Anxiety often tags along with ADHD, hiding in the background. It’s no wonder—kids with ADHD are constantly hearing reminders like, “Pay attention!” and “Get it done!” Imagine dealing with ADHD and the stress of feeling like you’re always falling short. It’s like trying to run an obstacle course with twice the hurdles. No wonder it feels so tough for them! And often parents are bound to use anxiety medication for children with ADHD hoping it will take away its symptoms.
As parents, our role is not only to support them but also to make informed decisions about effective treatment options. Treating ADHD and anxiety starts with understanding the root cause. First things first, let's demystify the intertwined enigma of ADHD and anxiety in children.
Attention Deficit Hyperactivity Disorder and Anxiety Disorders
Attention deficit hyperactivity disorder (ADHD) and anxiety frequently coexist, especially in children. Although an ADHD diagnosis can co-occur with other medical conditions, it is important to take note that ADHD and anxiety are distinct mental health conditions, but they can have overlapping symptoms. A 2022 study suggests that roughly half of people with ADHD also have an anxiety disorder.
A 2017 research review suggests that 31.6% of the likelihood of generalized anxiety disorder is linked to genetic factors. This is why it's important to look at family history when diagnosing ADHD.
In my Ridgefiled, CT cliinic, it is not uncommon for me to see kids with ADHD comorbidity, such as depression, anxiety, tic disorder, or bipolar disorder, may require different strategies and therapies to treat each disorder. ADHD symptoms can worsen anxiety symptoms and anxiety can contribute to ADHD symptoms. This is why it is important to have a tailored treatment and address root cause.
Identifying Anxiety Symptoms in Children with ADHD
- Excessive worrying about everyday situations or school failure
- Avoidance behaviors, such as refusing to participate in activities or avoiding certain places.
- Intense fear or irrational concerns about specific events or outcomes.
- Restlessness or a heightened sense of unease.
- Difficulty concentrating due to intrusive anxious thoughts.
- Increased irritability or emotional outbursts triggered by anxiety.
- Physical symptoms like stomachaches, headaches, or fatigue linked to stress.
- Sleep disturbances, including trouble falling or staying asleep.
- Amplified ADHD symptoms, such as hyperactivity or impulsivity, during anxious episodes.
- Overthinking or needing constant reassurance.
- Suicidal thoughts
Common Medication Options for Anxiety in Children with ADHD
Traditionally, when parents learn that their child has a diagnosis of ADHD, their minds tend to lean towards one solution – prescription medications.
But while stimulant and non-stimulant medications are often included in treatment plans for ADHD to enhance attention and reduce hyperactivity, their role in managing anxiety in children with ADHD is a bit more complex. You see, anxiety and ADHD can intertwine in complicated ways. When it comes to anxiety, they aren’t the best choices.
Selective Serotonin Reuptake Inhibitors
Most popular ADHD medications include stimulants like Ritalin, Adderall, and Concerta. Selective Serotonin Reuptake Inhibitors (SSRIs) like Celexa, Lexapro, and Prozac are considered as well.
Stimulant medications and other medications can exacerbate anxiety symptoms. It's not uncommon for most kids with ADHD to experience heightened social anxiety as a side effect of these ADHD drugs. It can manifest as increased nervousness, restlessness, or even full-blown panic attacks. The stimulant effect of these medications can sometimes mimic the symptoms of anxiety and create a challenging situation where it's hard to distinguish between the two.
Furthermore, FDA approved medications offer a relatively short duration of action, which means you may need to administer multiple doses throughout the day. Even with the right medication, doing so can lead to a rebound effect or what I like to call the “roller coaster effect”, where the child experiences a surge of medication-induced focus followed by a crash, which could increase their feelings of anxiety and irritability which can be observed in the first few weeks.
Antidepressants
- Antidepressants are the most effective medications for anxiety in children, and they work by boosting the level of serotonin in the brain.
- Selective serotonin reuptake inhibitors (SSRIs) are the most effective antidepressants for anxiety in children.
- Examples of SSRIs commonly prescribed for anxiety in children include Zoloft, Prozac, and Luvox.
- Selective norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that can be effective for most children.
Stimulants and Non-stimulant ADHD Medications
- Stimulant medicine like methylphenidate and amphetamines are common for ADHD but may increase anxiety symptoms.
- Non-stimulants, such as Atomoxetine, and certain antidepressants, like bupropion, are often preferred for managing both ADHD and anxiety.
- Stimulant medications, like Cotempla XR ODT, Dyanavel XR, Adzenys XR ODT, Aptensio XR , Ritalin SR, Quillivant XR, Focalin XR and Alpha Agonists are also often prescribed for ADHD children with anxiety. These medications can alter brain chemicals to manage child's ability for focus and impulse control.
It's essential to note that while stimulant medications can affect anxiety and treat depression, they don't address the underlying causes of anxiety disorders. Treating anxiety with medication may help a child temporarily concentrate better in school, but they won't necessarily equip them with the coping strategies needed to manage anxiety in different life situations. Anxiety often requires a tailored and holistic approach for effective management.
In some cases, children with ADHD might be prescribed different medications to manage their anxiety alongside stimulants. However, this polypharmacy approach can introduce more complexity and serious side effects, which may not always be in the best interest of your child's long-term well-being.
Debunking the Effectiveness of Stimulant Medications for Anxiety in Children with ADHD
Some parents might assume that since stimulants may improve attention reduce symptoms, they could also help with anxiety in children with ADHD. However, reality paints a different picture. The American Academy of Pediatrics states that stimulant medications are not recommended as a primary treatment for anxiety disorders in children with ADHD (American Academy of Pediatrics, 2011). They might even exacerbate anxiety symptoms in some cases.
These stimulant medications work by altering the levels of certain neurotransmitters in the brain, such as dopamine and norepinephrine. They essentially rev up the brain's engine to help children with ADHD pay attention, rein in impulsive behaviors, and manage hyperactivity. For many children, these medications affect their daily life.
However, it's crucial to recognize that while some stimulant medications may seem to provide little benefits, they are not the solution for everyone. Responses to these medications can vary widely from one child to another. Some children may see only modest gains or encounter side effects that outweigh whatever they may seem to provide.
The common side effects of ADHD medications can include:
- Insomnia – Stimulants can disrupt sleep patterns and cause sleep problems, making it challenging for children to get the rest they need for healthy development.
- Loss of Appetite – These medications can suppress appetite and lead to potential issues with growth and weight gain. Weight loss can be an alarming issue for growing kids.
- Increased Heart Rate and Blood Pressure – Stimulants can put added strain on the cardiovascular system, which can be a concern for some children with preexisting heart conditions. They are prone to increased risk of high blood pressure in children.
- Mood Changes – While stimulants can improve mood in some cases, they can also lead to mood swings, irritability, or emotional blunting in others.
- Risk of Dependency – Although the risk is relatively low when prescribed and taken as directed, stimulant medications have the potential for misuse and dependency, particularly in older adolescents.
- Tic Disorders – In rare cases, stimulants can exacerbate or trigger tics, which can be distressing for children and their families.
Exploring Natural Alternatives for Managing Anxiety in Children with ADHD
If stimulant medications aren’t the best for your kids, what's the alternative? Can you still help your child without the risks associated with stimulant and non-stimulant medications? Of course!
ADHD treatment can start with natural solutions that offer a plethora of possibilities to support brain health, enhance attention, stabilize mood, combat stress, and manage behavior. Here are some science-backed, safe, and effective treatment options:
Biofeedback
Biofeedback techniques can help children learn to control physiological functions like heart rate and muscle tension. This self-regulation tool can be particularly beneficial for managing your child's anxiety (Monastra et al., 2006).
Through biofeedback, individuals learn how to modify their physiology to improve their physical, mental, emotional, and spiritual well-being. Patients are required to participate actively in biofeedback training and to practice regularly between sessions, similar to physical therapy.
Using stress management training, clinical biofeedback can manage disease symptoms and improve overall health and wellness. Many people in the United States are using biofeedback and other natural therapies for their routine healthcare following research showing that biofeedback interventions are effective in treating different medical and mental health conditions (Frank et al., 2010).
Neurofeedback
The National Institute of Mental Health defines neurofeedback as a type of biofeedback that enables individuals to control their brain function by measuring brain waves and receiving feedback. Neurofeedback is known as a complementary and alternative treatment option for many brain conditions (Marzbani et al., 2016).
This non-invasive technique involves monitoring and training brain activity to improve self-regulation. Neurofeedback has shown promise in helping children with ADHD develop better focus and emotional control (Bakhshayesh et al., 2011).
Behavior Therapy
Behavioral interventions, like Applied Behavior Analysis (ABA) and Social Skills Training, can help children develop essential life skills, improve social interactions and emotional regulation, and reduce anxiety.
One of the shining stars in the world of natural interventions is Cognitive-Behavioral Therapy (CBT).
Cognitive Behavioral Therapy is a structured and goal-oriented approach that has shown remarkable efficacy in reducing anxiety symptoms in children with ADHD. CBT equips kids with the tools they need to cope with anxiety, addressing the root causes rather than merely masking the core symptoms of ADHD (Miranda & Jesus Presentacion, 2000).
Parent Training
Equipping parents with strategies to support their children with ADHD and anxiety can be incredibly beneficial. Parent training programs can teach effective communication, positive behaviors, behavior management techniques, and ways to create a supportive home environment (van den Hoofdakker et al., 2007).
According to the American Psychiatric Association, younger children should use behavioral strategies in the form of parent management training and school intervention as first-line treatments for ADHD. Evidence-based Parent-Child Interaction Therapy (PCIT) helps young children with ADHD and Oppositional Defiant Disorder (Parekh, 2017).
Nutritional Supplements
Some nutritional and herbal supplements, like magnesium and ginkgo biloba, are thought to have cognitive-enhancing properties. However, it's crucial to consult with a healthcare provider before introducing any ADHD supplements into your child's routine to ensure safety and efficacy.Research shows that there's a connection between low magnesium levels in the blood and ADHD. Children with ADHD tend to have slightly lower blood magnesium levels (Effatpanah et al., 2019). A healthy diet plus magnesium supplements can help alleviate ADHD symptoms in kids.
Tips for Parents in Managing ADHD and Anxiety in Their Children
Helping children with ADHD navigate the challenges of life can be both rewarding and demanding. When anxiety is thrown into the mix, it can make the journey even more complex. However, with the right strategies, lifestyle changes, and ample support, parents can play a pivotal role in effectively managing ADHD and anxiety symptoms in their kids. Here’s how:
1. Practice mindfulness and meditation
These practices have gained substantial recognition for their positive effects on attention and emotional regulation. Mindfulness exercises, such as deep breathing and guided meditation, can help children with ADHD and anxiety build greater self-awareness and develop techniques to symptoms effectively.
2. Make dietary adjustments
Nutrition plays a vital role in brain health. Consider incorporating foods rich in Omega-3 fatty acids, such as salmon and flaxseeds, which have been associated with improved attention and mood. Reducing processed foods and sugars can also contribute to more stable energy levels. Certain foods, like those rich in Omega-3 fatty acids, have been linked to improved attention.
3. Engage in physical activities
Regular exercise isn't just essential for physical health; it also has a profound impact on mental well-being. Encourage your child to engage in activities they enjoy, whether it's playing sports, dancing, or simply going for a walk. Exercise releases endorphins, which can help reduce anxiety.
4. Get adequate sleep
Prioritize a consistent sleep schedule and ensure your child gets enough rest. Sleep is essential for cognitive functioning, mood stability, and overall health. A well-rested child is better equipped to manage the challenges of ADHD and anxiety.
5. Initiate environmental modifications
Make adjustments at home and in school to create an environment that minimizes distractions and supports your child's specific needs. It might include installing designated study areas, using noise reduction tools, and creating organization systems.
6. Create a structured routine
Establishing a consistent daily routine can provide a sense of security and predictability for children with ADHD and anxiety. Their routine should include set times for meals, homework, play, and bedtime. Visual schedules or checklists can help them understand and follow the routine.
7. Break tasks into smaller steps
Children with ADHD may become overwhelmed by tasks that seem too large or complex. Break assignments or chores into smaller, manageable steps, and provide clear instructions. This can reduce frustration and anxiety.
8. Create a calm space
Designate a quiet and clutter-free area where your child can retreat when they need a break. Stock it with calming activities like coloring books, puzzles, or sensory tools. This space can serve as a haven during moments of overwhelm.
9. Limit screen time
Excessive screen time can exacerbate ADHD symptoms and anxiety. Set reasonable limits on screen use, especially before bedtime. Encourage other activities like reading, playing outside, or pursuing hobbies.
10. Foster effective communication
Foster open and honest communication with your child. Encourage them to express their feelings and concerns, and actively listen without judgment. Knowing they can talk to you about their struggles can alleviate anxiety.
Parents must recognize that this journey is both challenging and rewarding. Embracing a comprehensive approach that combines evidence-based treatments, natural alternatives, and parental support is key to helping your child thrive. If you're seeking a structured program that integrates these elements and provides expert guidance, consider exploring the BrainBehaviorResetTM Program. This program offers a holistic and personalized approach to address the unique needs of children with ADHD and anxiety, focusing on their brain health and overall well-being. Remember, you're not alone in this journey, and with the right resources and support, you can help your child unlock their full potential and lead a fulfilling life.
Parent Action Steps
☐ Take the time to learn about ADHD and anxiety in children.
☐ Consider incorporating natural solutions into your child's routine.
☐ Find local therapists who offer CBT for children with ADHD and anxiety.
☐ Create a supportive and open communication channel with your child.
☐ Implement a structured daily routine.
☐ Set reasonable limits on screen use, especially before bedtime.
☐ Collaborate with your child's school to create a supportive learning environment.
☐ Encourage your child to build positive relationships with peers.
☐ Remember to take care of yourself.
☐ Implement a reward system to motivate your child.
☐ Keep a record of your child's symptoms, behaviors, and responses to treatments.
☐ Take this ADHD Quiz to know if your child has Attention-Deficit Hyperactivity Disorder.
☐ Use the Solutions Matcher to get personalized treatment for your child.
Citations
References American Academy of Pediatrics. (2011). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. PEDIATRICS, 128(5), 1007–1022. https://doi.org/10.1542/peds.2011-2654
Bakhshayesh, A. R., Hänsch, S., Wyschkon, A., Rezai, M. J., & Esser, G. (2011). Neurofeedback in ADHD: a single-blind randomized controlled trial. European Child & Adolescent Psychiatry, 20(9), 481–491. https://doi.org/10.1007/s00787-011-0208-y
Effatpanah, M., Rezaei, M., Effatpanah, H., Effatpanah, Z., Varkaneh, H. K., Mousavi, S. M., Fatahi, S., Rinaldi, G., & Hashemi, R. (2019). Magnesium status and attention deficit hyperactivity disorder (ADHD): A meta-analysis. Psychiatry Research, 274, 228–234. https://doi.org/10.1016/j.psychres.2019.02.043
Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback in medicine: who, when, why and how? Mental Health in Family Medicine, 7(2), 85–91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939454/
Marzbani, H., Marateb, H., & Mansourian, M. (2016). Methodological Note: Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic and Clinical Neuroscience Journal, 7(2). https://doi.org/10.15412/j.bcn.03070208
Miranda, A., & Jesus Presentacion, M. (2000). Efficacy of Cognitive-Behavioral therapy in the treatment of children with adhd, with and without aggressiveness. Psychology in the Schools, 37(2), 169–182. https://doi.org/10.1002/(sici)1520-6807(200003)37:2%3C169::aid-pits8%3E3.0.co;2-8
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder. Journal of Neurotherapy, 9(4), 5–34. https://doi.org/10.1300/j184v09n04_02
Parekh, R. (2017). What Is ADHD? American Psychiatric Association; American Psychiatric Association. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
van den Hoofdakker, B. J., van der Veen-Mulders, L., Sytema, S., Emmelkamp, P. M. G., Minderaa, R. B., & Nauta, M. H. (2007). Effectiveness of Behavioral Parent Training for Children With ADHD in Routine Clinical Practice: A Randomized Controlled Study. Journal of the American Academy of Child & Adolescent Psychiatry, 46(10), 1263–1271. https://doi.org/10.1097/chi.0b013e3181354bc2
Dr. Roseann is a mental health expert in Self-Regulation who frequently is in the media:
- The Healthy 12 Silent Signs of Adult ADHD You Might Be Ignoring
- Scary Mommy What Is Self-Regulation In Children, And How Can You Help Improve It?
- Yahoo!Life Anxious and On-Edge? MDs Share the Best Supplements to Tame Stress Naturally
- The Healthy 12 Silent Signs of Adult ADHD You Might Be Ignoring
Always remember… “Calm Brain, Happy Family™”
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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©Roseann Capanna-Hodge 2025
Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health.
Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches.
She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain.
Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.
She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF).
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