Many parents and teachers assume that Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood mental health disorder. In fact, anxiety is the most prevalent mental health disorder in children. Studies indicate that 13 out of every 100 children ages 9 through 17 experiences some kind of anxiety disorder. Furthermore, according to the National Institute of Mental Health (NIMH), 25% of 13-18 year olds will experience an anxiety disorder during their adolescence. Anxiety disorders include Separation Anxiety Disorder (SAD) and Specific Phobias, which often occur in younger children, as well as Social Phobia, Generalized Anxiety Disorder (GAD), and Panic Disorder, which typically occur in older children or adolescents. Obsessive Compulsive Disorder (OCD) also has a childhood onset, with varying degrees of severity.
Although anxiety is the most common mental health condition in children, ADHD is the diagnosis more often given, particularly when the child demonstrates inattention or listlessness in the classroom. However, inattention and listlessness in the classroom as well as many other symptoms may indicate the existence of an anxiety disorder, not necessarily ADHD. For instance, if a child spends a long time on homework it may be because of general distractedness and difficulty staying on task, which is indicative of ADHD. An alternative explanation may be that the child wants to ensure that his/her homework is completely correct for fear of turning in something that is not perfect, which instead is indicative of anxiety. Or, a child with OCD may need to make sure that compulsive rituals are performed before s/he can complete the homework, rituals that may not be obvious to an outsider (e.g., erasing/re-erasing, aligning certain numbers, answering questions in specific sequence).
An incorrect diagnosis of ADHD can be problematic for several reasons, particularly if your child is actually struggling with anxiety.
First, your child will not receive the treatment s/he need in order to reduce anxiety. Cognitive-Behavioral Therapy combined with Family Systems Therapy is highly effective in treating anxiety disorders in children. This type of treatment is usually short-term and has long lasting effects. However, without a correct diagnosis your child will never be given the opportunity to overcome his or her anxiety. Without treatment, anxiety continues to persist into adulthood and generally becomes more severe.
Secondly, you may be encouraged to begin administering stimulant medication, such as Ritalin, Concerta, and Adderall, to your child as a pharmaceutical intervention. While stimulant medication can be highly effective in treating ADHD, it does have negative side effects, including drowsiness, appetite reduction, stomach aches, irritability, and headaches, among others. Your child will be exposed to the side effects of psychostimulants unnecessarily if s/he is taking the medication erroneously. In addition, stimulant medications actually worsen anxiety, since they are a class of drugs considered as “uppers” that will further increase the arousal already experienced in anxious children.
Thirdly, an incorrect diagnosis may adversely affect your child’s ability to perform in the classroom. Anxiety interferes with concentration and learning, and anxious children may become preoccupied with their fears, leaving them unable to concentrate on their lessons. Children with anxiety disorders often have difficulty making decisions, hindering their ability to engage in simple classroom activities. They may also be hesitant to ask questions or seek help. Treatment of ADHD is not likely to address any of these issues.
What can you do to ensure that your child is properly diagnosed?
- Determine the reason for the symptom. It is not enough to assume that inattention may be due to ADHD. Inquire why the behaviors are occurring in a sensitive, straightforward manner.
- Many pediatricians, teachers, and even mental health professionals are unaware of the overlap between symptoms of ADHD and anxiety. Make sure that the person providing your child’s assessment is familiar with both symptom clusters.
- Continually assess your child’s progress. If your child continues to engage in similar behaviors after treatment for ADHD has begun, s/he may be suffering from a co-occurring disorder or another disorder altogether.
Dr. Haider is a Licensed Psychologist and the Director of Training at the Renewed Freedom Center. She has worked extensively with young children, adolescents, and adults suffering from severe anxiety disorders, and employs cognitive-behavioral therapy integrated with mindfulness training. Dr. Haider is also trained in biofeedback, a practice that helps patients understand their mind-body connection to anxiety. Her background in school psychology gives her a unique perspective in working with children, while helping parents and school staff in understanding the impact of anxiety disorders on academic functioning. She has presented at conferences and authored papers on how to best help children with anxiety.