Kids with ADHD often have issues with working memory, organization and time management that make it hard to follow daily routines. This can lead to chronic stress. Kids with ADHD may also have more trouble managing stress than kids who don’t have ADHD.

That’s because ADHD can affect how kids manage their emotions. Kids with ADHD may get so flooded with emotion—in this case, anxiety—that they have trouble thinking clearly about how to deal with the situation.

For example, a child with ADHD who finds it difficult to pay attention for most of his math class may panic when he learns there will be a quiz the next day. Instead of thinking about solutions, like asking for help after class or getting notes from a friend, he may come home and get so anxious that he spends the afternoon playing a video game—and forgets to do his history report. And the cycle can go on from there.

Kids with ADHD are at higher risk for anxiety disorders than kids who don’t have ADHD. Because ADHD and anxiety disorders often occur at the same time, some researchers think many kids may be pre-wired to be both anxious and inattentive.

Trouble managing emotions or using coping skills can affect kids’ behavior in different ways. Some kids may act up and draw attention to themselves. Others might sit quietly and try not to be noticed.

Here are some behaviors that may be signs of anxiety in a child with ADHD:

  • Clowns around too much in class
  • Seems irritable or argumentative
  • Lies about schoolwork or other responsibilities he hasn’t met
  • Withdraws from people, perhaps by retreating to the bedroom or bathroom
  • Plays video games or watches TV nonstop

Sometimes kids with anxiety disorders can be misdiagnosed with ADHD, or vice versa. On the surface, the two issues may look similar. Here are some of the ways a child with either issue may act—but for very different reasons:

  • Be inattentive. A child with anxiety may seem tuned out or preoccupied because he’s distracted by worries. A child with ADHD is inattentive because he has a brain-based issue with sustaining focus.
  • Fidget constantly. A child with anxiety may tap his foot nonstop during class because he has a lot of nervous energy. A child with ADHD fidgets because of brain-based issues with hyperactivity or impulse control.
  • Work slowly. A child with anxiety may work slowly because he feels compelled to be a perfectionist. A child with ADHD takes a long time to get things done because of difficulties starting tasks and sustaining focus.
  • Fail to turn in assignments. A child with anxiety may get stuck on a task and be too anxious to ask for help. A child with ADHD doesn’t turn in assignments because of brain-based issues that involve poor planning and forgetfulness.
  • Struggle to make friends. A child with social anxiety may have emotional outbursts that alienate peers. A child with ADHD who’s inattentive can struggle socially because he doesn’t pick up on social cues. Or he may have issues with impulse control that annoy or alienate other kids.

There are several overlapping symptoms. But there are also key differences. Kids with anxiety disorders often show compulsive or perfectionist behavior. This is not as common in kids with ADHD.

Kids with ADHD tend to have issues with organization. This is not as common in kids with anxiety disorders.

Kids with anxiety tend to worry more about socializing than kids with ADHD. Kids with anxiety may also develop physical symptoms like sweaty palms, rapid breathing and stomachaches.

Getting a thorough evaluation is key to determining whether your child has ADHD, an anxiety disorder or both.

This is especially important if medication is being considered. ADHD medication may relieve anxiety in some kids. But there’s also a chance it may make some kids moreanxious. It all depends on how sensitive a particular child’s body is to a particular medication.

Here are some other ways you can help:

  • Tune in to your child’s negative behaviors. Try not to chalk them all up to ADHD or impulsivity. Acting up more than usual or disappearing into his video games could be signs of anxiety. Ask your child if something is worrying him or making him uneasy. Taking notes on what you’re seeing can help you look for patterns in your child’s behavior. It may help to refer to a checklist of anxiety symptoms in younger kids or teens and tweens.
  • If your child tells you he’s feeling anxious, validate his feelings. Rather than simply telling him to “calm down,” work with him to figure out next steps he can take.
  • Learn to control your own anxiety. Some parents of anxious kids struggle with anxiety themselves. Remember that your child is learning how to respond to stressful situations by watching how you react to them. Children can have an easier time coping with anxiety if their parents stay calm and positive.
  • Try not to take certain behaviors personally. It can be upsetting to parents when kids come home from school and say something rude or offensive. But your child may be letting off steam after a stressful day. When he’s calm, help him brainstorm ways to decompress like giving him some quiet time before you start asking him about school.
  • Help your child see the big picture. If he blows up while trying to do his math homework, wait for him to calm down. Then encourage him to reflect on what was making him so upset. Talk about what he might do next time to relieve some of that anxiety.
  • Consider psychological counseling. If your child’s anxiety is preventing him from functioning or enjoying life, he may need professional help. The psychologist at school may able to refer you to a therapist who specializes in treating kids with learning and attention issues. A therapist may also refer you to a physician if anti-anxiety medication might be helpful.
  • Explore Parenting Coach. Search this tool for expert tips based on your child’s grade level and issues. It provides practical ideas on how to help your child deal with anxiety, get organized and problem-solve.

Anxiety can be a lifelong reality for some children with ADHD. But with the right support and treatment, kids can manage both of these issues so they can thrive in school and in life.