ADHD and Anxiety

ADHD and anxiety frequently travel together and interact in clinically important ways. Executive dysfunction inherent to ADHD creates a fertile ground for chronic stress: missed deadlines, disorganization, and inconsistent performance drive anticipatory worry and hyperarousal. Anxiety then feeds back to impair working memory, attentional shifting, and inhibition, worsening the very executive functions that ADHD already taxes. Neurobiologically, both conditions involve dysregulation within fronto-striatal and fronto-limbic networks and altered catecholamine signaling; both are sensitive to sleep loss and circadian delay. Genetic data support partially shared heritability, while environmental contributors such as adverse childhood experiences further heighten risk for both. Evaluation should include structured screening for each condition, collateral information across settings, and a functional impairment focus. Treatment sequencing generally targets the most impairing domain; in many cases, optimizing ADHD management alleviates a substantial proportion of secondary anxiety. Stimulants are first-line for ADHD and, when titrated thoughtfully, often improve overall calm by restoring task control; atomoxetine is an evidence-based alternative when anxiety is prominent or stimulants are poorly tolerated. Adding CBT tailored to ADHD (organization, time management, cognitive restructuring around procrastination) and standard CBT for anxiety (exposures, worry management) provides additive benefits. Lifestyle interventions—regular aerobic exercise, sleep optimization or CBT-I, mindfulness/HRV-biofeedback—are low-risk, cross-cutting supports that can reduce arousal and improve attention. SSRIs/SNRIs treat primary anxiety but should be combined with ADHD-focused therapy or medication to address executive deficits; benzodiazepines are generally avoided due to dependence and cognitive dulling. Ongoing monitoring is key, as symptom balance and treatment tolerability can shift over time.

From a TCM perspective, the shared features of ADHD and anxiety—restlessness, distractibility, insomnia, palpitations—reflect Shen (mind/spirit) disturbance arising from different pattern constellations. Heart-Spleen deficiency can yield poor concentration, fatigue, and worry; Liver qi stagnation with phlegm-heat may present as irritability, impulsivity, and racing thoughts; yin deficiency with empty heat leads to insomnia, agitation, and anxiety. Because these patterns overlap, a single individualized plan can address both conditions by calming the Shen, harmonizing qi, clearing phlegm-heat, and nourishing deficiency. Acupuncture selections such as Yintang, HT7 (Shenmen), SP6 (Sanyinjiao), and DU20 (Baihui) are used to modulate autonomic tone and quiet internal agitation. Auricular acupuncture at Shenmen is commonly added for anxiety. Herbal formulas are chosen by pattern: Suan Zao Ren Tang (yin-blood deficiency with insomnia/anxiety), An Shen Ding Zhi Wan (timidity, palpitations, poor concentration), or Chai Hu Long Gu Mu Li Tang (constraint with yang rising). Gentle daily practices—regulated sleep-wake cycles, warm cooked foods at regular times, qigong/taiji, and breathwork—aim to smooth Liver qi and anchor the Shen. While clinical tradition is strong, modern evidence is still developing: small randomized trials suggest acupuncture can reduce anxiety symptoms, but findings for ADHD are mixed and heterogeneous. Accordingly, TCM approaches are best considered complementary to, not replacements for, established Western therapies, and should be guided by a licensed practitioner with attention to herb–drug interactions and individual safety.