ADHD Comorbidities & Related Conditions

ADHD, Anxiety, and Autism: Your AAA Guidebook

It can be hard — if not impossible — to tell where ADHD ends, and where autism or anxiety begins. Even more difficult? Figuring out how to help. Start here.

Mother and her daughter, diagnosed with ADHD and anxiety
Vertical shot of mother and daughter spending time together indoors
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Trust Your Instincts

No single parenting book addresses the unique experience of raising your child, especially if your child has anxiety along with ADHD, and/or autism spectrum disorder (ASD). There is no one-size-fits-all presentation — or approach to diagnosis and treatment. As parents, we are the experts when it comes to our children — how they operate and what’s not going to work for them. We can use that information to play detective and create our unique guidebook for understanding their behaviors, managing their lives, and helping them thrive. Here is how to get started.

Brain of a child with ADHD and anxiety
Puzzle in head. Vector flat illustration
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The ADHD-ASD Connection

ADHD and ASD are neurodevelopmental disorders that impact similar brain functions. They are distinct conditions but have similar symptoms and a common genetic link.

What helps distinguish ADHD from ASD is communication and social relatedness, but it is sometimes challenging to make these distinctions accurately. Some experts in the field argue that we should focus less on diagnostic labels and more on how a child’s functioning is impacted.

A young girl with ADHD and anxiety scared to turn in homework
Girl turning in homework
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How Anxiety Presents

Imagine a child with ADHD or ASD in class, trying to absorb verbal instruction. They might have attention problems or feel lost and confused, which can lead to anxiety – especially if they get called on, and they don’t have the answer or aren’t even sure of what is going on in the discussion. Anxiety makes it hard to think clearly, which increases stress.

Anxiety is the brain’s essential internal alarm system that activates our fight, flight, or freeze response. This reaction occurs when we feel vulnerable, in danger of being embarrassed, or are in trouble. Most children with ADHD and ASD experience anxiety this way a rise in feelings of fear or panic when faced with an uncomfortable situation; others have generalized anxiety disorder, which leads to chronic worrying.

[Self-Test: Does My Child Have Generalized Anxiety Disorder?]

Teacher working with a student with ADHD and anxiety
Male Student Writing Answer On Whiteboard
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Diagnosis Is Rarely Easy

“The different therapies and medication are helpful, but there are some lingering behaviors we just don’t understand.” If this sounds like you, it might be time to see a specialist. A more comprehensive psychoeducational or neuropsychological assessment could help you understand the source of your child’s struggles beyond ADHD.

You may be missing effective treatments because you didn’t realize an issue like anxiety or autism was present. A complete and accurate diagnosis is a key to unlocking new therapies and to accessing the appropriate services or accommodations at school.

Question marks on sticky notes, representing the questions of ADHD and anxiety
Question marks on sticky notes, representing the questions of ADHD and anxiety
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Is Comprehensive Best?

There are psychological, psychoeducational, neuropsychological, and hybrid evaluations that study a child’s functioning across a broad range of areas. These look at psychological functioning, thinking and intelligence, academic functioning (e.g., math, reading, and writing), emotional functioning, attention, memory, and executive functioning. Your child’s doctor should explain the different types of assessments available and recommend which ones they feel are most appropriate.

Comprehensive evaluations are always more accurate, but they can be costly and time intensive. They may also require travel if there isn’t access to specialists where you live. It might be necessary for you to miss work or for your child to miss school. When making an appointment, be sure to ask, “How are you going to determine whether my child is on the autism spectrum? What tools are you going to use?” Ask about the costs. Check with your health insurance company to find out if any of the tests are covered. It is crucial to weigh the pros and cons and determine what is best for your family.

An accurate diagnosis requires input from you, based on your experiences with and observations of your child’s behaviors and struggles. You should keep track of behaviors, struggles, and accomplishments. All of these provide clues on how to help your child best.

A young boy with ADHD and anxiety hiding in the closet
Sad boy, hiding in the closet
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Document Behavior Challenges

Behavior is a pressing concern for many parents. Tantrums, meltdowns, noncompliance, and shutting down are all outward signs or manifestations of problems you can’t see.

Maybe your child throws a fit, ignores you, or hides in the closet when they’re supposed to get dressed for school. What’s the real problem here? For you, it’s getting your child out the door on time. For your child, it could be school-related anxiety. Or discomfort transitioning from one activity to the next. Or a sensory issue related to his clothes. Or they are having trouble sleeping and is very tired.

Look at the reaction. Is it a fight reaction of tantrums and meltdowns? Is it a flight reaction of noncompliance? Or is a freeze reaction – shutting down, hiding, or not talking?

Young girl with ADHD and anxiety crying in class
little girl crying in school classroom
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Document Social Challenges

Is your child making friends? Do they avoid other children? Do they struggle in groups? Do they misbehave and say awkward things? These social challenges are outward signs of a problem caused by ASD, ADHD, or anxiety.

If a child is withdrawn, plays alone, and lacks interest in other kids, we sometimes associate those behaviors with ASD. Children with ASD also sometimes have trouble interpreting social cues and distinguishing between teasing, playfulness, and bullying.

Or, it could be that your child’s ADHD-related inattention or hyperfocus makes it difficult to cooperate, take turns, or play a game. Fear of failure, embarrassment, or exclusion might keep an anxious child from trying to join in with peers.

[Free Download: 14 Ways to Help Your Child With ADHD Make Friends]

A boy with ADHD and anxiety daydreaming in class
A boy with ADHD and anxiety daydreaming in class
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Document Learning Challenges

Kids with AAA tend to see things in black and white, yes or no, right or wrong. They do not recognize nuances. Learning challenges can be outward signs of your child’s problems with paying attention. Internal anxiety and stress over what’s coming next can cause difficulty in paying attention. Some children with ADHD or ASD are sometimes thinking about a TV show they watched or video games they played when they should be paying attention to school.

Weak class effort can be a symptom of ADHD and executive functioning weaknesses, which impact a child’s ability to keep instructions in their head, follow multi-step directions, and get started without support. Or a fear of failure could cause a kid to give up before even trying.

Angry boy with ADHD and anxiety sitting in bathtub
Angry boy with ADHD and anxiety sitting in bathtub
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How Do We Determine the Underlying Cause?

The purpose of the preceding steps is to look for clues and signs to determine: Is anxiety causing the issue? A symptom of ADHD? Or ASD? While you are gathering information, write down your observations, ask teachers for comments, and get your child to participate in this process actively. If they can articulate their feelings and experiences, ask questions such as:

  • When does the challenging behavior occur most often?
  • How frequently does it happen?
  • Is it part of a routine?
  • How long does it last?
  • What are possible contributing factors (i.e., hunger, transition, exhaustion)?
  • What is the trigger that preceded the behavior?
  • What function is this behavior serving?

For example, your child might resist taking a bath because of trouble transitioning from playing video games or because of a sensory issue. They might find it hardest to concentrate in school right before lunch and at the end of the day because of hunger. They might feel left out during recess, or someone could be bullying them. Dig deep for the reasons behind the behaviors. Solutions tailored to specific situations work best.

Mother comforting her daughter, who has ADHD and anxiety
Mother Comforting Daughter
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How to Create a Plan

Without an understanding of the root causes behind your child’s behavior, you can’t hope to set them up for success. It is best to take time to create a plan of action to help your child manage challenging behaviors, reactions, and emotions.

Step One — Identify the behavior problems and the situations that spark those behaviors.

Step Two — Ask questions and make observations to try to determine the underlying reasons for the behavior.

Step Three — Identify one desired behavior and discuss it with your child. It is easier for them to act in an appropriate way when they know what action you find acceptable.

Step Four — If possible, make changes or adjustments to the underlying cause to see if the undesired behavior continues; this is sometimes a matter of trial and error.

Choose a solution that makes sense and try it out. If it works, keep it in mind for future use, if it doesn’t, go back to Step Two to find out why. Then choose a different solution and try that.

Remember, kids can be inconsistent, hard to understand, and unpredictable, especially children with special needs. They might manage something one day and have a meltdown about the same situation another day. You might also notice that a strategy works one day and not another. These situations are frustrating, overwhelming, and familiar to other parents of children with ADHD and ASD. Keep in mind, it is also frustrating and overwhelming for your child. Keep a log of the behaviors and the strategies that were helpful, even for a short time, so you can continue to build on your child’s successes.

Drawing of the brain of someone with ADHD and anxiety
left and right brain functions concept, analytical vs creativity
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Behavior Strategies to Try

Modify your child’s environment when possible. For example, if your child has difficulty with disruptions to their routines, try to provide plenty of notice, a reason for the change, and how long it will last.

Teach your child how to manage their worry effectively by using apps that teach mindfulness and breathing techniques. Yoga and daily exercise also make fears more manageable.

Teach your child the difference between “Thinking Brain” and “Feeling Brain.” When a strong negative feeling occurs, they can train the Thinking Brain to say, “It is okay. You did this yesterday. You’ll get through it.” Practicing and reinforcing positive messages helps build up the muscle.

For inflexible kids who see things in black and white, teach them ways to see the situation from different perspectives. Sometimes, physically changing your location changes your view of a situation. Help them brainstorm problem solving to come up with different options.

Teach your child to pay attention to clues that something bad is about to happen and give them the language to talk about it.

Father playing video games with his son who has ADHD, anxiety, and autism
Father and son playing video games in living room
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Strategies for Social Issues

Set your expectations based on where your child is right now. Each child develops at their own pace. Instead of worrying because your child hasn’t reached certain milestones in social development, accept where your child is, and set goals accordingly. Encourage your child to expand his world while recognizing their unique comfort level and motivations.

If your child is comfortable playing with one friend, schedule one-on-one playdates instead of larger get-togethers or big birthday parties.

Seek out opportunities for your child to connect with others over shared interests. Look for clubs or classes that revolve around your child’s likes.

Seek out structured environments with adults who can help keep things moving in a positive direction.

Kids with ADHD, ASD, and anxiety tend to do better when they know what to expect — when they can see a clear beginning, middle, and end to an activity. Sometimes taking breaks or setting a time limit can make play a successful experience.

Set clear rules, expectations, and consequences. Be specific and concrete, especially with social boundaries. Communicate rules, expectations, and consequences to your child in ways they can understand.

Teacher discussing ADHD and anxiety with group of children
Schoolgirl at front of elementary class with teacher
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Strategies for Learning Problems

Work with your child’s school to come up with ideas for helping your child succeed in school. If you don’t have a Section 504 Plan or IEP, request an evaluation to determine if your child qualifies. Even if they do not, many schools and teachers are willing to work with parents to help a child learn better.

Write down areas where your child has difficulty during the school day, for example, sitting for long periods. Come up with potential solutions and work with the teacher on those easily implemented, with little disruption to the classroom.

Build solutions around your child’s strengths rather than focusing on weaknesses. For example, teachers can integrate your child’s unique interests in examples during math class or in choosing reading assignments.

Suggest strategies such as extra time for tests, taking tests in an area with fewer distractions, weekly emails to parents with progress reports, or advance notice of due dates for tests and reports.

Find opportunities for your child to show off their skills, build confidence, and take a leadership role among peers. Look for ways to build them up and increase self-esteem.

Kids with ADHD and anxiety running up stairs
Children running up stairs after school
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Step By Step

It is challenging to differentiate autism, ADHD, and anxiety. You might find it more helpful to focus on your child’s specific symptoms and behaviors rather than worrying about which condition caused them. Then, you can develop strategies built on a step-by-step process of learning. At times, it might feel like one step forward, two steps back. Just remember each step of the way, you are helping your child build life skills and resilience.

[Read This Next: Rules for Resilience]

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