When ADHD Goes Unaddressed
Why Does My ADHD Child Also Have Anxiety?
Understanding the Connection Between ADHD and Anxiety and What Families Can Do to Support Both
Kimberley Clayton Blaine, MA, LMFT
Licensed Clinical Family Psychotherapist
Treatment for Neurodivergent Children and Families
If your child has ADHD and also seems to carry a constant undercurrent of worry, dread, or fear that goes beyond what the situation calls for, you are not imagining a second problem. Anxiety is one of the most common co-occurring conditions in children with ADHD, and in many cases it does not arrive independently. It grows directly from the daily experience of living in a brain that struggles to organize,
regulate, initiate, and follow through. Understanding why anxiety so reliably accompanies ADHD, and what to do when both are present, gives families a much clearer path forward than treating each condition as though it appeared in isolation.
If your child came to mind while reading that, you are in exactly the right place. Kimberley Clayton Blaine, MA, LMFT works with families like yours through teletherapy, parent coaching, and online courses. Her books on understanding emotionally complex children are available at TheMisunderstoodChild.com. When you are ready, begin support here.
› Anxiety in children with ADHD is often secondary, meaning it develops as a result of
living with unaddressed ADHD.
When a child repeatedly forgets, underperforms, loses things, gets corrected, and feels different from peers, the nervous system begins to anticipate failure as its baseline. That anticipation, sustained over time, becomes anxiety. It is not a separate
condition that arrived from nowhere. It is the emotional residue of chronic dysregulation.
› Primary anxiety and secondary anxiety require different treatment priorities.
Primary anxiety exists independently of the ADHD and needs direct clinical attention in its own right. Secondary anxiety, which developed because the ADHD went unaddressed, often improves significantly when the ADHD is treated effectively. Knowing which is driving the picture guides the treatment sequence.
› ADHD and anxiety can mask each other, making both harder to identify.
A child whose anxiety looks like avoidance may be misread as oppositional. A child whose ADHD inattention looks like worry may be misdiagnosed as purely anxious. When both conditions are present, a clinician who understands the full neurodivergent profile is essential for accurate assessment.
› Hyperfocus is one of the most powerful anxiety-mitigation tools available for children
with ADHD.
When a child with ADHD finds a domain they are genuinely passionate about,
something pleasurable and dopamine-producing where their intensity becomes a strength, their brain can sustain focus for remarkable periods. That experience of mastery builds the sense of competence and self-worth that anxiety steadily erodes.
› SSRIs are a well-established and effective option for children with ongoing anxiety.
Selective serotonin reuptake inhibitors work by balancing serotonin levels in the brain, which helps calm the nervous system and reduce chronic anxiety. They are generally well-tolerated in children with a low side effect profile, and for families whose child is experiencing significant ongoing anxiety, a conversation with the prescribing physician about whether an SSRI is appropriate is a reasonable and often helpful next step.
A DEEPER LOOK FROM A SPECIALIST
Kimberley Clayton Blaine, MA, LMFT · Licensed Clinical Family Psychotherapist · Laguna Niguel, California
How Unaddressed ADHD Plants the Seeds of Anxiety
When you understand that ADHD is fundamentally a regulation and executive functioning condition, it becomes entirely logical that anxiety would grow alongside it or develop as a direct result of it. When a child cannot reliably organize the functions of daily life, cannot predict how things will go, cannot trust that they will remember, initiate, or follow through, they begin to feel psychologically unsettled. That unsettled feeling, repeated day after day across years of development, becomes trepidation. It
becomes a hesitation about going into the world confidently. It becomes a child who worries not because they were born anxious but because their experience has taught them that the world is unpredictable and that they are often underprepared for it. Secondary anxiety in children with ADHD is not a separate problem that arrived from nowhere. It is the emotional residue of living in a brain that has been working harder than average for a very long time without the right support.
Finding the Hyperfocus and Building the Expert
What I recommend first and foremost is finding the thing your child can hyperfocus on, something genuinely pleasurable and dopamine-producing, whether that is soccer, dance, acting, music, building, coding, or any domain where their intensity becomes an asset rather than a liability. Hyperfocus is one of the defining gifts of ADHD. When something is intrinsically rewarding, a child with ADHD can sustain attention and effort for remarkable stretches of time. That experience of mastery builds the very thing anxiety erodes: a genuine sense of competence, industry, and self-worth. A child who is an expert in something, who has a domain where they are known for their ability, carries that confidence into the harder parts of their life. This is not a small intervention. It is one of the most powerful anxiety-mitigation strategies available for this population and it is completely within a family's reach. If a child's world is consistently unpredictable, high-demand, and filled with non-preferred tasks, anxiety will fill the space. When their world also contains a domain of genuine mastery, anxiety has less room to grow.
What Families Can Do at Home and When to Consider Medical Support
Two things make an immediate and lasting difference at home. The first is a concrete personalized coping skills list that the child can rely on when anxiety climbs. Not a vague suggestion to breathe, but a specific written or visual menu of strategies that this particular child has tried and that actually work for their nervous system. Having that list available before anxiety peaks means the child does not have to problem solve from inside the distress. The second is whole-family regulation. I encourage parents to build and practice their own anxiety management strategies alongside their child, because a regulated parent is the most powerful co-regulator in the household. When everyone in the family is working as a team to reduce anxious tendencies, the child is not carrying the weight alone.
It is also worth knowing that for children whose anxiety is ongoing and significantly impacting their daily functioning, SSRIs, which are antianxiety medications that work by balancing serotonin in the brain, are a well-established and effective option. They are generally well-tolerated in children, have a low side effect profile, and can provide meaningful relief that allows a child to engage more fully with the therapeutic and skill-building work that addresses the ADHD underneath. This is always a conversation
to have with the child's prescribing physician, but it is a conversation worth having when anxiety is persistent and getting in the way of the child's quality of life.
Did the ADHD cause my child's anxiety or are they two separate things?
Often the ADHD came first and created the conditions for anxiety to develop over time. When a child repeatedly struggles to meet expectations, forgets important things, underperforms despite real effort, and feels chronically different from their peers, the nervous system learns to brace for difficulty as its default state. That bracing becomes anxiety. In other cases both conditions exist independently and each needs its own clinical attention. A thorough evaluation by a clinician who understands the full
picture of neurodivergent presentation is the most reliable way to understand which dynamic is at play for your specific child.
Should I treat the ADHD or the anxiety first?
When anxiety is secondary to the ADHD, meaning it developed because the ADHD went unaddressed, treating the ADHD effectively often produces meaningful reduction in anxiety on its own. When both conditions are primary and independent, both need simultaneous attention. The sequencing question is best answered by a clinician who knows your child, because getting it wrong means addressing one condition with tools that can inadvertently worsen the other. What is almost always true is that leaving either condition unaddressed while focusing exclusively on the other keeps the child stuck.
My child refuses to try new things and says they are scared of everything. Is this anxiety or ADHD?
It is likely both working together. The ADHD creates a history of unpredictable outcomes that makes new situations feel genuinely risky. The anxiety takes that history and turns it into a blanket avoidance of anything uncertain. A child who has been frequently surprised by their own failures learns to protect themselves by not trying. The most effective response combines gradual exposure to new experiences in low-stakes conditions, a strong area of mastery that builds confidence, and consistent co-regulatory support from a parent who stays calm and encouraging without pressuring. Over time this combination rebuilds the child's willingness to take manageable risks..
Are anxiety medications safe for children with ADHD?
SSRIs, which are the most commonly prescribed antianxiety medications for children, are generally well-tolerated and have a low side effect profile. They work by balancing serotonin levels in the brain and can significantly reduce the baseline anxiety load that makes everything else harder to manage. For children with both ADHD and ongoing anxiety, a conversation with the prescribing physician about whether an SSRI alongside or separate from ADHD medication is appropriate is a reasonable and often
very helpful next step. Medication decisions should always involve a physician who knows the child's full clinical picture, but medication is a legitimate and effective part of the support toolkit for many families navigating this combination.
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Kimberley Clayton Blaine, MA, LMFT
Licensed Clinical Family Psychotherapist · Founder, The Misunderstood Child
is a licensed clinical family therapist, nationally recognized
neurodivergent child specialist, and the founder of The Misunderstood Child. Known nationally for over a decade as The Go-To Mom™, Kimberley has been a pioneering voice in family mental health, parenting education, and child development since 1998. A Jossey-Bass published author, UCLA instructor, and contributor to the Wall Street Journal and USA Today, she now dedicates her practice to whole-family care for families raising emotionally complex and neurodivergent children. Her teletherapy, coaching, classes, and books are available at TheMisunderstoodChild.com.
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