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.
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
- Read: 5 Ways to Reframe Anxiety for Your Worried Teen
- Read: What If You Are Enabling Your Child’s Anxiety?
- Watch: Anxiety in Children: Overlooked Signs and Effective Supports
- Read: 6 Types of Anxiety
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.
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.
