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 can address the unique experience of raising your specific child. This is especially true if your child has anxiety, attention deficit disorder (ADHD or ADD), and/or autism spectrum disorder. 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 own children — how they operate and what's not going to work for them. We can use that information to play detective and create our own guidebook for understanding symptoms, managing their lives, and most importantly, 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 they share many symptoms (e.g., inattention, hyperactivity, repetitive and restrictive patterns of behavior) and a common genetic link. What helps us distinguish ADHD from ASD are communication and social relatedness, but it is sometimes challenging to accurately make these distinctions. And some experts in the field argue that we should focus less on diagnostic labels and more on how symptoms impact a child's functioning.

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 a verbal instruction. She might be having attention problems or feel lost and confused, which can create some anxiety – especially if the teacher calls on her and she doesn't have the answer or know what is being discussed. Anxiety can make it hard to think clearly, which can breed more anxiety.

Anxiety is the brain's helpful and essential internal alarm system that activates our fight, flight, or freeze response. This reaction occurs in our brains when we feel vulnerable, in danger of being embarrassed, or in trouble. Most kids with ADHD and ASD experience anxiety this way; others may have a separate, generalized anxiety disorder.

[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 medication is helpful, but there are some lingering behaviors we just can't understand." If this sounds like you, bring your child to a specialist for a more comprehensive psychoeducational or neuropsychological evaluation that can help you understand the source of his struggles beyond ADHD.

You may be missing effective treatments because you didn't realize an issue like anxiety or autism was present. An accurate diagnosis is key to unlocking new treatments and to accessing 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 how a child is 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; and also attention, memory, and executive functioning.

Comprehensive evaluations are always more accurate, but you have to weigh the time and cost associated with them to determine which is best for your family.

When you go into an appointment, ask, "How are you going to determine whether or not my child is on the autism spectrum? What tools are you going to use?"

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, non-compliance, and shutting down are all outward sign or manifestation of problems you can't see.

Maybe your child throws a fit, ignores you, or hides in the closet when he's 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 he's 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? Or does she avoid other children? Does she struggle in groups? Does she act inappropriately 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 make it harder for her to cooperate, take turns, or play a game. Fear of being embarrassed or excluded could also 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. They could suggest that he is distracted by the external stimuli of kids around him, or internally from anxiety and stress over what's coming next. Some children with ADHD or ASD are simply replaying a really awesome TV show in their heads or imagining a cool invention 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 her head, follow multi-step directions, and get started without support. Or it could be that a fear of failure makes a kid give up before she tries.

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 these preceding steps is to look for clues and signs to determine: Is anxiety causing the issue? A symptom of ADHD? Or ASD? Look to a comprehensive evaluation. Ask teachers for observations. Gather data at home and document clues and signs. Get your child to actively participate in this process. If he is able to articulate his experience, ask him and yourself these questions:

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

For example, your child may resist taking a bath because he has trouble transitioning from playing video games, or maybe it's because he has a sensory issue. Solutions, tools, and consequences must be tailored to each child's struggle.

For example, if a child throws a tantrum and then gets out of doing a task, the behavior is a tool used to avoid, escape, or get attention. Don't feed that.

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 him up for success. Step Number One is identifying the behavior problems and the specific challenges sparking those behaviors. Step Two is trial and error. Create a menu of strategies, and pick one or two that make the most sense. Try them to find out what happens, troubleshooting along the way. Kids can be inconsistent, hard to understand, and unpredictable. They may be able to manage something one day, and then the next day the same exact situation creates a meltdown. Some strategies might work one day, and not another. This is frustrating, overwhelming, and common.

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 reacts badly to a change in schedule, create a family calendar with reminders throughout the day so he knows what to expect. Teach your anxious child how to manage her worry effectively. Use apps that teach mindfulness and breathing strategies. Teach your child about her "Thinking Brain" and their "Feeling Brain." When she have a strong negative feeling, she needs to train her Thinking Brain to say, "Well it's okay, you did this yesterday. You'll get through it." Practicing, and reinforcing these positive messages, can help build up that muscle.

For inflexible kids who see things in black and white, teach them to go through a step-by-step process of seeing situations from different perspectives and problem solving to come up with different options.

Teach your child to look for clues that something bad is about to happen, and give them the language to talk about it. Yoga and exercise can help worries feel more manageable. Meet with a therapist or turn to medication to help kids who continue to struggle.

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

Manage expectations regarding what your child can handle. Encourage your child to expand his world while recognizing his unique comfort level and motivations. If your child is comfortable playing with one friend, schedule one-on-one play dates in lieu of big birthday parties. Encourage kids to connect over shared interests.

Seek out structured environments with adults who can help keep things moving in a positive direction. Kids with ADHD, autism, 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 really specific and concrete, especially with social boundaries. For example, "It's OK to high five when you're playing a game, but don't do it more than two times because it becomes awkward."

Rows of books about ADHD and anxiety
Rows of books
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Books That Help

Teach your child about social expectations and the consequences of poor social behavior using these books as tools:

1. The World of Julia Cook Children's Books
2. The Superflex Curriculum
3. The Asperkid's (Secret) Book of Social Rules
4. The Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations
5. Dawn Huebner, Ph.D. Children's Books

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

Modify the learning environment. Classrooms are one-size-fits-all, which doesn't work well for kids with differences. They may need accommodations in an IEP or 504 plan with extra time to movement breaks to specialized teaching. Focus on your child's strengths, what motivates her, what she loves, and what she is good at when designing classroom accommodations.

Find opportunities for your child to show off her skills, build confidence, and take a leadership role among peers. Look for ways to build her up, build her self-esteem, and build her stature among peers because she has so much to offer — the trick is just demonstrating those strengths well.

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

Differentiating between autism, ADHD, and anxiety is tough — and the distinctions might not even be that important. Maybe it's more helpful to focus on your child's specific symptoms and developing strategies built on a step-by-step process of learning. It might feel like one step forward, two steps back at times. Just remember: Each step of the way, we're building life skills and resilience.

[Rules for Resilience]

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