Is It Anxiety or ADHD? There May Be More to the Story

By Mahisha Balani, Nurse Practitioner

One of the things I enjoy most about working in mental health is that no two people present in exactly the same way. Two patients can describe very similar struggles, yet the reasons behind those struggles may be completely different.

Recently, I attended the CADDRA ADHD Intensive, where one message really stood out to me: the symptom we notice first isn’t always the root cause.

That resonated with me because it’s something I see regularly in clinical practice.

Many adults come to an ADHD assessment believing they have anxiety, depression, burnout, or simply a lack of motivation. Sometimes those explanations or diagnoses are accurate. Other times, ADHD may be contributing to those experiences—and occasionally, it has never been recognized.

Why Anxiety or ADHD in Adults Can Be Difficult to Distinguish

ADHD shares many symptoms with other mental health conditions. Difficulty concentrating, procrastination, fatigue, emotional overwhelm, forgetfulness, and low motivation can all be experienced by people with anxiety disorders, depression, trauma-related conditions, burnout, or ADHD.

ADHD and anxiety can also occur together. The presence of one does not rule out the other.

This is why I believe it’s so important not to stop at identifying the symptom. We need to understand why the symptom is happening.

Procrastination Can Have Different Underlying Causes

Take procrastination as an example.

One person may delay starting a task because they are worried about making a mistake or afraid of the outcome. Another person may desperately want to start but struggle with task initiation and executive functioning.

On the surface, both people procrastinate. The underlying reason, however, may be completely different. Understanding that difference can influence which treatment approaches and supports may be helpful.

When Executive Functioning Challenges Contribute to Anxiety

Another concept discussed during the intensive was something often referred to as cascade anxiety.

Some adults with ADHD may not initially develop anxiety because they worry excessively about everything. Instead, years of missed deadlines, forgotten appointments, unfinished projects, and repeated negative experiences can gradually create anxiety around performance and responsibilities.

In these situations, anxiety may develop, at least in part, as a consequence of living with unrecognized or unsupported executive functioning challenges.

This can look different from a primary anxiety disorder, where excessive worry may occur across many situations and may not be driven mainly by executive functioning difficulties. However, these experiences are not always easy to separate, and ADHD and anxiety may coexist.

The Most Obvious Symptom May Be a Clue

One statement from the conference stayed with me:

The most obvious symptom can become the explanation instead of the clue.

I think this is an important reminder for clinicians and patients alike.

Someone may say:

“I can’t focus because I’m anxious.”

Someone else may say:

“I’m exhausted because I’m burnt out.”

Or:

“I just have no motivation.”

Those explanations may be correct. However, they may also be only part of the picture.

A Comprehensive ADHD Assessment Looks Beyond Today’s Symptoms

Rather than focusing only on someone’s current symptoms, I want to understand how those difficulties developed over time. Childhood experiences, school, work, relationships, emotional regulation, executive functioning, and overall mental health can all help build a clearer understanding of what someone has been experiencing.

Ultimately, the goal isn’t simply to diagnose ADHD.

The goal is to understand the person sitting in front of me.

When we better understand the underlying mechanisms behind someone’s struggles, we are in a stronger position to recommend treatments and supports that are individualized, practical, and meaningful.

ADHD Assessment and Support at Embodied Resilience Wellness Clinic

If you have been experiencing difficulties with focus, procrastination, organization, motivation, emotional overwhelm, or ongoing anxiety and are wondering whether ADHD may be part of the picture, a comprehensive assessment can help you better understand what may be contributing.

Book an ADHD assessment with Mahisha Balani, Nurse Practitioner at Embodied Resilience Wellness Clinic. Appointments are available virtually across Ontario.

Disclaimer

This article is intended for educational purposes only and reflects my interpretation of current evidence, ongoing professional education, and clinical experience as a Nurse Practitioner. It should not be considered individualized medical advice. ADHD and other mental health conditions often have overlapping symptoms, and diagnosis requires a comprehensive assessment by a qualified healthcare professional.

References

Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. 5th ed. Toronto, ON: CADDRA; 2021.

National Institute for Health and Care Excellence (NICE). Attention Deficit Hyperactivity Disorder: Diagnosis and Management (NG87). Updated 2025.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. (DSM-5-TR); 2022.

Faraone SV, et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews. 2021;128:789–818.

Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ. Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry. 2017;17:302.