The Relationship Between ADHD and Social Anxiety: Similarities And Differences

Attention Deficit Hyperactivity Disorder (ADHD) and Social Anxiety Disorder (SAD) are two distinct conditions that often co-occur, with studies showing that around 30– 70% of individuals with ADHD also have SAD.

This high comorbidity rate highlights the importance of understanding both disorders and their interplay.

ADHD can make it harder to focus, regulate emotions, and pick up on social cues, while social anxiety creates fear of judgment or embarrassment. Together, they can reinforce each other, making daily life, relationships, and self-esteem more challenging.

Understanding their connection helps explain why treatment often needs to address both conditions at the same time.

ADHD and SAD similarities

Although ADHD and SAD are two distinct disorders, there are many ways in which their signs can overlap:

• Difficulty with social interactions: Both can make social situations challenging, albeit for different reasons. People with social anxiety may avoid interactions due to fear, while those with ADHD might struggle with social cues and impulse control.
• Avoidance behaviors: Individuals with social anxiety often avoid social situations, while those with ADHD may avoid tasks requiring sustained attention or complex social interactions.
• Trouble maintaining focus in social settings: Social anxiety can cause excessive self-focus, making it hard to concentrate on conversations. ADHD can lead to distractibility and difficulty following social exchanges.
• Overthinking: People with social anxiety tend to overthink social situations, while those with ADHD may hyperfocus on certain thoughts or ideas, sometimes leading to excessive worry.
• Low self-esteem: Both conditions can contribute to feelings of inadequacy and low self-worth, often due to perceived failures or difficulties in social or academic/professional settings.
• Impulsivity: While more commonly associated with ADHD, impulsivity can also manifest in social anxiety as sudden urges to escape uncomfortable social situations.
• Executive function challenges: Both disorders can affect executive functions, including organization, time management, and decision-making skills.

“My whole life I thought I just had severe social anxiety but it was all related to ADHD. My mind is BLOWN… Overthinking sentences before speaking… panicking and making mistakes when someone is watching me work.”

Impact of Having Both ADHD and SAD

Living with both ADHD and social anxiety disorder (SAD) can create a push–pull dynamic: ADHD may drive someone to seek stimulation and connection, while social anxiety makes them fearful of judgment and rejection. This conflict can affect multiple areas of life.

Relationships

In social settings, ADHD symptoms such as fidgeting, talking excessively, or blurting out comments may draw attention. Social anxiety then heightens self-consciousness, leaving the individual replaying interactions and worrying about how others perceived them.

• They may yearn for connection but withdraw out of fear of embarrassment.
• Difficulty reading social cues can add to misunderstandings, leading to strained friendships or dating challenges.
  Over time, this tension can lead to avoidance of social activities altogether, even when the person craves closeness.

Work and School

The combination of ADHD and SAD can make academic and professional environments especially challenging.

• Group projects or team meetings may feel overwhelming: ADHD creates struggles with organization and follow-through, while social anxiety fuels fear of saying the wrong thing.
• Planning events or presentations can trigger both forgetfulness (from ADHD) and obsessive worry (from SAD).
• Procrastination often increases, as tasks that involve social interaction feel doubly intimidating.
  This can lead to missed opportunities, underperformance, and feelings of being “less capable” than peers.

Self-Esteem and Well-Being

The interplay between ADHD and SAD often impacts how individuals view themselves.

• Repeated social difficulties can fuel self-criticism, reinforcing low self-worth.
• A cycle emerges: impulsive ADHD behaviors spark embarrassment, which social anxiety magnifies into shame or guilt.
• Constant overthinking and fear of failure may lead to exhaustion and emotional burnout.
  Together, these patterns can erode confidence, heighten feelings of isolation, and contribute to broader mental health difficulties such as depression.

Can ADHD cause SAD?

While it is hard to pinpoint exactly how and why social anxiety develops in people with ADHD, there are some possible contributing factors:

Rejection Sensitivity in ADHD

ADHD is frequently linked to Rejection Sensitive Dysphoria (RSD)—a profound emotional pain when facing actual or perceived rejection.

For example, a student with ADHD who blurts out in class might later replay the moment endlessly, convinced their peers now dislike them.

According to ADHD expert Dr William Dodson, rejection sensitivity is common in almost 100% of people with ADHD.

This heightened emotional pain response comes from ADHD-related brain patterns—overactivity in areas that process rejection and underactivity in areas that regulate emotions.

Over time, repeated experiences like this can make social interactions feel threatening, laying the groundwork for social anxiety.

Genetics and Brain Mechanisms

Both conditions also run in families, suggesting shared biological roots. ADHD is highly heritable, with genetic differences affecting dopamine and norepinephrine regulation, while social anxiety often appears in people who have close relatives with anxiety disorders.

Overlapping brain vulnerabilities—such as heightened threat detection and altered emotional processing—may help explain why both conditions frequently co-occur.

Role of Negative School or Social Experiences

Life experiences also play a major role. Children with ADHD are often criticized for being “too loud” or “off-task,” and research shows that over half experience peer rejection.

A child who is constantly scolded for interrupting or excluded from playground games may begin to fear social situations altogether.

Later in life, these patterns can continue—an adult with ADHD who forgets work deadlines might face embarrassment in meetings, reinforcing avoidance.

In both cases, repeated social failures or bullying create an environment where social anxiety can take hold, amplifying the struggles already caused by ADHD.

Differences between ADHD and SAD

It can be difficult for those diagnosing these disorders to differentiate between ADHD and SAD.

Below are some of the key differences between the two:

ADHD	Social Anxiety Disorder
Chronic disorder that affects attention, hyperactivity, and impulsivity.	Anxiety disorder characterized by excessive fear of social situations and intense self-consciousness.
Symptoms can include inattention, distractibility, forgetfulness, fidgeting, and impulsivity.	Symptoms can include fear of public speaking, fear of social situations, avoiding social situations, and physical symptoms such as sweating and blushing.
Likely to have many thoughts and difficulty focusing on one thought at a time.	Likely to have thoughts about social judgment and worries about social situations.
May have difficulty concentrating in many situations.	May have difficulty concentrating in social situations due to anxiety.
Often diagnosed in childhood but can persist into adulthood.	Often diagnosed in adolescence or early adulthood.
Stimulant medication, such as Ritalin and Adderall, are commonly used to manage symptoms.	Medications such as antidepressants and anti-anxiety drugs are commonly used to manage symptoms.
Social difficulties may arise from impulsivity or poor social skills.	Social difficulties arise from excessive fear of social situations.

Can ADHD be Misdiagnosed as SAD?

There are several ways in which ADHD can be misdiagnosed as SAD, including:

Overlap in symptoms

Since ADHD and SAD share several common symptoms, including difficulty with attention and concentration, restlessness, and irritability, these symptoms can make it difficult to differentiate between the two disorders, leading to a misdiagnosis.

Focus on anxiety

Clinicians may focus on anxiety symptoms, such as fear of social situations or avoidance of social interactions, and overlook other symptoms of ADHD, such as impulsivity or hyperactivity.

This can result in a diagnosis of SAD, even if ADHD is the underlying issue.

Social avoidance

People with ADHD may avoid social situations due to difficulties with social skills, leading clinicians to believe that the individual has SAD.

However, in ADHD, social difficulties may arise from impulsivity or poor social skills rather than anxiety.

Masking

Masking in ADHD refers to the conscious or subconscious efforts of individuals to hide or suppress their symptoms to conform to social expectations or avoid negative judgments.

This can make it even harder for clinicians to identify ADHD, as the individual may be mistaken as being socially anxious when they may actually be hiding their ADHD symptoms.

“My social anxiety was so bad that it sort of masked my ADHD… I had always considered anxiety my primary issue… I am starting to wonder if ADHD is the primary issue and that the ADHD is causing anxiety.”

How can ADHD and SAD be treated together?

Management for co-occurring ADHD and SAD typically involves a combination of medication and psychotherapy, tailored to address symptoms of both conditions.

Psychotherapy:

• Cognitive Behavioral Therapy (CBT) addresses negative thought patterns and behaviors associated with both disorders.
• Exposure therapy, a CBT technique, helps reduce fear in social situations for SAD.
• Social skills training improves communication and assertiveness, beneficial for both conditions.
• Mindfulness-based therapies enhance awareness, attention regulation, and stress reduction.

Medications:

Medications are not always necessary and depend on the impact signs of ADHD and SAD are having on daily life. Typically, the following are prescribed:

• Stimulants (e.g., Ritalin) can help manage ADHD symptoms and sometimes alleviate anxiety.
• Non-stimulants, particularly SNRIs like Strattera, may target both ADHD and anxiety symptoms.

A therapist can tailor treatment by:

1. Addressing ADHD-related social difficulties that may exacerbate SAD.
2. Teaching coping strategies for managing both inattention and social anxiety.
3. Gradually exposing clients to social situations while providing ADHD-specific support.
4. Combining anxiety management techniques with ADHD-focused organizational skills training.

The treatment approach should be personalized, considering the severity and impact of each condition on the individual’s life.

Managing ADHD and SAD

Below are some tips for helping someone manage both ADHD and SAD together:

Be kind to yourself

Those with ADHD and social anxiety are often their own harshest critics. Limiting negative self-talk can help reduce shame and build resilience.

One practical approach is to prepare reassuring phrases and place them somewhere visible—on sticky notes, in a journal, or as reminders on your phone. Examples include:

• “I don’t have to be perfect to be worthy of connection.”
• “My ADHD and anxiety make some things harder, but they also make me creative and resilient.”
• “Others are not judging me as harshly as I judge myself.”

If negative self-talk feels overwhelming or constant, reaching out to a doctor or therapist can provide additional support and strategies.

One Thing at a Time

When living with both ADHD and social anxiety, it’s easy to feel overwhelmed by wanting to “fix everything at once.” Instead, pick one manageable goal that feels like your biggest struggle and focus on that until progress is made. Small wins can build confidence and reduce anxiety.

Examples of one-thing goals include:

• Social: “I’ll answer one message from a friend this week instead of avoiding all texts.”
• Work/School: “I’ll finish just the introduction of my assignment before worrying about the rest.”
• Daily Routine: “I’ll aim to go to bed 30 minutes earlier three nights this week.”
• Anxiety: “I’ll attend one short social event and stay for at least 15 minutes.”
• Organization: “I’ll set one reminder on my phone each morning to help me stay on track.”

Each small step achieved provides proof that change is possible, reinforcing self-esteem and creating momentum for larger goals.

Journaling

Keeping a journal can be a good way of keeping track of feelings and emotions, and any progress you have made.

As people with ADHD and SAD can have a lot of fleeting and various thoughts, it can be good to get everything written down in a journal to help manage these thoughts and clear the mind.

A journal is only for the purpose of the individual, so there is no wrong way to do it. It can also be useful to help you pinpoint things you may want to discuss with the doctor or therapist.

Relaxation exercises

Those who have ADHD and SAD may find they get into spirals of anxiety or have racing thoughts. When anxious, breathing becomes shallow, among other physical sensations being triggered.

Completing some relaxation exercises, such as meditation, mindfulness, or deep breathing, can help to bring down the anxious symptoms.

Using these relaxation techniques can help you to slow down and keep you in the present moment instead of worrying about what needs to be done or focusing on future events.

Socialize strategically 

Socializing can be overwhelming when you have both ADHD and social anxiety. Start with small, manageable social interactions:

1. Begin with low-pressure situations, like texting or online chats with trusted friends.
2. Gradually progress to short, structured in-person meetings (e.g., grabbing a coffee for 30 minutes).
3. Use your ADHD strengths: If you tend to hyperfocus on interests, join groups or clubs related to your hobbies.
4. Prepare some conversation topics in advance to ease anxiety and help maintain focus.
5. Set a time limit for social events to prevent overstimulation and anxiety build-up.
6. Have an exit strategy ready, but challenge yourself to stay a little longer each time.

Learn your triggers

Anxiety can be triggered by specific events, such as public speaking or engaging in one-on-one conversations. Once you have identified your triggers, you can come up with ways to manage your anxiety in these situations.

For instance, someone who fears public speaking could prepare notes and practice their presentation to help them feel less anxious speaking in front of others.

Create an ADHD-friendly, anxiety-reducing schedule

Balancing ADHD’s need for structure with social anxiety’s need for predictability:

1. Use a digital planner or app with reminders to help manage ADHD forgetfulness and reduce anxiety about missed commitments.
2. Break your day into smaller time blocks (e.g., 30 minutes) to accommodate ADHD’s shorter attention span.
3. Include “buffer time” between tasks for transitions and unexpected ADHD distractions.
4. Schedule “worry time” – a specific period to address anxious thoughts, helping to contain anxiety throughout the day.
5. Plan for regular, short breaks to prevent ADHD burnout and manage anxiety levels.
6. Include self-care activities in your schedule, such as exercise or relaxation techniques.
7. For social events, add preparation time beforehand (to reduce anxiety) and decompression time afterward (to process and relax).
8. Use color-coding or symbols to categorize tasks, making the schedule more ADHD-friendly and less overwhelming.
9. Review and adjust your schedule regularly, being flexible to accommodate both ADHD impulsivity and anxiety-related needs.

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FAQs

References

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