ADHD and SAD Treatment and Symptoms

As many as 80% of people with attention-deficit hyperactivity disorder (ADHD) will have at least one other psychiatric condition in their lifetime. Just as untreated ADHD can lead to unnecessary problems in everyday life, comorbid conditions can cause a tremendous amount of harm in those with ADHD if left undiagnosed and untreated.

Though any anxiety disorder can coexist with ADHD, social anxiety disorder (SAD) is one of the most common. Learning the differences between the two conditions is important in the management and treatment of both.

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SAD and ADHD

It's entirely possible that anxiety disorders occur much more frequently in people with ADHD than they do in the general population. According to the National Comorbidity Survey Replication, 47% of adults with ADHD have an anxiety disorder—approximately 30% have SAD, specifically.

More research is needed to understand why ADHD and SAD co-occur in some people and not in others. Although experts don't know for certain why ADHD and SAD tend to occur together, some think that the factors that play a role in ADHD—genetics, environmental toxins, or premature birth—may also influence anxiety disorders.

Still, others believe that ADHD symptoms, themselves, contribute to anxiety. Often, ADHD symptoms—such as inattention, hyperactivity, and impulsivity—put a person at greater risk for being teased, bullied, or otherwise socially rejected. Fearing further rejection, many withdraw into themselves, avoiding any social setting that they find threatening.

Symptoms

On the surface, SAD and ADHD can sometimes look alike. The following are just a few ways symptoms of ADHD and SAD overlap:

  • Difficulty socializing: People with SAD may struggle to make and maintain friendships due to fears about rejection. Someone with ADHD is likely to have low impulse control and trouble picking up on social cues, making it difficult to sustain friendships.
  • Inattention: A person with SAD may seem tuned out, but they are really just distracted by worries. Those with ADHD are inattentive because of differences in the brain that affect focus.
  • Trouble completing tasks: People with SAD might become stuck on a task and be too anxious to ask for help. Those with ADHD might not turn in an assignment because of poor planning skills and forgetfulness.

Unfortunately, some symptoms of SAD can be misinterpreted as ADHD symptoms, and it isn't until outward behaviors—such as weight loss, sleeplessness, or refusal to attend social settings—that the social anxiety becomes more apparent. As a result, SAD often goes undiagnosed in those who also have ADHD.

Treatment for Co-Occurring SAD and ADHD

There are no clear or published guidelines on how to treat co-occurring ADHD and SAD. Only after your doctor determines how your anxiety functions can they develop the best treatment plan to meet your needs.

For instance, if your anxiety and ADHD are functioning independently of one another, your doctor may decide to treat both conditions simultaneously. Or they may choose to treat whichever condition is causing you the most problems first before moving on to the other condition.

However, if your doctor believes that your anxiety is being caused or heavily influenced by your ADHD, your doctor may take a different approach to treatment.

Medications

If your anxiety is the result of ADHD, your doctor may decide to treat your ADHD first with medications as this may reduce your anxiety symptoms. Common medications used to treat ADHD include:

  • Stimulants: Although stimulants primarily treat ADHD symptoms, as ADHD symptoms are controlled, you may also find some relief from your anxiety. In one study examining children and adolescents with ADHD and SAD comorbidity, Ritalin (methylphenidate) was found to be associated with a significant improvement in both ADHD and SAD symptoms. A similar study found the same improvements in adults using extended-release Ritalin.
  • Non-stimulants: Selective norepinephrine reuptake inhibitors (SNRIs) like Strattera (atomoxetine) may target both ADHD and anxiety symptoms. A 2009 study found that Strattera improved both ADHD and comorbid SAD in adults.

Talk Therapy

While medication has historically been the first line of treatment for ADHD, many people also benefit from non-medication therapies, and that is especially true of people who are also living with an anxiety disorder.

Approaches such as cognitive behavioral therapy (CBT) can address many of the underlying challenges of both ADHD and SAD—as well as the complicated symptoms that overlap between them. The goal of CBT is to provide techniques and practice for managing anxiety so that those with SAD.

A specific technique your therapist might recommend is exposure therapy, a type of CBT most often used when treating SAD, in which you and your therapist work together to gradually expose you to anxiety-provoking situations so you can develop healthy coping mechanisms and, over time, the situations elicit less fear. In other types of CBT, you can learn and practice social skills and relaxation techniques.

A Word From Verywell

A co-occurring diagnosis of SAD can be a lifelong reality for someone with ADHD. It's OK to feel overwhelmed. Learning more about the connection between these two conditions is the first step toward lessening the impact they have on your life. Just take a deep breath and know that with the right support, you can manage both ADHD and SAD, and thrive in life.

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  1. Sobanski E, Brüggemann D, Alm B, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2007;257(7):371-377. doi:10.1007/s00406-007-0712-8

  2. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716

  3. Koyuncu A, Alkın T, Tükel R. Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis). Early Interv Psychiatry. 2018;12(2):269-272. doi:10.1111/eip.12372

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington, DC. 2013

  5. Golubchik P, Sever J, Weizman A. Methylphenidate treatment in children with attention deficit hyperactivity disorder and comorbid social phobia. Int Clin Psychopharmacol. 2014;29(4):212-215. doi:10.1097/YIC.0000000000000029

  6. Koyuncu A, Çelebi F, Ertekin E, Kök BE, Tükel R. Extended-release methylphenidate monotherapy in patients with comorbid social anxiety disorder and adult attention-deficit/hyperactivity disorder: Retrospective case series. Ther Adv Psychopharmacol. 2017;7(11):241-247. doi:10.1177/2045125317714193

  7. Adler LA, Liebowitz M, Kronenberger W, et al. Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. Depress Anxiety. 2009;26(3):212-221. doi:10.1002/da.20549