Leah Koenig, MA, LMHC
Parent Coach ~ Family Therapist

Bellevue Family Counseling, LLC
1601 116th Ave NE, Ste. 102
Bellevue, WA  98004
 Anxiety and ADHD look similar in many children.

Anxiety or ADHD?

Will the Real Problem Please Stand up?

by Leah Koenig MA, LMHC
PCI Certified Parent Coach
® & Family Therapist

Distracted, angry, agitated, cannot control their impulses, bounceable, fearful and tentative.  These are often the litany of adjectives that describe children who have attention deficit disorder.  You may have heard some of these words describe your own child and yet although the adjectives may undeniably fit you know that somehow the label isn’t a match for your child.  

That may be because many of the symptoms that manifest as ADHD can also be the same for anxiety which is actually a more prevalent problem for children than ADHD.  But, how can you tell the difference?  What can you do to help?

Anxiety is rooted in emotion where as ADHD is a label for a cluster of symptoms that are very often neurologically and biochemically rooted.  How your child is perceived and the steps taken both at home and at school could be very different depending on the root cause of these troublesome behaviors.

Did you know that anxiety is actually more common in children than ADHD?

  • About 10% of children have ADHD with a greater percentage occurring boys.

  • About 25% percent of children have an anxiety disorder with a greater percentage in girls. 

  • 85% of teens who have been diagnosed with depression suffered from anxiety in childhood which was often undertreated.


Anxiety is that uncomfortable feeling we experience when we are worried, fearful, distressed or apprehensive about an upcoming event. These feelings occur naturally in all children, but when they begin to interfere with the child's ability to function, then they can be considered a disorder.

Children can express this anxiety both with emotional symptoms and/or physical symptoms.

Emotionally, you may find your child excessively worrying, having difficulty relaxing and settling, new fears may keep popping up or a continuation of recurring fears, separation problems such as clinging to mom and dad and shyness that limits activities

Other behaviors that are common to anxiety and similar to ADHD may be unexplained anger or crying, aggressive or obstinate behavior, regression to younger behaviors, unwillingness to participate in family or school activities.  You may see a child truly struggle with focus, concentration and decision making.

Physically, the child may experience headaches, muscle pains, nausea, stomach pain, or general weakness. The child may appear to be restless, unfocused, impulsive, and hyperactive.


Both children with ADHD and children with anxiety are often inattentive.  It is not a conscious choice by the child with ADHD to be inattentive; they simply cannot control it.  On the other hand, an anxious child is more likely inattentive because they are preoccupied by excessive worry, tension, and nervousness. When this child is calm, there are no signs of poor focus. Whereas a child with ADHD may feel calm inside and yet, still find they are inattentive. 

Children suffering from anxiety tend to have more physical based complaints such as headaches or stomach aches.  This is generally not the case for children with ADHD.  Some of the medications for ADHD can create physical discomfort but for a child that is not medicated this is usually not an issue.

In both children with ADHD and children with anxiety sleeping at night can be a problem. However it is the anxious one that will struggle with the resulting fatigue during the next day.


1. Listen and acknowledge your child’s fears - do not dismiss them.  This is not a time to be angry with your child or to punish them for having a fear.  Yes, this fear is frustrating and saddening to you because it prevents your child from fully experiencing life and success.  Be sure to acknowledge those thoughts to yourself and then put them aside to be there for your child.

2. Reinforce with practical information to counteract the anxious thoughts.  If they are afraid of spiders then most likely they are having irrational thoughts, worrying about being bitten or attacked.  Buy a non-fiction book about spiders and together help them learn good things about the spider and the rarity of being bitten.  Add to this some gradual exposure or even role play around the anxious situations if this is practical and helpful.

3. Collaborate with your child to create a plan and talk about different options they can use to manage their anxiety or fear.  When the anxiety comes, acknowledge and validate their feelings for a few moments and then gently remind them of the plan.

4. Teach a relaxation technique to your child and then model it when they are around.  Let your child see how you relax.  Active relaxation helps release the energy productively.  Vacuum, go for a walk, enjoy the rhythmic nature of a skipping rope; these are all great active techniques.  Passive relaxation would be something such as stopping and taking a few deep calming breaths, counting slowly to twenty, or visualizing a calming place like a park or beach.  If you do this a few times in front of your child, when anxiety erupts they will have a model in their mind of what they can do to manage.

5. Transitions are hard for children so prepare them in advance.  Figure out which moments cause the most anxiety during a transition and make a plan ahead of time so you are not under pressure to think creatively in the moment.  Some pre-planning will grant you the time to model being the calm leader in the moment and may help you feel better about your parenting skills



For young children, mostly under age eight, play therapy may uncover internal conflicts and worries.  Since children do not yet have all the words to describe their inner experience, play therapy can help the child touch these feelings and find a way to express them.  Once the feelings are expressed, the therapist will help the child creatively think of solutions and integrate those solutions into their play. This brings the child empowerment over their problem.

If the child is able to put words around what might be going on for them, the therapist and child may talk directly about these anxieties and brainstorm solutions.  Then the therapist may engage in role play or non-directed play so the child can experiment with these new ideas.

With a slightly older child, perhaps grade three and above, once the root of the anxiety is uncovered the therapist can use behavioral techniques to help the child manage the anxious reactions.  The therapist may guide the child through the scenarios that cause them anxiety and offer tools to better cope with the problem.  Together they may also work to distinguish between helpful and non helpful reactions.

Without building skills to manage anxiety, the child will often be left feeling helpless which will only fuel the anxiety and most likely give way to depression as they get older.   Remember, children are seeing so many things in their world for the first time.  A child with anxiety is often facing a single idea or experience they do not yet have the tools to manage effectively.  This can cause anxiety to spill over their whole day.  By first discovering the cause of the anxiety, validating their feelings, and then building a tool box of possible helpful behaviors, your child will become confident that they are capable of overcoming the inevitable fears and anxieties that arise in life.