Children with ADHD are highly likely to struggle with a co-occurring anxiety disorder like social phobia. Whether anxiety is a symptom of ADHD or a more pervasive problem, it's essential for parents to identify the issues as accurately as possible so that you can help your children get better.
What Is Social Anxiety?
It's difficult, as a parent, to watch your child struggle with the symptoms of ADHD. You want to be as helpful as possible, but finding the most effective treatment can be a tedious, frustrating process. That's why it's important to understand the facets of your child's disorder--or disorders. We'll walk you through the definition of social anxiety and its symptoms so that you feel better prepared to take further action.
According to the American Psychiatric Association's diagnostic manual, social anxiety disorder involves pervasive and disabling discomfort in the face of certain social situations. This means that a person's fear exceeds normal expectations and interferes with their ability to go about daily life. Social anxiety goes beyond shyness and introversion. Your child may feel so anxious about talking with classmates or getting graded by a teacher that they get physically sick or are otherwise unable to attend school.
Here is a list of symptoms to look for in your child:
- Fear without a clear cause
- Lack of control over worry or fear
- Prolonged crying and severe tantrums
- Withdrawing from family and friends
- Extreme clinginess
- Stress and irritability
- Difficulty remembering facts or processing concepts
- Physical immobility
- Insomnia and fatigue
- Brief panic attacks (fast heartbeat, labored breathing, nausea, shaking)
- Constant headaches and stomachaches
- Muscle tension
Social Anxiety and ADHD
For many children with ADHD, anxiety is a symptom of trying to cope with ADHD. In those cases, anxiety is defined as being secondary to ADHD because it is caused by the inability to focus, years of criticism from teachers, and so on. Yet, studies have found that 44% of children with ADHD also have a distinct anxiety disorder. Unlike secondary symptoms, a comorbid disorder will not go away if the child is treated for ADHD. In terms of co-occurring anxiety, generalized anxiety disorder is the most prevalent, with social anxiety being the second most common.
Though common, it can be hard to identify because anxiety symptoms are internal, which means they exist within a child but do not present as external behavior (like verbal outbursts or aggression). As a result, signs of anxiety can be hidden by the more obvious symptoms of ADHD and often go unnoticed. Generally speaking, ADHD children with comorbid anxiety will be less antagonistic and impulsive but much more withdrawn and stressed.
For example, your child may be experiencing intense guilt, fear, or even irritability without you or their teacher knowing. Further, some symptoms of social phobia like restlessness and poor concentration can be misinterpreted as ADHD symptoms. Social anxiety can occur under the radar until outward behaviors surface, such as weight loss, sleeplessness, or refusal to attend school.
As a concerned parent armed with the right information, you may be able to help distinguish comorbid social anxiety in your ADHD child. Look for fear and worry that is specific to certain situations or thoughts. The most revealing sign to look for is if your child tries to avoid potentially fearful situations on a consistent basis. If your child suffers from social anxiety, they will do everything in their power to steer clear of the interactions or places that trigger their fear.
For example, your kid may fear taking tests because of their inability to focus on the material and the prospect of being criticized by their teacher. As a result, on test days, they wake up complaining that they couldn't sleep and their head hurts. They refuse to get out of bed and stage a tantrum when you ask them to get dressed.
Causes of Comorbid Social Anxiety
Knowing the potential cause of your child's social anxiety can help you understand their struggles more fully and target treatment moving forward. Here are common causes of co-occurring social anxiety in ADHD children:
- Environmental toxins: Like ADHD, anxiety disorders can be caused by exposure to chemical contaminants and preservatives in high doses.
- Family history: Anxiety disorders are passed from child to parent at rates of 30-35%. Further, relatives of individuals with comorbid ADHD and anxiety are two times more likely to have an anxiety disorder than individuals with ADHD only.
- Prenatal conditions: Severe stress, depression, and anxiety experienced during pregnancy can lead to childhood anxiety.
- Gender: Social phobia presents in girls more often than boys, at a ratio of 3:2, possibly because of differences in how young girls respond to negative experiences.
- Parenting style: Social anxiety disorder is associated with caregivers who are overcontrolling or overprotective, or who lack warmth and acceptance toward their child.
- Bullying: Social anxiety is highly correlated with childhood teasing, bullying, and lack of peer acceptance.
- Recent events: Divorce, natural disasters, changing schools, or losing a pet could all act as a stressor that triggers anxiety.
- Medication: Taking ADHD stimulants could amplify existing anxiety, causing it to be a more pervasive problem.
You can read more about causes in the article Social anxiety disorder: A review of environmental risk factors by Brook and Schmidt.
Effects of Social Anxiety
Apart from causing debilitating fear, social anxiety can affect how a child performs at school and how they act in social situations. In the classroom, children with comorbid social anxiety and ADHD are actually less likely to go off-task, and their anxiety reduces their hyperactivity. However, kids with both are also found to be more inattentive. Since they are so preoccupied with trying to control their fear, they get distracted from the conversation happening in the classroom. This causes them to have longer reaction times than children with ADHD only.
While comorbid social phobia and ADHD can influence how your child functions at school, their performance will likely be on par with pure ADHD kids. Because they do not act out as much, they spend more time on their school work. The more detrimental effects of social anxiety result from the fear of social interactions. These children tend to withdraw from family and friends, which can lead to isolation and depression. Their uncontrollable fear causes them to avoid situations where they can be judged negatively by others, such as speaking up in class, playing with peers, or even ordering at a restaurant.
The effects of social anxiety can reach far beyond childhood. In a review of research on the comorbidity of ADHD and anxiety, researchers Jarrett and Ollendick found that 35% of ADHD children still suffered from anxiety disorders in mid-adolescence and early adulthood. By attacking social anxiety disorder head on, you can help save your child from social isolation and pervasive fear in the future.
Diagnosing Social Anxiety
Anxiety with ADHD is a product of the inability to function in daily life, which is why it's so important to recognize and treat ADHD early. Improving those symptoms could help offset social and cognitive limitations, thereby alleviating anxiety. The DSM-V criteria for diagnosing social anxiety requires the anxiety to occur in settings with peers and adults, and it must last for 6 months or more.
It's important to note that moderate amounts of stress and anxiety are normal for both parents and children. With a healthy amount of anxiety, children are motivated to do well at school, with relationships, and for activities. It's when the level of anxiety exceeds normal expectations that you should suspect a problem. While it's normal for your child to get nervous before a school play, the thought of singing in front of a crowd should not cause them to lose sleep for days on end or to retreat from family and friends.
If you are concerned that your ADHD child suffers from social anxiety, please talk to a medical professional. Your child's pediatrician or therapist will know best what questions to ask and how to interpret symptoms. To help their diagnosis, keep a log of your child's symptoms. You should also consider them an important source of information. While they may not fully understand or reveal their suffering, you can listen closely to what they say and take notes on the language they use. The more information the diagnostician has, the more equipped they will be to help!
If you do suspect that your child is suffering from anxiety, try to get to the bottom of it as quickly as you can. Finding the right treatment for your child can be complicated, and you want to help your child feel more relaxed and capable as soon as possible.