Can a Child Have Both ADHD and Anxiety? What Parents Should Know
Many families are surprised to learn that ADHD and anxiety often occur together. In fact, co-occurring (“comorbid”) conditions very common for children with ADHD, and anxiety disorders are among the most common partners. Large reviews and meta-analyses consistently show high rates of comorbidity, underscoring the importance of screening for both conditions during an evaluation (Njardvik et al, 2025).
Why do ADHD and anxiety so often co-occur?
Researchers point to a few likely pathways:
Shared vulnerabilities: Genetics and brain-based differences in attention, executive function, and emotion regulation can increase risk for both ADHD and anxiety. Conceptual reviews describe overlapping etiological factors and bidirectional influences between the two conditions (Jarrett & Ollendick, 2008).
Functional “feedback loops”: Everyday ADHD challenges (missed details, disorganization, time-blindness) can create repeated experiences of underperformance and social stress. Over time, many children begin to anticipate failure, fueling anxious worry and avoidance. Studies linking anxiety with executive-function load (especially working memory) help explain why demands that stretch executive skills can spike anxiety in youth (Marsh et al., 2025; Marsh et al., 2024).
Masking and compensation: Some children, particularly those with higher cognitive ability, work incredibly hard to compensate for ADHD weaknesses. That “hidden labor” can temporarily keep grades up while quietly increasing stress, perfectionism, and anxiety. Importantly, research shows ADHD in high-IQ youth looks clinically similar to ADHD in other children (i.e., high IQ doesn’t cancel ADHD); the profile still includes executive-function weaknesses that can drive worry under load (Cadenas et al., 2020; Katusic et al., 2011).
Bright kids are not “immune” to ADHD
Families sometimes wonder whether strong test scores or advanced vocabulary mean a child “can’t really have ADHD.” Population-based and clinical studies show otherwise: ADHD occurs at all IQ levels, and even highly intelligent children with ADHD show the characteristic cognitive pattern (e.g., working-memory and processing-speed weaknesses) alongside functional impairment at school and at home. In other words, intelligence can help compensate, but it does not cure (Cadenas et al., 2020; Katusic et al., 2011). These types of learners present with elevated rates of ADHD and highlight how uneven profiles (very high reasoning with relative weaknesses in attention, planning, or written output) can lead to frustration, inconsistent performance, and anxiety (Cornoldi, Giofre, & Toffalini, 2023; Eren et al., 2018). Families and teachers may notice patterns such as:
Procrastination that’s really avoidance: Tasks with many steps (book reports, multi-page math sets) evoke worry and are put off; avoidance temporarily lowers anxiety but worsens academic backlogs (Marsh et al., 2025; Marsh et al., 2024).
Perfectionism and overcontrol: Bright children may set unrealistically high standards to cover ADHD-related slip-ups, driving anxious over-checking and slow work. 2e literature frequently notes this “high ability + uneven output” cycle and the stress it produces Eren et al., 2018).
Social strain: Missing subtle cues (interrupting, rushing, or withdrawing to avoid mistakes) can create peer friction, fueling social anxiety and further withdrawal. Comorbidity reviews describe how the two conditions can amplify one another in social contexts (Jarrett & Ollendick, 2008).
ADHD and Anxiety Evaluations
At the Center for Pediatric Neurodiversity, we assess the whole child. Our evaluations typically integrate:
Multi-method testing of attention, working memory, processing speed, and executive skills
Anxiety screening (including the form the anxiety takes—worry, avoidance, somatic symptoms, social fear)
Contextual data from caregivers and teachers to see how skills show up in real life
Strengths and interests, because leveraging strengths is protective for mental health
This approach aligns with research showing that high IQ does not erase ADHD features and that anxiety can interact with executive-function load (Cadenas et al., 2020; Katusic et al., 2011).
What helps? Evidence-based care for co-occurring ADHD and anxiety
The good news: treatments work, and they can be combined.
Cognitive-behavioral therapy (CBT) is effective for pediatric anxiety, including when ADHD is present. Studies show children with ADHD can benefit from manualized CBT for anxiety, and in some cases ADHD symptoms also improve as avoidance decreases and coping skills grow (Goould, Porter, Lyneham, & Hudson, 2018).
ADHD medications generally improve attention and task follow-through. Medication choices and sequencing are individualized in collaboration with the family and prescribing clinician (Coughlin et al., 2015; Khoodoruth, Ouanes, & Khan, 2022; Soul et al., 2021)
School supports, such as extended time broken into checkpoints, scaffolded planning (rubrics, exemplars, interim deadlines), and reduced-demand testing environments, lower executive-function load that fuels anxiety while directly targeting ADHD-related bottlenecks.
Allowing choice, complexity, and depth in areas of passion, while giving explicit structure for output (outlines, graphic organizers, writing frames), reduces perfectionistic avoidance and preserves motivation.
When to seek an evaluation
Consider a comprehensive assessment if your child shows a mix of:
High verbal reasoning or advanced knowledge and
Disproportionate difficulty starting/finishing work, perfectionistic delays, test anxiety, or social withdrawal when performance is public
An evaluation can clarify the roles of ADHD and anxiety, identify a child’s learning profile, and map out a plan for skill-building and supports. Contact us for more information.
References
Jarrett, M. A., & Ollendick, T. H. (2008). A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clinical psychology review, 28(7), 1266–1280.
Katusic, M. Z., Voigt, R. G., Colligan, R. C., Weaver, A. L., Homan, K. J., & Barbaresi, W. J. (2011). Attention-deficit hyperactivity disorder in children with high intelligence quotient: results from a population-based study. Journal of developmental and behavioral pediatrics : JDBP, 32(2), 103–109.
Cadenas, M., Hartman, C., Faraone, S., Antshel, K., Borges, A., Hoogeveen. L., & Rommelse. N. (2020). Cognitive correlates of attention-deficit hyperactivity disorder in children and adolescents with high intellectual ability. J Neurodevelop Disorders, 12(6).
Marsh, C. L., Harmon, S. L., Cho, S., Chan, E. S. M., Gaye, F., DeGeorge, L., Black, K. E., Irwin Harper, L. N., & Kofler, M. J. (2024). Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?. Research on child and adolescent psychopathology, 52(5), 773–787.
Marsh, C. L., Harmon, S. L., Cho, S., Chan, E. S. M., Gaye, F., DeGeorge, L., Black, K. E., Irwin Harper, L. N., & Kofler, M. J. (2024). Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder?. Research on child and adolescent psychopathology, 52(5), 773–787.
Eren, F., Çete, A. Ö., Avcil, S., & Baykara, B. (2018). Emotional and Behavioral Characteristics of Gifted Children and Their Families. Noro psikiyatri arsivi, 55(2), 105–112.
Gould, K. L., Porter, M., Lyneham, H. J., & Hudson, J. L. (2018). Cognitive-Behavioral Therapy for Children With Anxiety and Comorbid Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 57(7), 481–490.
Coughlin, C. G., et al. (2015). Meta-analysis: Reduced risk of anxiety with psychostimulants in children with ADHD. Journal of Child and Adolescent Psychopharmacology.
Khoodoruth, M. A. S., et al. (2022). Systematic review: Atomoxetine for anxiety symptoms in youth with ADHD. Journal of Affective Disorders Reports.
Njardvik, U., et al. (2025). Meta-analysis of psychiatric comorbidity in youth with ADHD. Clinical Psychology Review.
Cornoldi, C., et al. (2023). Cognitive characteristics of intellectually gifted children with ADHD (2e-ADHD). Intelligence.