Though any anxiety disorder can coexist with ADHD, social anxiety disorder (SAD) is one of the most common. Learning the differences between the two conditions is important in the management and treatment of both.
SAD and ADHD
It’s entirely possible that anxiety disorders occur much more frequently in people with ADHD than they do in the general population. According to the National Comorbidity Survey Replication, 47% of adults with ADHD have an anxiety disorder—approximately 30% have SAD, specifically. 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 for being teased, bullied, or otherwise socially rejected. Fearing further rejection, many withdraw into themselves, avoiding any social setting that they find threatening.
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.
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.
Treatment
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. A 2009 study found that Strattera improved both ADHD and comorbid SAD in adults.
Talk Therapy
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.
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.
