Imagine your dread going to a party because you forget names mid-conversation, miss social cues, or mentally replay awkward moments for days. Is that ADHD or Social Anxiety, or both at once?
Attention-Deficit/Hyperactivity Disorder (ADHD) and Social Anxiety Disorder (SAD) are separate conditions, but they co-occur at high rates. This overlap is not a coincidence. It’s a complex of neurological wiring, learned experiences, and shared symptoms.
In this article, I explore the “why” behind this common dual diagnosis and look at the neurological links, the social fallout from ADHD that breeds anxiety, and the importance of untangling these threads for effective treatment.
The Overlap: More Than Just Chance
Around 3% of adults are affected by ADHD. One of the most common co-occurring conditions is Social Anxiety Disorder (SAD), found in about 80% of those with ADHD who present at a clinic. It is among the most common anxiety diagnoses [1].
A 2024 review of ADHD and social anxiety reported that rates of each in the other group vary widely (roughly 30-50%). However, the study showed that having both conditions is associated with greater impairment than having either alone [2].
Individuals with ADHD are up to four times more likely to develop SAD than the general population. So there is a significant underlying connection beyond random chance.
Symptom Overlap
There are a number of symptoms that overlap in both conditions. These include distractibility, mind going blank, and difficulty following conversations. In ADHD, this is due to problems with regulating attention. In SAD, it is from overthinking and heightened self-focus.
In both conditions avoiding social situations can happen. For ADHD, it may be to escape boredom, overstimulation, or repeated failure. In SAD, it is due to fear of being viewed negatively or embarrassment.
These overlapping symptoms are shared in both conditions:
- Experiencing difficulty following conversations and missing social cues.
- Talking over others, blurting, or “oversharing,” then ruminating intensely afterward.
- Feeling restless or on edge in groups, with racing thoughts and poor sleep around social events [3].
What Is ADHD?
ADHD is a neurodevelopmental disorder of which the core symptoms are inattention, impulsivity, and hyperactivity. In addition to the core symptoms, there are commonly associated deficits in executive functions, such as working memory, planning, cognitive flexibility, as well as emotional regulation and social skills [2].
What is Social Anxiety Disorder?
SAD, or social phobia, is characterized by a fear of being judged by others. Social situations are perceived as so intimidating that they are endured with intense anxiety or entirely avoided, even though the affected person rationally knows that the fear is exaggerated compared to the actual danger of the situation.
For a diagnosis of SAD, the fear, anxiety, or avoidance must cause clinically significant distress or impairments in important areas of life. These may be in relationships, work, or school, with symptoms continuing for at least 6 months.
The Core of the Overlap: Three Intertwined Pathways
Three pathways help explain the overlap.
Pathway 1: The Neurological and Executive Function Link
Both conditions involve the brain’s prefrontal cortex, which is responsible for executive functions. In ADHD, forgetting what was just said (impairments in working memory), blurting out thoughts (inhibition), and emotional regulation are often present. In SAD, the brain’s fear center, the amygdala, is overactive. It interprets social scrutiny as a threat.
An ADHD brain struggling to filter stimuli and regulate responses is more vulnerable to feeling overwhelmed in social situations. This creates a basis for anxiety to take hold.
Pathway 2: The Social Consequences of ADHD Symptoms
Specific ADHD symptoms lead directly to stressful social experiences.
- Inattention: Feelings of being “out of sync” result from missing subtle cues, jokes, or shifts in conversation.
- Impulsivity: intense regret and rumination may follow Interrupting, oversharing, or speaking without a filter.
- Hyperactivity (internal or external): Fidgeting or a racing mind can make it hard to be present, causing distraction and perceived disinterest.
- The Result: A pattern of repeated minor (or major) social mishaps, negative feedback, and rejection usually develops.
Pathway 3: From Repeated Struggles to Learned Anxiety
The cumulative effect of Pathway 2 leads to anticipatory anxiety. Before an event even occurs, the individual begins to expect failure, embarrassment, or rejection.
Instead of connection, social situations become associated with threat. So SAD develops as a learned, protective response to anticipated ADHD-related challenges. The anxiety isn’t just about being judged; it’s often a realistic fear of one’s own brain making a familiar, frustrating error.
How Social Anxiety Worsens ADHD
Co-occurring anxiety is associated with more severe ADHD symptoms and can intensify inattention and working memory problems, especially in social or performance contexts [4].
In socially anxious individuals with ADHD, worry and rumination consume cognitive bandwidth, making it even harder to track conversations, recall details, and inhibit impulsive responses, which then produces more negative experiences and reinforces both conditions.
The Challenge of Dual Diagnosis
Telling these two conditions apart makes for a challenging diagnosis, as symptoms can mask each other:
- Is social withdrawal due to fear (anxiety) or to sensory overload/boredom (ADHD)?
- Is restlessness from anxiety or hyperactivity?
It’s essential to have an assessment by a psychiatrist, since treating only one condition often leads to limited progress.
Treatment: An Integrated Approach
The recommended best practice is to focus on both conditions, including:
Medication: Stimulants for ADHD. They can sometimes reduce anxiety by improving executive control. Antidepressant SSRIs may help with the anxiety component.
Therapy: Cognitive Behavioral Therapy (CBT). This is the best evidence-based therapy for both conditions. It can help reframe anxious thoughts and develop practical skills for organization, impulse control, and reading social cues.
Skills Training: Direct coaching in social skills, as well as with ADHD management tools (e.g., scripting, mindfulness) can develop confidence and reduce the “unknowns” that fuel anxiety.
Finding Support for Healing at Corner Canyon
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from anxiety, trauma, PTSD, CPTSD, other mental health conditions, or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] Filion Quenneville A., et al. 2022. Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems. Psychiatry Research. Volume 310. 2022. 114423.
[2] Jakobsson Støre, S., et al. (2024). The Relationship Between Social Anxiety Disorder and ADHD in Adolescents and Adults: A Systematic Review. Journal of Attention Disorders, 28(9), 1299–1319.
[3] Cuncic A. 2025. Understanding ADHD and Social Anxiety. verywellmind.com.
[4] Bishop C., et al. 2019. An examination of the association between anxiety and social functioning in youth with ADHD: A systematic review. Psychiatry Research. Volume 273. 2019. Pages 402-421.