Is It ADHD or Is It Anxiety? Why Your Child’s Restlessness Might Be Neither—Or Both
You’ve noticed your child can’t sit still during homework. They’re fidgety at dinner, constantly interrupting, and seem perpetually on edge. The teacher mentions concentration problems. Your GP suggests anxiety. An online quiz points to ADHD. You’re caught between conflicting advice, watching your child struggle whilst nobody can quite name what’s wrong.
Here’s what nobody tells you: ADHD and anxiety don’t just share symptoms. They create each other.
When Anxiety Looks Like ADHD (And ADHD Looks Like Anxiety)
A child staring out the window during maths isn’t necessarily daydreaming. She might be replaying this morning’s argument with her brother, worrying about tomorrow’s test, and wondering why she can’t just think straight like everyone else seems to. That’s anxiety masquerading as inattention.
Another child bounces his leg through every lesson, taps his pencil, and can never quite settle. Teachers call it hyperactivity. But peel back the layers and you’ll discover a brain that’s not racing—it’s exhausted. He’s not overactive. He’s internally restless from years of getting it wrong, disappointing people, and trying desperately to keep up with expectations his brain isn’t wired to meet easily.
This is where diagnosis becomes detective work. Because these two conditions don’t just sit side by side—they weave through each other like tangled string, and pulling at the wrong thread can unravel everything.
Understanding ADHD as the Great Accumulator
ADHD isn’t simply about having a short attention span or being a bit bouncier than other children. It’s about what I call the “invisible weight of daily struggle”—the emotional freight that builds up when your brain works differently in a world designed for neurotypical minds.
Think about your child’s typical day. Morning starts with forgetting where they put their shoes (again). There’s the sharp tone in your voice when you’re running late. At school, they mishear instructions and complete the wrong task. A classmate makes a cutting remark about them being “slow.” They lose their place whilst reading aloud. Playtime is tricky because they misread social cues and inadvertently upset someone. Homework takes three times longer than it should, with you growing increasingly frustrated at the kitchen table.
Each incident seems small. Inconsequential, even. But these micro-moments aren’t isolated—they’re cumulative.
Every misplaced item becomes another confirmation that they’re “careless.” Every misunderstood instruction adds weight to the belief that they’re “not trying hard enough.” Every friendship wobble reinforces the fear that something about them is fundamentally difficult to be around. Layer upon layer upon layer, these experiences don’t just create stress—they create a nervous system that’s permanently braced for the next disappointment.
This is ADHD’s emotional distress syndrome. It’s not that children with ADHD are inherently anxious. It’s that living with unrecognised or unsupported ADHD creates the perfect conditions for anxiety to flourish. The restlessness you see isn’t hyperactivity in the traditional sense—it’s a body that can’t settle because the mind has learnt that settling means facing all those uncomfortable feelings.
Why Parents Get Trapped Between “Try Harder” and “Calm Down”
When you don’t understand this connection, it’s easy to fall into two unhelpful patterns. You might push your child to focus more, work harder, be more organised—essentially asking them to fix a neurological challenge through willpower alone. Or you might tiptoe around them, desperately trying to reduce stress, inadvertently reinforcing the message that the world is threatening and they’re fragile.
Neither approach addresses what’s actually happening. Your child doesn’t need to try harder or worry less. They need their brain’s fundamental wiring to be understood and supported.
The Medication Puzzle That Confuses Everyone
This is where things become genuinely complicated for parents. You’ve probably heard contradictory advice about medication. Some people insist that stimulants will make an anxious child worse. Others claim medication is essential. Meanwhile, you’re just trying to help your child get through the school day without feeling like a failure.
Let me share something that might surprise you. When parents tell me their child became more anxious on stimulant medication, I don’t immediately assume the medication is wrong. I wonder whether we’ve truly understood which came first—the ADHD creating the anxiety, or genuine anxiety disorder that happens to coexist with attention challenges.
Here’s what actually happens in many cases. When stimulant medication is correctly prescribed for genuine ADHD, it helps the brain’s executive functions work more efficiently. Suddenly, your child can organise their thoughts. They remember instructions. They complete tasks without that gnawing sense of failure. The internal restlessness—the product of all those accumulated micro-traumas—begins to settle because the daily struggle lessens.
But if the dose is wrong, the timing is off, or the diagnosis isn’t quite right, stimulants can indeed heighten feelings of anxiety. This doesn’t mean stimulants are “bad” for anxious children. It means we haven’t yet understood your child’s complete picture.
The Non-Stimulant Confusion
Many parents prefer non-stimulant ADHD medications, believing they’re gentler or safer for children who seem anxious. What most people don’t realise is this: every non-stimulant medication used for ADHD was originally developed as an antidepressant.
Let that sink in for a moment. Medications like atomoxetine (Strattera) weren’t designed to treat attention problems. They were designed to improve mood and reduce anxiety. Researchers later discovered they also had some benefits for concentration, particularly by dampening the anxiety component that often accompanies ADHD.
So when non-stimulants work for a child with ADHD, they’re often treating the emotional distress and a bit of the attention difficulty—but not the full ADHD picture. They’re addressing the anxiety that ADHD created, rather than the ADHD itself.
This is why stimulant medication, when correctly prescribed and monitored by an experienced clinician, remains the gold standard. Not because it’s stronger or more powerful, but because it directly targets the brain circuits responsible for attention, motivation, and emotional regulation. It addresses the root cause rather than just managing the symptoms that the root cause created.
Understanding What’s Underneath Before Treating What’s on Top
This is the heart of effective ADHD management, and it’s what’s often missing when parents bounce between different practitioners seeking answers. Unless a clinician takes time to tease out all the overlapping pieces—sleep patterns, learning challenges, coordination difficulties, speech development, emotional regulation, even diet and exercise—medication alone rarely provides the complete answer.
I always emphasise what I call “holistic management.” This doesn’t mean rejecting medication in favour of supplements and wishful thinking. It means understanding your child as a whole person, not just a collection of symptoms to suppress.
Your child’s internal restlessness might stem primarily from ADHD’s executive function challenges. Or it might be anxiety that looks remarkably like ADHD because anxious children appear inattentive when their minds are catastrophising rather than learning. Often, it’s both conditions genuinely coexisting, each making the other worse.
Getting this diagnosis right transforms everything—not because labelling your child helps, but because accurate understanding guides accurate treatment. You stop barking up wrong trees. You stop investing time and money in interventions that can’t work because they’re addressing the wrong problem. You start seeing improvement because you’re finally supporting your child’s actual brain, not the brain you assumed they had.
What This Means for Your Family Tonight
If you’re reading this at 2am, worried sick about whether you’re doing enough, here’s what I want you to understand. Your child’s struggles are real. The restlessness, the emotional intensity, the apparent inability to just settle and focus—these aren’t character flaws or deliberate misbehaviour. They’re the visible manifestations of a brain that’s working incredibly hard in a world that doesn’t naturally accommodate how it functions.
The solution isn’t about whether medication is “good” or “bad.” It’s about whether you have the right understanding of your child’s unique neurology. It’s about finding someone experienced enough to distinguish between ADHD creating anxiety, anxiety mimicking ADHD, or both conditions genuinely present. It’s about ensuring that any medication prescribed is the right medication at the right dose, prescribed by someone who monitors progress and adjusts thoughtfully.
Most importantly, it’s about recognising that understanding is the most powerful intervention you possess. When you truly understand why your child behaves as they do—when you can see past the surface behaviours to the struggling brain beneath—everything changes. Your frustration transforms into compassion. Your child stops internalising shame and starts building resilience. The whole family can finally stop battling and start supporting.
Ready to Understand Your Child’s Unique Brain?
Getting an accurate diagnosis isn’t about labelling your child. It’s about finally seeing them clearly enough to offer the right support. If you’re exhausted by conflicting advice and ready for answers that actually make sense of your child’s struggles, proper assessment changes everything.
Dr Flett offers comprehensive ADHD and anxiety assessments that look at the whole child—not just a checklist of symptoms, but the complete picture of how your child’s brain works, what’s making daily life difficult, and what will actually help. Consultations are available at The Assessment Centre, 8 Village Road, Kloof, Durban. Zoom consultations are available for families across South Africa.
Call 031 1000 474 or visit drflett.com to begin understanding your child’s brain—and transforming their future.
Because when parents truly understand their child’s ADHD, anxiety, and development, confusion becomes clarity, frustration becomes insight, and struggle becomes the foundation for genuine growth.Retry
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I’ll integrate all this medication data while maintaining Dr Flett’s warm, empathetic voice and the narrative about ADHD vs anxiety.
Is It ADHD or Is It Anxiety? Why Your Child’s Restlessness Might Be Neither—Or Both
You’ve noticed your child can’t sit still during homework. They’re fidgety at dinner, constantly interrupting, and seem perpetually on edge. The teacher mentions concentration problems. Your GP suggests anxiety. An online quiz points to ADHD. Meanwhile, you’re caught between conflicting advice about medication—some people insist stimulants will make an anxious child worse, whilst others say they’re essential.
Here’s what nobody tells you: ADHD and anxiety don’t just share symptoms. They create each other. And understanding which came first transforms everything about treatment.
When Anxiety Looks Like ADHD (And ADHD Looks Like Anxiety)
A child staring out the window during maths isn’t necessarily daydreaming. She might be replaying this morning’s argument with her brother, worrying about tomorrow’s test, and wondering why she can’t just think straight like everyone else seems to. That’s anxiety masquerading as inattention.
Another child bounces his leg through every lesson, taps his pencil, and can never quite settle. Teachers call it hyperactivity. But peel back the layers and you’ll discover a brain that’s not racing—it’s exhausted. He’s not overactive. He’s internally restless from years of getting it wrong, disappointing people, and trying desperately to keep up with expectations his brain isn’t wired to meet easily.
This is where diagnosis becomes detective work. Because these two conditions don’t just sit side by side—they weave through each other like tangled string, and pulling at the wrong thread can unravel everything.
Understanding ADHD as the Great Accumulator
ADHD isn’t simply about having a short attention span or being a bit bouncier than other children. It’s about what I call the “invisible weight of daily struggle”—the emotional freight that builds up when your brain works differently in a world designed for neurotypical minds.
Think about your child’s typical day. Morning starts with forgetting where they put their shoes (again). There’s the sharp tone in your voice when you’re running late. At school, they mishear instructions and complete the wrong task. A classmate makes a cutting remark about them being “slow.” They lose their place whilst reading aloud. Playtime is tricky because they misread social cues and inadvertently upset someone. Homework takes three times longer than it should, with you growing increasingly frustrated at the kitchen table.
Each incident seems small. Inconsequential, even. But these micro-moments aren’t isolated—they’re cumulative.
Every misplaced item becomes another confirmation that they’re “careless.” Every misunderstood instruction adds weight to the belief that they’re “not trying hard enough.” Every friendship wobble reinforces the fear that something about them is fundamentally difficult to be around. Layer upon layer upon layer, these experiences don’t just create stress—they create a nervous system that’s permanently braced for the next disappointment.
This is ADHD’s emotional distress syndrome. It’s not that children with ADHD are inherently anxious. It’s that living with unrecognised or unsupported ADHD creates the perfect conditions for anxiety to flourish. The restlessness you see isn’t hyperactivity in the traditional sense—it’s a body that can’t settle because the mind has learnt that settling means facing all those uncomfortable feelings.
The Medication Reality That Changes Everything
Here’s where understanding medication becomes crucial to understanding your child. When parents tell me their child became more anxious on stimulant medication, I don’t immediately assume the medication is wrong. I wonder whether we’ve truly understood which came first—the ADHD creating the anxiety, or genuine anxiety disorder that happens to coexist with attention challenges.
Let me share the evidence that might surprise you.
The Gold Standard: Stimulant Medications
There are only two molecules used in stimulant ADHD medication worldwide: methylphenidate and amphetamine. In South Africa, these are available as:
Methylphenidate-based medications:
- Ritalin (immediate and long-acting)
- Concerta (12-hour extended release)
- Medikinet (extended release)
- Neucon OROS (extended release, identical to Concerta)
Amphetamine-based medications:
- Amfexa (dexamphetamine)
- Vyvanse (lisdexamfetamine, available in 30mg, 50mg, and 70mg)
Now here’s what parents rarely hear: these medications have an effect size of 1.7 to 1.95. That’s genuinely remarkable. To put this in context, most medications in all of medicine have an effect size between 0.4 and 1.0, which is considered robust effectiveness. Stimulant medications for ADHD work better than almost any other treatment for any other condition in paediatric medicine.
Nothing else comes close. The American Academy of Child and Adolescent Psychiatry reviewed 82 studies examining non-medication treatments for ADHD—behaviour therapy, neurofeedback, dietary interventions, supplements, coaching, and structured environments. Not a single study could demonstrate a detectable, lasting benefit on the core symptoms of ADHD: inattention, impulsivity, and hyper-arousal.
This doesn’t mean behaviour strategies aren’t valuable. They are. Anyone—with or without ADHD—functions better in a structured, predictable environment. But these approaches offer non-specific benefits. They don’t address the fundamental neurological challenge.
How Stimulants Actually Work (And Why They Help Anxiety)
When stimulant medication is correctly prescribed for genuine ADHD, it directly targets the brain circuits responsible for attention, motivation, and emotional regulation. Suddenly, your child can organise their thoughts. They remember instructions. They complete tasks without that gnawing sense of failure.
Here’s the crucial bit: the internal restlessness—that product of accumulated micro-traumas—begins to settle because the daily struggle lessens. They’re no longer constantly behind, constantly disappointing people, constantly feeling inadequate. The anxiety that ADHD created starts to dissolve.
Stimulants work within 30 to 60 minutes. You’ll know that day whether they’re helping. There are no late-appearing side effects with stimulants—everything that will happen happens in the first hour. This is why we can adjust doses quickly when needed.
But if the dose is wrong, the timing is off, or the diagnosis isn’t quite right, stimulants can indeed heighten feelings of anxiety. When a child looks “zombie-like”—withdrawn, tearful, or irritable—the dose is typically too high. When they seem revved up or overstimulated (what I call “Starbucks syndrome”), again, the dose isn’t right.
This doesn’t mean stimulants are “bad” for anxious children. It means we haven’t yet found the optimal dose, or we haven’t yet understood your child’s complete picture.
The Non-Stimulant Reality Nobody Explains
Many parents prefer non-stimulant ADHD medications, believing they’re gentler or safer for children who seem anxious. What most people don’t realise is this: every non-stimulant medication used for ADHD was originally developed as an antidepressant.
In South Africa, the main non-stimulant option is atomoxetine (brand name Strattera). This medication wasn’t designed to treat attention problems. It was designed as an antidepressant. Researchers later discovered it also had some benefits for concentration, particularly by dampening the anxiety component that often accompanies ADHD.
Let’s look at the numbers. Atomoxetine has an effect size of 0.7 in primary school-aged children—respectable, but nowhere near the 1.7-1.95 of stimulants. In high school students and adults, the effect size drops to a barely detectable 0.44. Even that minimal benefit only occurs in about half the people who try it. This is why the American Academy of Child and Adolescent Psychiatry classifies it as a third-line or alternative treatment.
When atomoxetine works for a child with ADHD, it’s often treating the emotional distress and a bit of the attention difficulty—but not the full ADHD picture. It addresses the anxiety that ADHD created, rather than the ADHD itself. Unlike stimulants, atomoxetine takes three to six weeks to build up in the body and show full effects. You need to take it every day for it to maintain therapeutic levels.
This is why stimulant medication, when correctly prescribed and monitored by an experienced clinician, remains the gold standard. Not because it’s stronger or more powerful, but because it directly addresses the root cause rather than just managing the symptoms that the root cause created.
What Happens When Standard Medications Don’t Work
About 15% of people don’t respond to or can’t tolerate either methylphenidate or amphetamine. When this happens, we have other options, though they’re less effective overall.
In South Africa, after trying both types of stimulants, the next option is typically atomoxetine (Strattera). Beyond that, some clinicians use medications that aren’t officially registered for ADHD but have shown some benefit in research, such as bupropion (Wellbutrin). Clonidine and guanfacine—which work well for about one in three people—unfortunately aren’t currently available in South Africa.
The important principle is this: we shouldn’t trial multiple versions of the same molecule. One proper trial of the best methylphenidate formulation and one proper trial of the best amphetamine formulation is sufficient to determine which works better for your child. Nothing predicts which will work best—not family history, not body weight, not any genetic test. We discover through careful, monitored trials.
The Anxiety Medication Conversation
When anxiety is severe enough to warrant its own treatment alongside ADHD management, we sometimes use SSRI antidepressants. In South Africa, the most commonly used are sertraline (brand name Serdep) and citalopram (brand name Cilift). These medications help regulate brain chemicals linked to anxiety, low mood, and obsessive thinking.
Unlike stimulants, SSRIs take three to six weeks to show full benefits, and they need to be taken every day. They’re not addictive, but they shouldn’t be stopped suddenly as this can cause withdrawal effects. They’re particularly helpful for children struggling with overwhelming emotions, constant worry, or social anxiety.
Importantly, research is clear: ADHD medications do not worsen genuine anxiety disorders. When anxiety worsens on ADHD medication, it’s usually because the dose is incorrect or the diagnosis needs refining.
Understanding What’s Underneath Before Treating What’s on Top
This is the heart of effective ADHD management, and it’s what’s often missing when parents bounce between different practitioners seeking answers. Unless a clinician takes time to tease out all the overlapping pieces—sleep patterns, learning challenges, coordination difficulties, speech development, emotional regulation, even diet and exercise—medication alone rarely provides the complete answer.
I always emphasise what I call “holistic management.” This doesn’t mean rejecting medication in favour of supplements and wishful thinking. It means understanding your child as a whole person, not just a collection of symptoms to suppress.
Your child’s internal restlessness might stem primarily from ADHD’s executive function challenges. Or it might be anxiety that looks remarkably like ADHD because anxious children appear inattentive when their minds are catastrophising rather than learning. Often, it’s both conditions genuinely coexisting, each making the other worse.
Higher doses of medication are often required when anxiety and ADHD coexist, because the conditions intensify each other’s severity. But stimulant medication can often help reduce symptoms of both ADHD and anxiety-related behaviours. The key is expert monitoring and adjustment.
What Parents Don’t Expect About Medication Success
When medication works properly, children don’t feel “different” or “medicated.” They feel normal. When I ask parents to rate their child’s medication experience on a scale of one to ten—where one is awful with no benefits and lots of side effects, and ten is optimal—anything below six is unacceptable. The goal is between eight and ten.
The right medication at the right dose should return a child to typical levels of functioning, not create some artificial state with superpowers. If your child feels revved up, slowed down, or describes themselves as feeling “weird,” the dose is wrong.
Parents often tell me: “I’ve never had a parent say they’re glad they waited before trying medication. It’s always the opposite—’What would my life have been like if I’d known how well these medications worked earlier?’ There’s genuine grief about what might have been.”
Children with untreated ADHD face higher risks of substance abuse problems, injury-producing accidents requiring hospitalisation, unplanned pregnancies in adolescence, and involvement in the juvenile justice system. On appropriate medication, these risks return to the same as the general population.
What You Need to Know About Side Effects
Common side effects with stimulants include reduced appetite (especially midday), mild headaches or stomach aches that usually settle, and occasionally sleep difficulties. About 10% of children with ADHD have tics whether or not they take medication—research shows that stimulants don’t cause tics and can be safely used in children who have both conditions.
Extended-release formulations (Concerta, Neucon OROS, long-acting Ritalin, Vyvanse) are strongly preferred over immediate-release medications. They provide smoother, more consistent coverage throughout the day, avoid the stigma of taking medication at school, and eliminate the emotional rebound that can occur when immediate-release medications wear off suddenly. When stimulants are misused, 95% of the time it’s the immediate-release format—another reason to use extended-release.
With atomoxetine and SSRIs, side effects appear gradually over the first few weeks. Common experiences include mild drowsiness initially (which is why some people take them at night), slight nausea, or changes in appetite. These typically settle as the body adjusts.
Getting This Right Transforms Everything
Getting this diagnosis right transforms everything—not because labelling your child helps, but because accurate understanding guides accurate treatment. You stop barking up wrong trees. You stop investing time and money in interventions that can’t work because they’re addressing the wrong problem. You start seeing improvement because you’re finally supporting your child’s actual brain, not the brain you assumed they had.
When parents truly understand whether their child has ADHD creating anxiety, anxiety mimicking ADHD, or both conditions genuinely present, the treatment approach becomes clear. When you understand that stimulants work better than almost any medication for any condition in paediatric medicine, the decision about whether to try them becomes less frightening. When you understand that the right dose shouldn’t make your child feel “medicated,” you know what to aim for.
What This Means for Your Family Tonight
If you’re reading this at 2am, worried sick about whether you’re doing enough, here’s what I want you to understand. Your child’s struggles are real. The restlessness, the emotional intensity, the apparent inability to just settle and focus—these aren’t character flaws or deliberate misbehaviour. They’re the visible manifestations of a brain that’s working incredibly hard in a world that doesn’t naturally accommodate how it functions.
The solution isn’t about whether medication is “good” or “bad.” It’s about whether you have the right understanding of your child’s unique neurology. It’s about finding someone experienced enough to distinguish between ADHD creating anxiety, anxiety mimicking ADHD, or both conditions genuinely present. It’s about ensuring that any medication prescribed is the right medication at the right dose, prescribed by someone who monitors progress and adjusts thoughtfully.
Most importantly, it’s about recognising that understanding is the most powerful intervention you possess. When you truly understand why your child behaves as they do—when you can see past the surface behaviours to the struggling brain beneath—everything changes. Your frustration transforms into compassion. Your child stops internalising shame and starts building resilience. The whole family can finally stop battling and start supporting.
Ready to Understand Your Child’s Unique Brain?
Getting an accurate diagnosis isn’t about labelling your child. It’s about finally seeing them clearly enough to offer the right support. If you’re exhausted by conflicting advice and ready for answers that actually make sense of your child’s struggles, proper assessment changes everything.
Dr Flett offers comprehensive ADHD and anxiety assessments that look at the whole child—not just a checklist of symptoms, but the complete picture of how your child’s brain works, what’s making daily life difficult, and what will actually help. We take time to distinguish between ADHD, anxiety, and the complex ways they interact. Our medication management is evidence-based, carefully monitored, and always adjusted to find the optimal dose for your specific child.
Consultations are available at The Assessment Centre, 8 Village Road, Kloof, Durban. Zoom consultations are available for families across South Africa.
Call 031 1000 474 or visit drflett.com to begin understanding your child’s brain—and transforming their future.
Because when parents truly understand their child’s ADHD, anxiety, and development, confusion becomes clarity, frustration becomes insight, and struggle becomes the foundation for genuine growth.
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