The anxiety is half the story.
Why so many adults get treated for anxiety for years before anyone looks underneath, and what a proper assessment can do about it.
You have tried every intervention, and the anxiety is still here.
Many of the adults I assess have spent years, sometimes decades, being treated for anxiety. They have had CBT. They have tried SSRIs. They have done mindfulness apps, breathing exercises, journalling, and yoga. Some of it helped. None of it solved the problem.
If this sounds like your story, there is a reasonable chance the anxiety is not the full picture. In a significant proportion of adults who present with persistent, treatment-resistant anxiety, ADHD is sitting underneath it, driving the symptoms. Anxiety is louder and easier to label, so it is what gets treated. The ADHD sits quietly beneath, untouched.
From the outside, it is textbook anxiety.
Adult ADHD produces a state of internal restlessness that is almost indistinguishable from generalised anxiety. Your mind races. You struggle to switch off at night. You feel keyed up without a clear reason. You overthink decisions. You procrastinate and then panic. You feel permanently slightly behind.
But there is a tell, and it is in what you are actually worrying about.
- ADHD worry is anchored in real-world overwhelm, not catastrophic imagination.
- It sounds like "I have twelve open tabs in my brain" rather than "something bad is about to happen."
- The agitation tracks tasks, timelines, and deadlines rather than existential threat.
- Traditional anxiety treatment helps for six or twelve months, then plateaus.
- Sleep suffers more when life is busy than when it is quiet.
- The worry often drops away the moment you actually start the thing, if you can get there.
If more than a few of these ring true, the anxiety you have been treating may not be the whole problem. It may be the symptom of something else.
For many of my clients, what looked like twenty years of anxiety was really twenty years of ADHD with nowhere safe to put itself.
Dr Alex Hull
The two conditions feed each other until it is hard to tell where one ends.
ADHD and anxiety form a closed loop that gets louder over time. Your ADHD makes it hard to plan, prioritise, and follow through on what matters. You miss deadlines, forget commitments, or leave important things to the last minute. Over years, the consequences teach your nervous system that daily life is not safe. Anxiety rises as a protective response.
Anxiety then makes the ADHD worse. When you are in a state of high arousal, working memory shrinks, focus narrows, and decision-making becomes harder. So you miss more. The loop tightens.
By the time someone reaches my clinic, they often describe feeling wired and exhausted at the same time. The technical term is hyperarousal with executive fatigue. The everyday version is, I am burning out while standing still.
Short appointments cannot untangle this.
Clinically, ADHD and generalised anxiety overlap on almost every surface marker: difficulty concentrating, sleep disruption, restlessness, irritability, and feeling on edge. A thorough assessment can unpick which is primary. A twenty-minute appointment cannot. The result is that anxiety gets labelled and treated while the ADHD sits beneath, untouched.
Women are disproportionately affected by this pattern. Research consistently shows that women with ADHD are diagnosed with anxiety or depression first, sometimes for many years, before their ADHD is recognised. The internalising presentation of ADHD, where restlessness is turned inward rather than shown as obvious hyperactivity, reads as anxiety to most clinicians. The pattern repeats so reliably it has become one of the clearest indicators in the adult ADHD literature.
Treating the ADHD often treats the anxiety as a by-product.
Getting the diagnosis right changes the treatment. If ADHD is driving the anxiety, then treating the ADHD, through medication, psychological strategies, or both, often takes the edge off the anxiety as a natural side-effect. Many of my clients report their anxiety reduces significantly within weeks of starting appropriate ADHD treatment, because the underlying overwhelm finally has somewhere to go.
The reverse is also worth knowing. If your anxiety is genuinely primary, and your ADHD-like symptoms are produced by a chronically hyperaroused nervous system, then an ADHD diagnosis would be inaccurate and ADHD medication would not help. A good assessment tells you clearly which is which, and what the relationship between them looks like for you specifically. That clarity is worth a great deal.
A single checklist will not untangle this knot.
When you book an assessment with me, we do not rely on a symptom questionnaire. The assessment covers a detailed developmental history going back to childhood, a careful look at your current functioning across work, relationships, and daily life, and screening for the conditions that overlap with ADHD, including anxiety, depression, autism, and trauma. The QbCheck objective attention test is included as standard.
The clinical interview is 90 minutes, online, and conducted by me personally. You receive a full written report and a feedback session to talk through what the findings mean and what to do next. If ADHD is present, we map out how it is interacting with your anxiety and what treatment pathway makes sense for you. If it is not, the report explains what is more likely driving your experience, and what to do about that.
All of it is included in a single all-inclusive fee. No hidden extras.
If this sounds like your loop.
The most useful first step is usually a free consultation call. It is a conversation, not a commitment. We can discuss your experience, whether an assessment is likely to help, and any questions you have about the process.