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For children and adolescents at every grade level, the yearly back-to-school transition typically comes with a period of adjustment.
If your child is stressed or struggling to adapt as the new school year gets underway, get in touch with our team at THINK Neurology for Kids. School-related anxiety and attention-deficit hyperactivity disorder (ADHD) share similar core features — and they often overlap. Here’s what you should know.
Back-to-school stress, or something more?
For some kids, the switch from freedom and relaxation to focused learning and a calendar full of extracurricular activities seems to prompt sleep problems, lack of focus, impatience, and restlessness. Is it normal stress — or something that warrants a closer look?
It’s normal for certain issues to surface when a child is under greater pressure. Even so, this type of pressure is often what reveals hidden struggles beneath the surface, such as an anxiety disorder or ADHD.
Anxiety and ADHD have overlapping signs
Anxiety disorders and ADHD are two of the most common mental and behavioral health conditions among school-age children. Both can cause difficulty with focus, behavior, and emotional regulation — but their root cause is not the same:
- ADHD is a neurodevelopmental disorder that affects executive functioning
- Anxiety disorders involve intense worry or fear that interferes with daily life
In the classroom, both conditions can play out in similar ways, but for differing reasons.
Inattention and poor focus
ADHD makes it harder for kids to pay attention and stay focused because their brain craves ongoing stimulation, even when they feel calm. ADHD is also associated with thoughts that jump from one topic to the next (e.g., a wandering mind) when a task feels boring.
Anxiety can make it hard for a child to stay focused or pay attention because their mind is preoccupied by specific worries, fears, or worst-case scenarios (e.g., failing a test, making friends). Thoughts are more tightly focused on perceived dangers or making mistakes.
Restlessness and movement
With ADHD, fidgeting comes from high energy coupled with an internal, physical drive to move — it’s basically a subconscious way to facilitate the automatic release of excess energy. For kids with anxiety, fidgeting, pacing, and nail-biting come from stress, nervous energy, physical tension, or a sense of dread.
Procrastination and avoidance
When kids with ADHD leave tasks undone, it’s usually because they’re distracted, bored, or lack motivation. Kids with anxiety, on the other hand, may heavily procrastinate or even fail to complete a given task due to high perfectionism or a fear of “doing it wrong.”
Symptom timing and patterns
ADHD causes kids to struggle with organization, time management, impulsivity, and focus all year long and in almost every setting — not just during the school year or in the classroom: They’re just as likely to act without thinking, misplace things, or be messy at home.
Childhood anxiety symptoms typically flare up around specific stressful triggers, like the first day of school, an important test, problems with peers, or social events. In the absence of such triggers, kids with anxiety tend to be calmer or more easygoing.
ADHD and anxiety frequently occur together
To make matters more complicated, ADHD and anxiety are “high-overlap conditions,” meaning they often co-occur: According to the CDC, two in five kids with ADHD (40%) also struggle with persistent anxiety. It’s easy to see how ADHD can give rise to anxiety:
- Time management issues cause worry about being tardy or getting a detention
- Organizational challenges can lead to fears of being unprepared for class
- Impulsive comments that are ill-received can trigger fear of judgment
- Negative self-talk about academic difficulties can cause avoidance anxiety
The hard part is discerning whether your child’s issues are driven by ADHD boredom and excess energy, the excess worry and fear of failure caused by anxiety, or both.
ADHD clues
ADHD is more likely to prompt some degree of “disruptive behavior” consistently (e.g., aimless movement, easy distraction, messiness, impulsive choices).
Anxiety clues
Anxiety symptoms are more likely to be internalized for a longer period of time (e.g., quiet preoccupation, stomachaches) and then eventually expressed in behavior once your child feels overwhelmed (e.g., nervous tension, perfectionism, stress avoidance).
Does my child have ADHD, anxiety, or both?
Sleep problems, trouble focusing, disorganization, impatience, and restlessness could be signs of school-related anxiety, ADHD, or both — just as they could also point to high stress levels or even depression.
The bottom line? It’s important to seek expert evaluation and care when your child is struggling, and we’re here to help: Schedule a visit at your nearest THINK Neurology for Kids office in The Woodlands, Sugar Land, or Houston, Texas, today.
Our team — including Shaun Varghese, MD, Cristina Marchesano, MD, Lorena Herbert, MD, Barbara Kiersz-Mueller, DO, Lauren Weaver, MD, Alicia Walls, MD, Sundeep Mandava, MD, Sherwin Oommen, MD, Robby Korah, FNP-C, Jennifer Duchaney, CPNP-PC, Tammy DeLaGarza, FNP-C, and Heather King, CPNP-PC — has the expertise and experience to make sense of your child’s challenges and get them back on track.