Q. I am adult female, 47 years old, who had been recently diagnosed with ADD. I have a friend who had GAD, ADD and other issues impacting her life. She knows me very well and thinks that I may have both. They both seem to have a lot of related characteristics. How do I know for sure if I have both, or either? I have asked my therapist in a note, but it has been a month and he is yet to respond.

A. Yes, there are some common features in attention-deficit hyperactivity disorder (ADHD) and generalized anxiety disorder (GAD). For example, both can involve difficulty concentrating and restlessness. Some research indicates that there is a higher prevalence of ADHD in adults with anxiety disorders than would be expected by chance (Mancini et al, Psychol Med May, 1999). Some researchers believe that "ADHD with anxiety" may represent a distinct subtype of ADHD, and may respond somewhat less robustly to stimulants like methylphenidate (Ritalin) (Tannock et al, J Am Acad Child Adolesc Psychiatry July 1995).

One absolutely critical distinction exists, though: for a diagnosis of ADHD to be made, there MUST be symptoms of either inattention or hyperactive/impulsive behavior BEFORE age 7-if there is no such evidence, the individual does not have ADHD. Thus, to make the diagnosis of ADHD, a very careful history must be taken, preferably with input from parents, teachers/school records, or both. There are also retrospective scales that help make the diagnosis of ADHD, such as the Wender Utah Rating Scale (WURS). There is no laboratory or biochemical test for either GAD or ADHD, though neuropsychological testing may help distinguish the two.

Some clinical features that may help: usually the individual with GAD reports (1) excessive "worry" or apprehension, accompanied by 3 or more of the following: (2) restlessness, (3) being easily fatigued, (4) difficulty concentrating, (5) feeling irritable, (6) feeling muscle tension, or (7) experiencing sleep disturbance. With the exception of restlessness, difficulty concentrating and feeling irritable, the other features would not be typical in the person with pure ADHD, though they may be seen in some cases. Since the both GAD and ADHD have important treatment implications, I would certainly consider a second opinion from a psychiatrist with experience in ADHD, if your therapist is unable to clarify this question for you.

February, 2001

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