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

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