How often have you heard these statements?
“I just want to get this right.”
“If I can’t find the right word to use here the sentence won’t be perfect.”
“It’s so hard to put all the pieces together on paper.”
“What if I don’t get an A?”
“How do I compare with my peers?”
“Sometimes I worry so much that I can’t think about anything else.”
“There are so many things to keep track of, I’ll never get finished.”
“I never had trouble with school before, now I am, what’s wrong with me?”
“If I don’t turn it in, I won’t make any mistakes.”
“I’ll do it, just leave me alone about it.”
Anxiety and ADHD
Anxiety and ADHD — these diagnoses often come together and one may look like the other, but they are quite different when looked at closely and situationally. The Anxiety Disorders Association of America estimates that 50% of people diagnosed with ADHD also have an anxiety disorder, and anxiety in children and teens often overlaps with depression. Each of these diagnoses, separately and together, has a negative impact on executive functions, too. These overlaps can make it challenging to tease out the primary or driving issue, but what’s most important is identifying the contributing factors and strategically and systematically planning for intervention at home and at school to disrupt the negative loop.
As diagnoses are refined, we find that students with ADHD (whether it’s inattentive type, hyperactive type, or combined type) often find it difficult, if not challenging, to focus and concentrate most of the time in a multiplicity of situations and locations. It’s often a struggle for a student with ADHD to follow multiple steps of a process, manage multiple deadlines, and shift gears without becoming overwhelmed. Students with ADHD can become anxious and panicked due to their worry about missing deadlines, not turning in work or struggling to pay attention in school as this is a pattern which has often been repeated with negative consequences and feelings of distress. Their challenges are generally not situational in nature, though it’s notable that children with ADHD can often focus extremely well, even hyperfocus, on a self selected and high interest task or activity.
Anxiety can be generalized as well; however, it is more often than not triggered by specific situations or events, which can cause students to find it difficult to concentrate and/or focus at that specific time. Students with anxiety may worry about their peer relationships (maybe also family relationships or the home situation) and how their peers view them both academically and socially. These students often become distracted by their worries, which can lead to the development of physical symptoms, such as stomachaches, rapid breathing, and trouble sleeping to name a few. Additionally, many of our students with an anxiety disorder also have perfectionist tendencies, and/or compulsive tendencies, which can render them unable to begin an assignment or assessment due to the anxiety about not being able to complete it successfully or perfectly.
With our very bright, persistent, and perfectionist students, it’s not uncommon to see some rigidity and performance anxiety. Attention and anxiety are closely related, and if a student is focused on “being right” or “not making mistakes” or “needing it to be perfect”, it can make it difficult to begin, or complete, a new and challenging task. Moreover, with these students who are used to “getting it” on the first try, being in a situation where they might not “get it right away” can feel incredibly humbling and frustrating, thus leading to avoidance and/or resistance and overwhelming anxiety. We often see these challenges with our students who are openly labeled “gifted and talented” at very young ages and then encounter certain academic challenges as they age up.
How do we help students manage their anxiety and ADHD?
First, we have to consider the specific factors, variables and triggers in each child’s situation. An intervention plan should be carefully developed that considers both the home and school environment as well as any other activities or transitions in a student’s week. Small changes can often have a big impact, so we like to look for those opportunities first. If there’s a longer history or more escalated concern, the value of a comprehensive evaluation with a skillful and thorough psychologist cannot be underestimated. Then we help families to translate that information into an actionable plan at home and at school.
Second, all of our students, and especially our students with anxiety and ADHD, benefit from consistency, predictability, and order. Having and practicing routines leads to mastery and ease with transitions and provides great comfort to children. Parents can establish morning routines, after school routines, evening routines, bedtime routines, and weekend routines. At the same time, we need to also help our children develop comfort with flexibility and change. For our children with high levels of anxiety, this flexibility can be extremely difficult, so we need to plan for practice opportunities in a safe space. Students with anxiety and ADHD also benefit from having clean, organized, and thoughtful spaces at home and at school. Organized spaces provide comfort and structure while modeling successful executive function skills for our students.
Third, all of our students, and especially our students with anxiety and ADHD, need parents and teachers to impose technology boundaries. Technology use is a major “time robber” and contributor to off-task behavior and anxiety in children and adolescents. Teaching our students how to responsibly use technology as a tool is critical to their academic and personal success. Achieving responsible use is a much more complicated discussion, but undoubtedly it starts with planning, discussing, and establishing expectations that are enforced with consistency, predictability, and transparency. To the extent that expectations and messages can be consistent between home and school is especially valuable, but it’s okay to have specific expectations at home that differ from school or from friends. Creating a “phone jail” during homework time and dinner time could be very useful for all members of the family. Consider “silent” times when all mobile devices are set to silent or “do not disturb.” Consider “screen free” times within the course of your family’s week. Parents and teachers need to model their own responsible use as well.
Fourth, we encourage families to consider a second sandbox when thinking about school placement. Boarding schools (and Junior Boarding Schools) — which come in many shapes and sizes — are often a better environment for our students with stress sensitivities triggered by city stimuli. New York City is incredibly fast-paced and energized, which is great for the adults who choose to live here, but it’s not always so great for our students. We’re fortunate to have such easy geographic access to so many campuses offering incredible academics, learning support, advisory, arts, sports, and diverse communities, which become extended families and neighborhoods. For students needing therapeutic school environments, we have tremendous resources in that category as well.
Faya, Laurie, and I help families everyday with educational problem solving, which includes school planning and school placement, developing and implementing intervention plans, refining (or overhauling) their weekly schedules, and partnering with their schools more effectively. Whenever possible, we work in close collaboration with psychologists, psychiatrists, pediatricians, occupational therapists, speech therapists, school leadership, school learning specialists, and classroom teachers to optimize resources and coordinate planning. A big challenge for families is knowing what to do at home to support learning and how best to partner with their child’s school. Without this close partnership between home and school, it’s very difficult to successfully mitigate challenges around anxiety and ADHD. If your child is struggling, we can help. Please contact us for more information.
These links may also be of interest:
Written by Brad Hoffman, M.S.Ed., Board Certified Educational Planner and Learning Specialist, Faya Hoffman, M.A., Board Certified Educational Planner and Learning Specialist, and Laurie Gross, M.A.T., Special Educator and Reading Specialist. Brad, Faya, and Laurie comprise the senior Leadership Team for My Learning Springboard.