It’s Not Necessarily ADHD
Understanding Inattention within the Anxious Child
Timmy is an 8-year-old in the 3rd grade. He has always been known to be a shy, nervous kid who prefers to keep to himself and wait for others to approach him. He favors routine, and becomes anxious about change or when he is in a new, unfamiliar situation. When Timmy is in the classroom, he gets bored easily, often stares out of the window, and even dozes off at times. He is frequently late to school and often complains of having headaches and feeling nausea. Although his vocabulary is quite high for his age and grade level, his academic achievement is below what is expected. Timmy spends an inordinate amount of time on assignments, and always needs extra time to complete assignments and tests. He has problems copying off the board, sitting still, and just staying on track overall. On top of that, Timmy seems to be quite forgetful, so he usually does not have the materials he needs to complete tasks. Although, his teacher reports that he has a hard time paying attention and often gets behind in his work, Timmy does make astute comments and show a great deal of general knowledge. In fact, he often talks about world problems and events seen on the news, and displays great compassion and empathy for them. At this point, Timmy’s parents are frustrated that he is not reaching his potential. They have heard time and time again that Timmy is an ADHD kid and his primary problem is that he just has difficulty focusing. His parents’ frustration continues, as they are at a lost when medication and behavioral methods aimed at ADHD have minimal effects for Timmy, and he continues to have problems focusing and sitting still.
How often have we witnessed this scenario? The fact is that inattentiveness can be caused by various factors, oftentimes unrelated to Attention- Deficit/Hyperactivity Disorder (ADHD). However, over the previous decade, the media has trained us to identify and attribute any sign of inattentiveness to ADHD. The fact is that Timmy’s inattention, boredom, fidgetiness, forgetfulness, falling behind on tasks, academic underachievement, and difficulty staying on track has little to do with ADHD. This misassumption has led to many misdiagnoses, and resulted in numerous frustrated teachers, parents, not to mention the child him/herself. Symptoms of inattention, distraction, fidgetiness, and what appears to be boredom do not automatically spell ADHD, and instead, can indicate anxiety in children.
Anxiety is the most common cause of mental, emotional, and behavioral problems during childhood and adolescence. However, it is often overlooked or misjudged in children and adolescents. About 13 out of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorders. About half of children and adolescents with an anxiety disorder have a second anxiety disorder or other mental or behavioral difficulty, such as depression. If left untreated, anxiety disorders in children will likely progress into adulthood. Thus, it is foremost necessary to learn to identify the correct underlying cause of a child’s inattentiveness. A proper assessment is the first step to prevent long-term difficulties at school and minimize frustration for others involved in the child’s life. From a valid assessment, we can determine a proper diagnosis and establish an effective treatment plan. Therefore, it is critical that parents and teachers understand the difference between anxiety disorders and ADHD in children.
Anxiety vs. ADHD
Although on the surface level Timmy’s difficulty with concentration and focus may appear to be the result of ADHD, a closer look at the clues reveal underlying causes that actually point to symptoms of anxiety. Children with ADHD have a difficult time paying attention and focusing. They may also be impulsive and have difficulty with self-control, and be hyperactive. A child with an anxiety disorder may have symptoms that appear the same, however, the symptoms are actually behavioral manifestations of the child’s preoccupation with excessive worry, fears, and tension. Let’s take a closer look at Timmy’s specific symptoms that are caused by anxiety rather than ADHD.
ñ Timmy is a shy, nervous kid who prefers to keep to himself and wait for others to approach him. Children with anxiety do not always understand why they have excessive worries and catastrophic thoughts that trigger intense fears. They cannot comprehend that the experience of the internal “fight-and-flight” sensation actually serves a survival purpose. From their lack of understanding of what is going on with their mind and body, they may attribute these symptoms to “something is wrong with me.” They may purposely keep their distance from others, especially peers, to keep their “oddities” hidden and prevent others from noticing.
ñ Timmy favors routine, and becomes anxious about change or when he is in a new, unfamiliar situation. Children with anxiety regularly feel apprehensive about their environment. They are hyper-vigilant and on guard for any remotely potential catastrophic event to occur. They view their world as an unsafe place filled with unfamiliar and dangerous possibilities of harm, real or imagined. To maintain a sense of security and certainty, they prefer to be in familiar situations, leaving out the need to second-guess anything. When they are put in new environments, they feel intense fear about the uncertainties of their environment, and may even react with extreme temper tantrums.
ñ Timmy gets bored easily, often stares out of the window, and even dozes off at times. He is frequently late to school and often complains of having headaches and feeling nausea. Children with anxiety disorders often complain that their bodies hurt, and that they feel ill. These are physical manifestations of our internal physiological sensations of anxiety. Children with anxiety may also experience tiredness from lack of sleep at night. Morning and bedtime periods tend to be more difficult than midday for anxious children, making morning routines that much more time-consuming. Although they may appear bored or distracted, anxious children are actually too preoccupied with fears and worries to participate in activities and stay on task. Instead, their minds are elsewhere and lost in their worrisome thoughts, which can negatively affect their academic performance.
ñ Timmy spends an inordinate amount of time on assignments, and always needs extra time to complete assignments and tests. He is forgetful, and has problems copying off the board, sitting still, and staying on track. Children with anxiety are so consumed with their worries and fears of uncertainty and harm that they have little room in their minds for anything else. In fact, it is rather difficult to stop the train of apprehensive thoughts once the worry engine is triggered. This makes it extremely hard for anxious children who are in the midst of their worrisome thoughts to have the necessary attention span long enough to retain effective memory skills for their classroom tasks. It also makes it difficult for the anxious child to remain still and maintain calmness. As a result, the time needed to complete tasks if often prolonged.
After taking this closer examination of Timmy’s condition, it is clear that his behavioral manifestations stem from anxiety rather than ADHD, as it may have initially appeared. We now have a better understanding of his behaviors and symptoms. Assessing for anxiety gives us a more complete perspective, allowing us to determine a proper diagnosis and establish an effective treatment plan. Thus, learning how inattentiveness presents itself within the anxious child is the first step to gaining specific strategies for working with the child successfully within the school and with the family.
Dr. Jenny C. Yip’s experiences with Obsessive-Compulsive Disorder (OCD) began long before her current position as Executive Director of the Renewed Freedom Center. Since childhood, Dr. Yip has fought her own personal battle with OCD. Inspired by her struggles and motivated to helping others overcome theirs, Dr. Yip has dedicated her professional career to treating families and individuals with severe OCD, performance and sports anxiety, body image issues, and related anxiety disorders. Dr. Yip has developed her own innovative treatment modality integrating Mindfulness Training and Strategic Paradoxical Techniques with CBT in the treatment of children and adolescents. She’s published numerous articles, presented at more than 35 national and international conferences, and worked to train other professionals in the field to be effective clinicians. She holds a Doctor of Psychology (Psy.D.) in Clinical Psychology from Argosy University, Washington, DC – an APA accredited program. She is an Institutional Member of the International OCD Foundation (IOCDF), a Clinical Member of the Anxiety Disorders Association of America (ADAA), and a Clinical Member of the Association for Behavioral and Cognitive Therapies (ABCT). She also serves on the Board of Directors of the Los Angeles County Psychology Association (LACPA) where she chairs the Membership Committee and the Cognitive Behavior Therapy Special Interest Group (CBT SIG).
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