ADHD and social anxiety

The short answer

ADHD and social anxiety can both make conversations hard. The reasons differ.

• With ADHD, you may drift off mid-conversation, interrupt, blurt things out, forget names or plans, or lose track of what someone said. The problem is attention and impulse control. It happens whether or not you are nervous.
• With social anxiety, your mind may go blank or you may hold back, because you are afraid of being judged. When you feel safe, it eases.

Many people have both. Then the two feed each other: ADHD slips lead to embarrassment, embarrassment leads to fear, and fear makes attention even harder.

What ADHD is

ADHD (attention deficit hyperactivity disorder) is a difference in brain development. It shows as long-standing trouble with attention, restlessness, or acting on impulse, starting in childhood. In adults it often looks like disorganization, forgetfulness, an inner restlessness and trouble finishing things.

How often do they occur together?

Often, but nobody knows exactly how often. A review of 41 studies of teenagers and adults found very wide ranges:

• Among people with social anxiety, between 1.1% and 72.3% also had ADHD.
• Among people with ADHD, between 0.04% and 49.5% also had social anxiety.

The ranges are wide because the studies used different groups and methods. The reviewers rated all but two studies as weak quality. What they did agree on: people with both conditions had more problems in daily life than people with only one. The authors suggest that anyone with one condition should be checked for the other.

Why they overlap

Several reasons make sense, though few have been tested well:

• Years of social slips. Interrupting, forgetting, missing cues and being told off can teach you to expect judgement.
• Feeling different. Many adults with ADHD describe a lifetime of feeling “too much” or “not quite right” in groups.
• Shared look. Both can make you avoid eye contact, go quiet, or leave early. A clinician who sees only one may miss the other.

How to tell which is which

Both can be true at once. A clinician can assess each.

What this means for treatment

When both are present, treating only one can leave you stuck.

• ADHD treatment (medication, coaching, practical strategies) can reduce the slips that feed the fear.
• Social anxiety treatment, such as cognitive therapy for social anxiety, works on the fear itself. Therapists may adapt it: shorter tasks, written summaries, reminders for practice between sessions.
• Medication for anxiety, such as SSRIs, may be considered alongside ADHD medication. This must be planned with a doctor who knows about both. Never change or combine medicines on your own.

A word about alcohol

Some people with ADHD and social anxiety drink to get through social events. In one forum thread, a person said they drank only to cope with social anxiety and that it helped about half the time. Others in the thread warned about mixing alcohol with ADHD stimulant medicine, and about days of “hangxiety” afterwards. See alcohol and social anxiety. If drinking or low mood feels out of control, see crisis lines.

Getting assessed

If you think you might have ADHD, social anxiety or both, tell your doctor about both. Bring examples from childhood as well as now. See talking to your doctor.