Written by: Belle DeGeus, MA

Many kids and teens enter therapy saying, “I’m really anxious.” And often, they are. But in some cases, that anxiety is a response to something deeper, Attention-Deficit/Hyperactivity Disorder (ADHD).

ADHD is still widely misunderstood. People often think of hyperactivity or impulsive behavior, yet for many children and adolescents, ADHD presents in quieter, less visible ways. Racing thoughts, overwhelm, forgetfulness, emotional intensity, and difficulty with planning or organization are common experiences. Kids with both anxiety and ADHD often try very hard to do well, which can leave them feeling worn out. Because these challenges don’t always disrupt classrooms or draw attention, ADHD is frequently overlooked.

The Overlap Between Anxiety and ADHD

Anxiety and ADHD share many features, which can make them hard to distinguish. Both may involve overthinking, perfectionism, trouble sleeping, avoidance of mentally demanding tasks, and emotional ups and downs under stress. The key difference often lies in what comes first.

In ADHD, anxiety frequently develops as a reaction to repeated overwhelm, such as, missed expectations, difficulty keeping up, or challenges with focus and organization. In primary anxiety, worry often shows up on its own and sounds like constant “what if” thoughts. When ADHD goes unrecognized, kids may only be treated for anxiety, while the underlying cause remains unaddressed.

When ADHD Wears an Anxiety Mask

Many children and teens with ADHD develop behaviors consistent with anxiety as coping strategies. When attention, planning, or emotional regulation don’t come easily, youth may feel the need to overprepare, overthink, or stay constantly alert to their environment. This mental effort can look identical to or develop into generalized anxiety.

At the same time, youth who are especially kind, sensitive, or eager to please, may learn to mask their struggles. They may work extra hard, stay highly aware of others’ emotions, or hold their feelings and behaviors in until they’re alone. On the outside, they appear capable and composed. On the inside, they’re often overwhelmed.

Over time, masking can take a significant toll. Chronic stress, burnout, low self-esteem, anxiety, depression, or negative beliefs about oneself can develop, even when a child seems to be “doing fine.”

Emotional Sensitivity: A Strength and a Challenge

Many individuals with ADHD are deeply perceptive and emotionally sensitive. They often notice subtle changes in tone, facial expression, or group dynamics and absorb emotional information quickly. This heightened awareness can be a genuine strength, but it can also make emotional regulation more difficult.

Kids with ADHD often feel joy, disappointment, rejection, and stress intensely, and they may need more support to calm their nervous systems once activated. This emotional intensity is sometimes misunderstood as moodiness or immaturity, when it more accurately reflects differences in emotional regulation and brain processing.

At the same time, this sensitivity is a powerful asset. Many adolescents with ADHD are intuitive, empathetic, and emotionally intelligent. They read between the lines, connect deeply with others, and often possess strong creativity and insight. When supported appropriately, these traits can become sources of resilience, leadership, and deep connection.

Why Early Recognition Matters

An accurate ADHD diagnosis isn’t about labeling, it’s about understanding. It gives kids and teens language for experiences they may have struggled to explain and can replace years of self-criticism with clarity and self-compassion.

In today’s fast-paced, high-demand world, many environments aren’t designed for the ADHD brain. Expectations for sustained attention, productivity, and constant self-management can make daily life feel exhausting. Without understanding why certain tasks are harder, youth often internalize shame. With awareness and support, they can learn effective strategies, advocate for accommodations, and build confidence in who they are.

When children with ADHD are supported early, they can learn how to balance their sensitivity and awareness with boundaries, self-understanding, and practical tools, allowing them to grow into thoughtful leaders, creative thinkers, and emotionally attuned adults.

Therapy and Assessment at Ballard Clinic

Ballard Clinic provides neuropsychological assessments to help understand how a child’s or teen’s brain works. The goal isn’t just to give a diagnosis, but to identify strengths and challenges so support can be matched to their real needs. Assessments help explain why certain struggles happen, not just that they do.

When assessment is combined with therapy, kids and families learn practical tools and strategies that support daily life at school, in relationships, and in how they see themselves. This support helps youth move from just getting by to feeling confident and growing.