When ADHD Masks as Anxiety or Depression in Teens: What the Research Says

Adolescence is a turbulent time, full of rapid change. Sometimes, what looks like anxiety or depression may actually—or additionally—be ADHD. Getting the diagnosis right is crucial. Misdiagnosis can delay proper care, worsening outcomes. Below are what the research and clinical literature tell us about how ADHD can be misdiagnosed, how often it co-occurs with anxiety and depression, what the risks are if ADHD goes untreated, and why comprehensive evaluation matters.

ADHD, Anxiety & Depression: Where Symptoms Overlap

Symptoms of ADHD in adolescents often mimic or overlap with those for anxiety and depression. Because of this, ADHD can be misdiagnosed as just anxiety, just depression, or only mood issues:

• Teens with ADHD frequently report difficulty concentrating, restlessness or irritability, and sleep disturbances. These same complaints are also common in both anxiety and depression. BioMed Central+2PMC+2

• Emotional dysregulation (difficulty managing frustration, mood swings) is now understood to be part of many ADHD presentations, and overlaps with mood or anxiety disorders. BioMed Central+1

• Fatigue, low motivation, loss of enjoyment (anhedonia) may be prioritized by the teen or family, overshadowing more “behavioral” symptoms of ADHD like disorganization or impulsivity. PubMed+1

Because of these overlaps, without careful assessment, ADHD symptoms may be hidden or under-recognized when anxiety and/or depression are present.

Co-Occurrence Rates: How Often ADHD and Mood/Anxiety Disorders Go Together

Here’s what the research shows in terms of how commonly ADHD co-occurs with anxiety or depression in adolescents and young people:

• According to the CDC (2022 data), almost 78% of children with ADHD have at least one other co-occurring condition. Anxiety is one of the more common ones. CDC

• A large recent review (adult ADHD) found that 25-50% of individuals with ADHD also have an anxiety disorder, and rates of depressive disorders in people with ADHD range from around 18.6% up to ~53%, depending on the sample. Frontiers

• Longitudinal studies show that adolescents who were diagnosed with ADHD in childhood tend to display elevated symptoms of depression over time; those ADHD symptoms that persist into adolescence are correlated with greater risk of mood disorders. BioMed Central

These numbers suggest that co-occurrence is very common; treating one condition without assessing the other can mean missing a big part of what’s going on.

The Risks of Misdiagnosis or Partial Diagnosis

When ADHD is misdiagnosed (or only part of the picture), several risks emerge:

1. Incomplete Treatment
   If a teen is treated only for anxiety or depression (through therapy, SSRIs, etc.) but the ADHD is undiagnosed/unmanaged, many ADHD symptoms remain untreated — inattention, impulsivity, disorganization. This means academic, social, and functional impairments continue.

2. Delayed or Inadequate Intervention
   The teen may not receive ADHD-specific interventions (medication, behavioral strategies, coaching) that could help with executive functioning skills, organization, time management. Early intervention in ADHD tends to have better outcomes.

3. Compounding of Symptoms
   ADHD left untreated can worsen anxiety or depression. For example, chronic failure (academic, social) or sorted feedback (criticism, missed deadlines) can contribute to low self-esteem, demoralization, or anxiety about performance.

4. Risk of Self-Harm and Substance Use
   Studies show that co-occurring ADHD and depression increase risk for self-harm more than depression alone. Substance use is more common among adolescents with ADHD, especially when ADHD is untreated. BioMed Central+2Frontiers+2

5. Long-Term Consequences
   Research shows untreated ADHD is associated with poorer social functioning, lowered self-esteem, greater risk of accidents, more disciplinary/legal issues, employment difficulties, and poorer overall life outcomes. ChADD+3PMC+3PubMed+3

Outcomes of Untreated ADHD: What the Evidence Shows

A few key research findings:

• In a massive systematic review of long-term outcomes in ADHD (Shaw et al.)—over many studies—about 74% of outcomes for untreated ADHD show poorer outcomes vs non-ADHD controls in domains like academics, social functioning, occupation, etc. Only about 26% of outcomes were similar. PMC

• A focused review on self-esteem and social function (Harpin et al., 2016) found that in individuals with ADHD who were untreated, a substantial majority had worse long-term self-esteem (57% worse vs controls) and social function (73% worse vs controls). Treatment improved these outcomes in many cases. PubMed

• The “umbrella” review from French et al. (2024) reports that ADHD, particularly when underdiagnosed/undertreated, is linked with educational and vocational underachievement, antisocial behaviour, substance abuse, criminal justice involvement, driving problems, and also psychiatric comorbidities including anxiety and depression. Frontiers

• Another study shows pharmacologic treatment (medication) of ADHD is associated with reduced risk of suicidal behaviors, substance misuse, and accidental injuries. For example, a large Swedish registry‐based study reported that ADHD medication was associated with a ~17% reduction in suicidal behavior, 15% in substance misuse, 12% in transport accidents, and 13% in criminality compared to those not treated. The Guardian

Why Misdiagnosis Happens: Barriers & Causes

• Symptom overlap: Many key symptoms (inattention, restlessness, irritability) appear both in ADHD and in mood or anxiety disorders. Distinguishing whether inattention is due to worry, rumination, depression, or ADHD’s distractibility is tricky. BioMed Central+1

• Masking & Compensation: Teens may learn to mask ADHD symptoms, or hyperfocus in some areas, limiting visibility. Also, anxiety and depression may lead to internalizing behaviors that cover up ADHD’s external behaviors.

• Gender bias: Girls, in particular, may be more likely to be diagnosed with anxiety or depression first, because ADHD in girls often presents with inattention or internalizing symptoms rather than overt hyperactivity.

• Partial assessments: Some evaluations focus only on mood or anxiety screening, but do not systematically evaluate executive functioning, history of attention issues, family history of ADHD, or school/work behavior.

How a Proper Evaluation Should Be Done

To reduce the risk of misdiagnosis and ensure adolescents get all the support they need, a comprehensive psychiatric evaluation should include:

1. Detailed History

   • Developmental history (when symptoms first started)

   • School and academic performance, teacher reports

   • Family history of ADHD, mood/anxiety disorders

2. Symptom Inventories / Rating Scales

   • ADHD rating scales (e.g. Conners, Vanderbilt) across settings (home, school, social)

   • Depression and anxiety scales

   • Screening for substance use, sleep issues, sleep deprivation

3. Assessment of Functioning

   • How symptoms affect daily life: academic/work performance, relationships, behaviors

4. Observations & Interviews in Multiple Settings

   • Reports from parents, teachers, or peers when possible

   • Self-reports from the teen

5. Consider Co-occurrence / Dual Diagnosis

   • Often, treating both (ADHD + anxiety/depression) is necessary

6. Review of Sleep, Physical Health, Environment

   • Sleep problems can worsen attention and mood

   • Stressors (trauma, social stress) contribute

Treatment Implications When ADHD & Anxiety/Depression Co-Occur

When ADHD is properly diagnosed alongside mood or anxiety disorders, treatment plans tend to be more effective:

• Medication: ADHD medications (stimulants or non-stimulants) reduce core ADHD symptoms; they may also contribute to reductions in suicidal behavior, substance misuse, and risk behaviors. The Guardian

• Therapy: Including cognitive behavioral therapy or other evidence-based therapy tailored to mood/anxiety but adjusted to factor in ADHD’s executive function challenges (structuring sessions, breaking tasks into small steps).

• Behavioral and skills training: Coaching for organization, time management, planning.

• Lifestyle changes: Good sleep hygiene, exercise, routines; which can alleviate both ADHD and depression/anxiety symptoms.

The Takeaway for Adolescents, Families & Schools

• If treatment for anxiety or depression does not seem to be improving focus, academic progress, or organization, that may be a red flag to consider ADHD assessment.

• Early, accurate diagnosis is beneficial: untreated ADHD has strong evidence of poorer outcomes in many life domains.

• Treating ADHD when present alongside mood/anxiety disorders tends to lead to better overall functioning, less risk of secondary issues, and better quality of life.

At Open Road Psychiatric Services, we specialize in thorough, compassionate evaluations that consider the full picture: ADHD, mood, anxiety, and more. We help teens and their families develop treatment plans that address all contributing factors—not just the obvious ones. If you suspect ADHD might be part of what’s going on, we’d be honored to work with you and your teen to find a clearer path forward.