Trouble completing tasks: People with SAD might become stuck on a task and be too anxious to ask for help. Those with ADHD might not turn in an assignment because of poor planning skills and forgetfulness.

Misdiagnosis

Having both conditions at the same time can also contribute to misdiagnosis. Unfortunately, some symptoms of SAD can be misinterpreted as ADHD symptoms, and it isn't until outward behaviors—such as weight loss, sleeplessness, or refusal to attend social settings—that the social anxiety becomes more apparent. As a result, SAD often goes undiagnosed in those who also have ADHD.

Diagnosis of ADHD and Social Anxiety

In order to diagnose ADHD and social anxiety, a doctor or mental health professional will ask questions about symptoms, conduct psychological assessments, and collect a medical history. 

ADHD

ADHD can be categorized into three subtypes: inattentive type, hyperactive type, and combined type. To be diagnosed, children and adults must exhibit symptoms of inattention or hyperactivity for six months or longer. Such symptoms may include:

• Struggling to pay attention
• Making careless mistakes
• Not following directions
• Trouble organizing tasks
• Difficulty remaining skill
• Talking excessively
• Frequently interrupting others

Symptoms must begin before age 12, be present in two or more settings, and interfere with the individual's ability to function in daily life. Such symptoms must also not be the result of another mental disorder or medical condition.

Social Anxiety

In order to be diagnosed with social anxiety disorder, a person must:

• Experience fear reactions that are out of proportion to the danger the situation presents
• Symptoms must interfere with a person's ability to function in their daily life
• People must experience this anxiety in almost all social situations

Additionally, symptoms of social anxiety must be present for six months or longer and must not be due to substance use, a medical condition, or another mental health condition.

Treatment of ADHD and Social Anxiety

There are no clear or published guidelines on how to treat co-occurring ADHD and SAD. Only after your doctor determines how your anxiety functions can they develop the best treatment plan to meet your needs.

For instance, if your anxiety and ADHD are functioning independently of one another, your doctor may decide to treat both conditions simultaneously. Or they may choose to treat whichever condition is causing you the most problems first before moving on to the other condition.

However, if your doctor believes that your anxiety is being caused or heavily influenced by your ADHD, your doctor may take a different approach to treatment.

Medications

If your anxiety is the result of ADHD, your doctor may decide to treat your ADHD first with medications as this may reduce your anxiety symptoms. Common medications used to treat ADHD include:

• Stimulants: Although stimulants primarily treat ADHD symptoms, as ADHD symptoms are controlled, you may also find some relief from your anxiety. In one study examining children and adolescents with ADHD and SAD comorbidity, Ritalin (methylphenidate) was found to be associated with a significant improvement in both ADHD and SAD symptoms. A similar study found the same improvements in adults using extended-release Ritalin.
• Non-stimulants: Selective norepinephrine reuptake inhibitors (SNRIs) like Strattera (atomoxetine) may target both ADHD and anxiety symptoms. One study found that Strattera improved both ADHD and comorbid SAD in adults.
  

Psychotherapy

While medication has historically been the first line of treatment for ADHD, many people also benefit from non-medication therapies, and that is especially true of people who are also living with an anxiety disorder.

A specific technique your therapist might recommend is exposure therapy, a type of CBT most often used when treating SAD, in which you and your therapist work together to gradually expose you to anxiety-provoking situations so you can develop healthy coping mechanisms and, over time, the situations elicit less fear. In other types of CBT, you can learn and practice social skills and relaxation techniques.

Coping With ADHD and Social Anxiety

If you have ADHD and social anxiety, there a many coping methods that can make your life easier to manage.

Lifestyle Changes

There are several lifestyle changes that may help make disruptive ADHD characteristics easier to cope with. Such strategies may also offer relief from feelings of social anxiety. Some you might try include:

• Meditation: Meditation can be a useful relaxation tool that can combat feelings of anxiety and increase self-awareness.
• Journaling: Journaling can be a helpful form of self-expression that can relieve feelings of anxiety and help you notice patterns and triggers that tend to make your symptoms worse. Writing things down can also help people with ADHD combat forgetfulness.
• Creating routines: Having a structured routine can be helpful for managing stress and anxiety. For people with ADHD, it can also be a way to get tasks done without getting off-track. Instead of getting distracted, you'll have a greater awareness of where you should be and what you should be doing.

Support Groups

Support groups can be a great source of encouragement, resources, and advice. You'll be able to talk to people who have had similar experiences and get advice about how to manage different aspects of your condition.

Of course, the idea of participating in a support group can be intimidating for many people with social anxiety disorder. One way to deal with this is to consider joining an online support group. This will allow you to gradually practice interacting with others in an online format. Over time, you may find that attending in-person support meetings can also be helpful.

Summary

It is not uncommon for people with ADHD to have co-occurring conditions, including social anxiety disorder. The exact reasons why they often co-occur are not clear, but genetics and environmental factors may play a part. Characteristics of ADHD may also make it more likely for people to feel anxious in social situations.

While having both conditions can lead to complications and make diagnosis more difficult, treatments are available that can help. Medications, psychotherapy, and lifestyle changes can help people manage the traits and symptoms of both conditions in order to function better in daily life.

A Word From Verywell

A co-occurring diagnosis of SAD can be a lifelong reality for someone with ADHD. It's OK to feel overwhelmed. Learning more about the connection between these two conditions is the first step toward lessening the impact they have on your life. Just take a deep breath and know that with the right support, you can manage both ADHD and SAD, and thrive in life.