Click each of the images below to learn more about ADHD and its co-occurring conditions.

The following is a personal essay that reflects the opinion of its author.

Too often, a parent with a quiet child who has attention problems will leave the doctor’s office feeling frustrated, ignored, dismissed, or misunderstood.

Did the doctor really understand our concerns? Was there any medical gaslighting?

Indeed, medicine still has blind spots about how ADHD is diagnosed and treated, and this is especially true for females and people from racial and ethnic minority groups. After more than 20 years of practicing child and adolescent psychiatry, I still find it helpful to pause and consider what might be influencing me to not get it right.

Maybe it’s because of my medical training. In the medical school classroom and on patient rounds, I was encouraged to think about a differential diagnosis, the full range of possibilities. On tests and in real-life practice, however, I was taught to identify key symptoms, move quickly toward a diagnosis, and begin treatment, often with medication.

The Flip Side of Efficiency

I was encouraged to recognize the “classic” ADHD patient: a hyper and inattentive young boy. But such diagnostic efficiency can lead me to miss the quiet child who is merely inattentive or to mislabel the deeper issue of trauma that might be causing the restlessness.

[Webinar Replay: “When Willful Ignorance Causes Doctors to Dismiss Your ADHD Concerns.”]

Trauma, anxiety, depression, sleep problems, learning differences, and autism all have overlapping symptoms with ADHD. I often find elementary-age, adolescent, or young adult students feeling overwhelmed and suffering from anxiety and depression as well, which leads me to question which came first: the ADHD or the emotional struggles.

An adult who has spent years compensating for their ADHD may present as anxious or burned out. Of course, not every distracted or overwhelmed person has ADHD. Sometimes, what looks like ADHD is instead the result of chronic stress, language barriers, learning challenges, excessive screen use, or another condition that deserves a different response.

I’m also aware of how time and billing pressures influence my ability to feel confident in a diagnosis or treatment. In both busy primary care and mental health practices, clinicians are often expected to move quickly. An ADHD diagnosis usually requires a wider lens and more unbillable time to gather input from parents, teachers, partners, rating scales, developmental history, and examples from work, school, and home.

Stereotypes and bias also taint proper diagnoses. Girls and women are often overlooked because their ADHD may show up as disorganization, perfectionism, emotional exhaustion, or shame. Black, Latino, and other minority children are more likely to receive punishment instead of the support they need.

[Free Download: What Every Thorough ADHD Diagnosis Includes]

This is also true for children learning in their second language. I often receive referrals for a child who can’t pay attention in school because they don’t understand the English language, not because they have ADHD. Unfortunately, stereotypes and bias affect even the best clinicians. Slowing down and considering all angles is especially important so as not to mislabel or mistreat patients in these circumstances.

We, clinicians, need to keep learning by investing in continuing education, practicing cultural awareness and humility, and being good listeners. Ultimately, the best ADHD care is collaborative, curious, and committed to a patient’s wellbeing.

Medical Gaslighting Prevention: Next Steps

• Free Download: How to Talk to Your Doctor About Medical Research
• Read: “Medical Gaslighting Convinced Me That I Didn’t Have ADHD”
• Read: A Clinicians’ Guide to Better Patient Communication

Luke Smith, M.D., is a psychiatrist and the director of El Futuro in Durham, North Carolina.

Leaving projects until the 11th hour. Easily falling off task. Misplacing or forgetting completed homework. Carrying a chronically messy backpack. These everyday behaviors are signs of weak executive functioning skills common in students with ADHD, autism, and learning differences.

Executive functioning (EF) skills are needed for planning and prioritizing tasks, managing time efficiently, solving problems, regulating emotions, and retaining information. These functions, which originate in the brain’s prefrontal cortex, dictate how we move toward and accomplish our goals.

[Read: Executive Dysfunction, Explained!]

Scientists believe that five primary brain circuits relate to executive function and dysfunction, and each of them can be impaired by ADHD.

• Dorsolateral prefrontal circuit: Referred to as the brain’s command center for EF, this area is linked to planning, problem-solving, and working memory. Impairments lead to problems with focus, emotional regulation, and remembering and processing information in real time.
• Anterior cingulate cortex: This region’s functions are impulse control, attention regulation, and emotional control. Irregularities lead to difficulties sustaining focus on boring tasks, resisting impulsive behaviors, and controlling emotions and mood shifts.
• Medial prefrontal cortex: This circuit acts as the control center for decision-making focus, impulse control, and reward processing. Abnormalities result in impaired focus, impulsivity, and difficulty weighing consequence and delaying gratification.
• Ventromedial prefrontal cortex: The role of this circuit is to recognize and manage emotional and impulsive behaviors, and to deliver sustained attention and focus to keep an individual on task and motivated to achieve long-term goals. Impairments cause inattention, challenges staying on task, and poor control over emotionally driven and impulsive behaviors.
• Orbitofrontal cortex: This region is involved in decision making, risk taking, impulse control, reward processing, staying motivated, and goal-driven behaviors. Irregularities in this brain region cause individuals with ADHD to be more likely to seek immediate gratification over long-term rewards, take unwise risks, and struggle to stay focused and achieve goals.

Different ADHD brains will experience different circuitry impairments and, therefore, different symptoms of poor EF, says Russell Barkley, Ph.D. One individual’s greatest challenge may be working memory while another’s may be emotional regulation or time management. Regardless, these circuits are responsible.

[Quiz: Executive Dysfunction Test – Symptoms in Adults with ADHD]

Executive function is judged by the strength of these seven skills, according to Barkley:

• 1. Self-awareness: How well you recognize your own strengths and weaknesses
• 2. Inhibition or self-restraint: How well you pause before acting, speaking, or responding
• 3. Non-verbal working memory: How well you can picture things mentally
• 4. Verbal working memory: How well you can hold information in your mind
• 5. Emotional regulation: How well you manage and modify emotional response
• 6. Motivation: How well you work diligently toward a goal
• 7. Planning and problem solving: How well you prepare, prioritize, and adjust to obstacles

These seven executive functions develop over time. Early detection of impairments can help parents catch early signs of ADHD, Barkley says, and seek a professional evaluation, treatment, and accommodations before a child begins to struggle in school.

Executive Functioning Skills: Next Steps

• Watch: “How to Manage Executive Function Challenges: A Guide for Adults with ADHD”
• Download: Common Executive Function Challenges — and Solutions
• Watch: The Neuroscience of the ADHD Brain

Carole Fleck is Editor-in-Chief at ADDitude magazine.

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ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

May 18, 2026

Symptoms of inattention appear in both ADHD and anxiety, but new research suggests that distinct brain mechanisms are associated with this behavior in each condition. A study published in the Journal of Attention Disorders found that children with ADHD and those with anxiety notice or focus on information at the very beginning of a task in similar ways; however, they behave differently after realizing they have made a mistake.¹

Determining whether a symptom of inattention is explained by underlying ADHD or anxiety can be challenging for clinicians. Distractibility, poor concentration, and forgetfulness are core traits of inattentive ADHD. Though inattention is not a clinical symptom of an anxiety disorder, children with anxiety may appear distracted and forgetful.

“ADHD and anxiety disorder symptoms overlap,” says William Dodson, M.D. “Both cause restlessness. An anxious child can be highly distracted because they are thinking about their anxiety or their obsessions. Both can lead to excessive worry and trouble settling down enough to fall asleep. It takes time to do a comprehensive history to determine whether a patient is struggling with one or both conditions.” About half of children with ADHD also meet the diagnostic criteria for a co-existing anxiety disorder.¹, ¹

For the study, researchers examined distinct stages of the attentional process — from initial focus to error correction — to chart differing behaviors among 111 children, ages 7 to 11. The participants were divided into four groups: ADHD-only, anxiety-only, ADHD-and-anxiety, and typically developing (TD). Electroencephalography (EEG) recorded the participants’ brain activity as they completed three computerized attention tasks of various difficulty.

The study found that children with ADHD, anxiety, or both conditions exhibited similar early attention and arousal regulation difficulties when they began a task. More specifically, the groups showed weaker neural responses to important cues, in deciding what to pay attention to, and in adjusting alertness levels based on task demands, compared with the TD group. The TD group’s brains shifted into a more activated, “ready” state before starting difficult tasks, while the other groups’ brains did not.

Distinct patterns emerged between the ADHD-only, anxiety-only, and ADHD-and-anxiety groups at the attentional engagement, performance monitoring, and performance evaluation phases of the study.

Children with Anxiety and Inattention

Children with anxiety showed signs of heightened error monitoring. Their brains reacted more harshly when mistakes occurred, indicating that they were hypersensitive to errors and potential failure. At the same time, they showed reduced conscious processing of those mistakes afterward. In other words, anxious children appeared to overreact automatically to errors without learning from them.

The researchers suggest that this anxiety-related inattention may stem partly from excessive self-monitoring and worry. The anxious brain may become so focused on avoiding mistakes and rumination that it remains mentally “stuck” on the error and is unable to redirect. This cycle of heightened error sensitivity combined with inefficient conscious evaluation could contribute to the distractibility and difficulty with sustaining attention seen in children with anxiety.

Children with Inattentive ADHD

In contrast, the ADHD-only group was less likely to recognize mistakes or practice post-error slowing (immediately slowing down after making an error to improve performance on the next attempt). This finding suggests that attention issues in children with ADHD are caused by a reduced ability to monitor performances and use feedback from the environment to adjust behaviors.

Children with ADHD and Anxiety

Findings from the study showed evidence of two types of attention issues working in tandem among the ADHD-and-anxiety group. Anxious behaviors, such as hypervigilance or worrying about making a mistake, appeared to act as a compensatory mechanism that offset typical ADHD symptoms. The anxious behaviors paradoxically reduced ADHD symptoms, such as impulsivity, and improved focus, but in doing so created a different attention issue (getting stuck, careless mistakes). In this case, when children are inattentive, it is not only because of their ADHD but because their anxiety prevents them from moving on and focusing on the task at hand.

Understanding the different neural mechanisms underlying inattentive symptoms could help clinicians more accurately distinguish between ADHD-related and anxiety-related inattention.

“Inaccurate or incomplete diagnoses can delay appropriate treatment, potentially leading to greater functional impairment and worsening symptoms,” the researchers wrote. “The attentional processes identified in the present study as differing between ADHD and anxiety symptom profiles may represent promising candidate targets for objective assessment to support clinical characterization.”

Source

¹ Pranjić, M., Peisch, V., Li, Y., Troxel, M., Lee, K., & Arnett, A.B. (2026). Inattention in pediatric attention-deficit/hyperactivity disorder and anxiety: Neurophysiological evidence for distinct and overlapping cognitive Mechanisms. Journal of Attention Disorders. https://doi.org/10.1177/10870547261445680

¹Bowen R., Chavira D.A., Bailey K., Stein M.T., Stein M.B. (2008). Nature of anxiety comorbid with attention deficit hyperactivity disorder in children from a pediatric primary care setting. Psychiatry Research. https://doi.org/10.1016/j.psychres.2004.12.015

¹Reimherr F.W., Marchant B.K., Gift T. E., Steans T. A. (2017). ADHD and anxiety: clinical significance and treatment implications. Current Psychiatry Reports. https://doi.org/10.1007/s11920-017-0859-6

Just as micronutrients (in conjunction with stimulant medication) can help improve certain ADHD symptoms in many people, the opposite is also true: Deficiencies in key contributors to your body’s neurotransmitters and proteins can worsen your mood, concentration, and impulsivity.

The good news is that basic blood tests will reveal the imbalances that may be impeding your daily functioning. Ask your clinician to check your bloodwork for the following levels, which are based on functional medicine ranges for optimizing health and preventing disease, rather than standard reference ranges, which are designed to diagnose clinical diseases. Be sure to consult with your doctor before taking any supplements.

Vitamin D

If vitamin levels are below 40 ng/ml, which is often considered insufficient, take 5,000 IU of vitamin D, combined with K2 to help with absorption. When vitamin D levels are lower than 30 ng/ml, the bare minimum, symptoms can include chronic fatigue, poor focus, irritability, poor stress resilience, and sleep disturbances. When levels are corrected over 6 to 12 weeks, patients report improved mood stability, energy, and cognitive clarity, plus fewer PMS symptoms. Once the level is above 40, you can maintain with 2,000 IU per day.

Foods with vitamin D include fatty fish, like salmon and sardines, egg yolks, tofu, dairy and plant-based milk, orange juice, and oatmeal.

[Free Download: Brain Food: Healthy Eating Tips to Counter ADHD Symptoms]

Omega-3 Fatty Acids

The optimal omega-3 index (EPA+DHA in red blood cells is 8% or higher. This range is associated with the lowest risk for cardiovascular and inflammatory diseases. Daily intake to achieve this is typically 1,500 to 4,000 mg of combined EPA/DHA, with a 2:1 ratio of omega-6 to omega-3.

Salmon, sardines, chickpeas, walnuts, pumpkin seeds, avocado, and fish oil supplements are rich in omega-3 fatty acids.

Complete Blood Count (CBC)

This blood test analyzes your red and white blood cells, platelets, hemoglobin, and hematocrit to determine if you are anemic. Iron is essential for synthesizing dopamine, a neurotransmitter vital for powering executive functions. Low iron impairs dopamine function, exacerbating ADHD traits.
If your hemoglobin is under 13.5 g/dL for a woman and 14.0 g/dL for a man, you are deficient. If your hematocrit is below 36% for a woman and 40% for a man, you are deficient.

If this is the case for you, consider eating iron-rich goods, like spinach, lentils, tofu, red meat, and fish, and/or taking an iron supplement. Taking vitamin C with a supplement can boost absorption. The more easily absorbed iron supplements include ferrous fumerate, gluconate, and bisglycinate. Avoid ferrous sulfate, which can cause indigestion and constipation.

Vitamin B12

The optimal level for vitamin B12 is above 600 pg/ml. If you fall below this level, take a daily supplement with 2 mcg of vitamin B12 and retest your levels in six months. Symptoms of low vitamin B12 include fatigue, memory loss, mood changes, confusion, depression, and irritability.

Foods rich in B12 include beef, clams, salmon, tuna, fortified nutritional yeast, plant-based milk, and some breakfast cereals.

Magnesium Glycinate

Magnesium levels can be decreased by stimulant medications, as well as by conditions including diabetes, kidney disease, and gut issues. An RBC magnesium reference range is typically between 4.2 and 6.8 mg/dL and can be maintained by a daily intake of 360-480 mg of magnesium for adults. Research links low magnesium levels with poor concentration, irritability, depression, mood swings, fatigue, muscle cramps, and insomnia.

Green leafy vegetables, legumes, nuts, seeds, and whole grains are good sources of magnesium.

[Free Download: Top 5 Vitamins and Supplements for ADHD ]

Zinc

Optimal values are 90-120 mcg/dL. Levels below 70 mcg/dL in women and 74 mcg/dL in men are considered inadequate. If deficient, take 30 mg of zinc picolinate twice daily for 6 months, then retest. Many people are deficient in this mineral, which affects attention, energy, and mood.

Shellfish, red meat, poultry, seeds, nuts, eggs, dairy, and grains are rich in zinc.

A Blood Test for Vitamin D Deficiency: Next Steps

• Read: 10 Supplements and Vitamins for Brain Health
• Read: Do Melatonin, Omega 3 & Dietary Supplements Help ADHD?
• Free Download: The Best Vitamins and Supplements for Managing ADHD Symptoms
  

Maggie Alexander, ND, MS, PMHNP, is a psychiatric-mental health nurse practitioner and author of Shine with ADHD: Unlock Your Potential with Skills, Medicine, and Micronutrients (#CommissionsEarned). 

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

April 29, 2026

The distinct symptom profiles of ADHD — namely, inattention and hyperactivity-impulsivity — follow their own unique behavioral and developmental pathways, and they may benefit from targeted interventions and treatment, suggests a new study published in Frontiers in Psychology.¹

Findings from the study show that ADHD symptoms arise not from a single deficit, but from different underlying brain systems involved in attention, behavioral control, emotional regulation, and sleep.

The research team found that symptoms of hyperactivity and impulsivity typically decrease as children age and are more commonly observed in boys, whereas inattention remains stable throughout development and affects boys and girls at similar rates. Overall, symptoms of inattention were found to be more severe than symptoms of hyperactivity and/or impulsivity.

Learning challenges appeared to be the strongest predictor of inattention, according to the study. Children with more severe inattentive symptoms showed greater difficulty sustaining focus, filtering out distractions, and managing mental effort. “These deficits directly impact classroom learning and explain the strong association [of inattention] with academic difficulties,” the researchers wrote.

The researchers also found strong associations between symptoms of hyperactivity-impulsivity and oppositional or conduct-related behaviors, emotional dysregulation, as well as specific sleep disruptions, such as restless sleep, nightmares, or unusual nighttime movements.

Sleep emerged as an important factor across both symptom clusters, but in different ways. While general sleep difficulties were loosely connected to inattention, disturbances in sleep–wake transitions, specifically restless sleep, nightmares, or sleep talking were a significant predictor of hyperactivity-impulsivity.

“Poor sleep may impair brain regulation systems, especially those tied to impulse control and emotional reactivity,” the researchers wrote.

“Sleep problems in youth with ADHD are associated with several negative outcomes,” said Stephen P. Becker, Ph.D., in the ADDitude webinar “Why Am I Always So Tired? The Latest Science on Improving Sleep in Children and Teens with ADHD.” “They impact functioning during the day, be it at school or at home, and they are associated with mental health problems over time. Sleep problems in adolescents with ADHD are tied to poorer quality of life, as well as poor academic performance and lower grades.”

Low-Anxiety, High-Impulsivity Subtype

Interestingly, children with lower levels of anxiety tended to show higher levels of hyperactivity and impulsivity, leading researchers to infer that anxious behaviors may suppress overt hyperactive behaviors. Children with anxiety may be more cautious, self-aware, or responsive to consequences, while children with low anxiety may be more prone to risk-taking and impulsive actions and less responsive to threat cues.

This finding points to a possible “low-anxiety, high-impulsivity” subtype of ADHD.

The recognition that different ADHD symptom profiles are driven by different neurological mechanisms could reshape how clinicians diagnose and treat the condition and its many subtypes.

For example, children with primarily inattentive symptoms may benefit most from academic support, cognitive interventions, and strategies that strengthen attention and information processing. Children with more pronounced hyperactivity and impulsivity may respond best to behavioral therapy, emotional regulation support, and interventions that address sleep quality.

This cross-sectional study was conducted at the outpatient Cognitive Center of Guangxi Zhuang Autonomous Region People’s Hospital, between December 2020 and December 2022. It included a sample of 331 children aged 6 to 12 years with ADHD.

Source

¹Fu Y, Qin Z, Qin L, Zhang H, Liu H, Huang S and Li D (2025) Multidimensional factors associated with ADHD core symptoms in children: cognition, sleep, behavior, and demographics. Front. Psychiatry. https://doi.org/10.3389/fpsyt.2025.1658202

April 19, 2026

People with ADHD are more likely than their neurotypical peers to take positive and prosocial risks as well as negative risks, according to a new study in the Journal of Attention Disorders.¹

The study marks the first research to explore the prevalence of positive or prosocial risk-taking behaviors in an adult ADHD population. “The vast majority of risk-taking research focuses on negative and undesirable outcomes,” the study authors write. “And thereby often neglects a potential positive side of risk-taking behavior.”

The researchers explored the contributions of ADHD characteristics as well as depression, anxiety, and stress to risk-taking behavior in all its forms. Prosocial risks are defined as risky behaviors that may lead to positive outcomes, performed for the benefit of someone else, such as advocating for a vulnerable group, intervening in a fight, or attending a protest. Positive risks are defined as risky behaviors that may lead to positive outcomes performed for one’s benefit, such as adventurous travel, trying out for a performance or sports team, or public speaking.

ADHD symptoms were associated most strongly with negative risk-taking but also with positive and prosocial risk-taking to a lesser extent. ADHD characteristics appeared to contribute more to risk-taking behaviors of all kinds than did anxiety, depression, and stress. As the participants’ age increased, their likelihood of taking negative and positive risks decreased.

Additionally, researchers found that, “All three forms of risk-taking were interrelated, suggesting that a higher reported likelihood of one type coincided with increased likelihoods of the others.”

In the correlational study, 611 Dutch participants completed surveys about their likelihood of engaging in negative, positive, and prosocial risk-taking behaviors. Participants also completed a questionnaire that measured symptoms of ADHD as well as depression, anxiety, and stress.

Further research is needed, write the study’s authors, since the association between ADHD traits and positive or prosocial risk-taking is likely multi-factorial and, “may be influenced by a variety of factors, including internalizing conditions.” Still, they conclude: “These insights may contribute to a more nuanced understanding of ADHD, with potential implications for fostering positive self-concept, promoting acceptance of the condition, and supporting adaptive coping strategies.”

The Upside of Risk Taking: Upstanders and Advocates

The ability of many individuals with ADHD to demonstrate the courage of their convictions, high levels of empathy, and a passion for justice has long been observed. “If managed correctly, a healthy dose of frustration and sadness regarding inequities can be useful,” says Marcy Caldwell, Psy.D., in the ADDitude article “Why ADHD Brains Can’t Just Ignore Unfairness.” “The world needs individuals who are committed to making a positive difference in the lives of others.”

ADDitude readers have shared many such accounts of altruism. “My daughter has a strict sense of what’s right and has no problem telling someone when they’re in the wrong,” says Rebecca, an ADDitude reader, in the article, “What I Would Never Trade Away.” “Right now, as her mom, it drives me insane at times, but I know it’s a true superpower.”

Another reader named Karen shares a similar reflection: “My daughter always watches out for the ‘little guy.’ If someone is getting picked on or bullied, she will step up and have their back.”

Stories of individuals with ADHD taking risks with unfortunate results are all too common, but there are many stories of risks that yield benefits in relationships, personal growth, and business.

“I was bored by work in the ’70s and saw a newspaper ad for a volunteer nursing job in Yemen,” says Susan, an ADDitude reader in the United Kingdom. “I didn’t know anything about it or even where Yemen was, but I applied, got the job, and spent two amazing years there.”

“Risk-taking. Impulsivity. Sensation seeking. Hyperfocus. Curiosity. We associate these traits and qualities with some of the most successful, trailblazing entrepreneurs of our time, writes Linda Roggli, PCC., in “Entrepreneurship and ADHD: Fast Brain, Fast Company.” “In some ways, the ADHD traits most commonly associated with challenges are the same ones lauded by successful entrepreneurs.”

Source

¹Fuermaier, A. B. M., Dong, H., Pollak, Y., Braams, B. R., & Dekkers, T. J. (2026). ADHD Characteristics Are Linked to Divergent Risk-Taking Behaviors. Journal of Attention Disorders. https://doi.org/