Q: For Teens with ADHD and Anxiety, Do Stimulants Help — or Hurt?

Anxiety affects nearly a third of teens with ADHD. Here, an expert discusses how to untangle symptoms and devise a treatment plan that addresses both.

Profile of teen girl, with her chin in her hands, looking worried
Lost ADHD teens don’t have necessarily have anxiety, but they also don't have energy or a positive view on life. They might easily shut down when they feel depressed or defeated. Parents often struggle with telling them to buck up or comforting them out of their rut. The best strategy is to gently, repeatedly remind them what needs to be done and tell them you believe they can do it. 

Q: “My teen has anxiety and ADHD. Which should we treat first? Will a stimulant make their anxiety better or worse?”

Anxiety is one of the most common comorbidities in teens and college students with ADHD, especially for girls. More than half of girls with ADHD will have some level of anxiety.

When I’m considering how to proceed with treating comorbid ADHD and anxiety, I always think: “What’s driving the bus?”

[Read: ADHD and Anxiety – Symptoms, Connections & Coping Mechanisms]

For some people, the anxiety is a true, primary diagnosis. This would include cases where the anxiety takes the form of OCD or panic disorder. In those cases, I would likely start by treating the anxiety, and then move on to treating the ADHD.

Then there are other situations where the anxiety may be directly related to the ADHD. In these cases, the anxiety may arise because the patient is feeling out of control, unable to manage time, unable to keep all these different balls in the air. Is the patient anxious because they’re overwhelmed by these things? If so, treatment of ADHD can help quite a bit with anxiety.

[Self-Test: Generalized Anxiety Disorder in Adults]

In these cases, I’ll usually start by treating the ADHD. While stimulants can sometimes exacerbate anxiety in some patients, this can typically be avoided by using long-acting, smooth-release formulations of stimulants and by starting low and going slow as you titrate dosage, monitoring anxiety throughout. Atomoxetine or viloxazine can also be effective at treating ADHD in people with co-occurring anxiety disorders. If other options don’t prove effective, guanfacine is an ADHD treatment option that doesn’t exacerbate anxiety.1

Anxiety in Teens: Next Steps

The content for this article was derived from a webinar presented by The American Professional Society of ADHD and Related Disorders (APSARD) titled “ADHD Treatment in the Primary Care Setting: The Teenage Years” with Greg Mattingly, M.D., which was broadcast on October 13, 2023.

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1Mattingly, G., Wilson, J., Ugarte, L., & Glaser, P. (2021). Individualization of attention-deficit/hyperactivity disorder treatment: Pharmacotherapy considerations by age and co-occurring conditions. CNS Spectrums, 26(3), 202-221. doi:10.1017/S1092852919001822