My own personal combo is complex trauma with anxiety and a side of PTSD. All of these present in ways that mirror much of the same checklists as ADHD. While struggling with my own symptoms, I was prescribed a wide variety of treatments. Many of which made me more physically ill than the rapid heart rate and lightheadedness of a panic attack right before I had to drive on a highway, which I was unable to do for many years. 

The Center for Disease Control stated that in 2022, 39.1% of children with ADHD also suffered from anxiety (Centers for Disease Control and Prevention, 2024). There seems to be a steady increase in the anxiety diagnosis in each age group with only 23.7% of children aged 3-5 years old also having anxiety compared to 43.3% in 12-17 year-olds (CDC, 2024). The numbers also greatly differ between the sexes with 31.7% of males with ADHD also having anxiety compared to 52.8% of females (CDC, 2024). 

These co-occurring instances are more related to the area of the brain that is the culprit of creating these two neurodiversity diagnosis rather than them being BFFs who always stick together. They are most like first cousins who share the same genetics.  

Dopamine is an important neurotransmitter that allows for the brain to signal across nerve fibers. It’s like a bridge between parts of the brain (University of Michigan Department of Psychology, n.d.). Often, those bridges end up with gaps causing things like Parkinson’s disease, which is actually how the purpose of dopamine was even uncovered (Ford, 2024). Neurotransmitters are like the cell phone towers that allow us to send texts. If you are in a basement or a bunker, the messages won’t get through.  

Our bodies were originally created with a very clear fight or flight response system. When we are in a stressful situation, our bodies trigger cortisol which forces us into action to avoid the scary basement I just mentioned (MIT News Office, 2025). You may be catching the connection to Parkinson's now as those with Parkinson' s disease often lose the ability to control their muscles. When we are in a state of high stress, we often clench our muscles. Dopamine is the counter to that heightened stress response and it signals to us that the danger is gone and we can stop producing cortisol and relax (MIT News Office, 2025).

Dopamine is slightly misunderstood as many believe it is a chemical that allows us to feel pleasure (Ford, 2024). The reality is that dopamine itself is telling us what experiences are safer, which in itself will create emotions related to pleasure. One can still feel pleasure without dopamine (Ford, 2024). Dopamine is more of a guide for us to seek out safety and relaxation, not pleasure itself. 

Dopamine essentially helps us understand what the reward of a behavior will be. Wolfram Schultz calls this the “reward prediction error” which means that dopamine helps us understand HOW to get positive rewards (Schultz, 2016). We know from Pavlov and his dogs that we can change behavior through a reward system (Pavlov, 1927).

What Schultz is proposing is that dopamine is the key to helping humans make a prediction about a future reward or lack of a reward (Schultz, 2016). Dopamine also allows us to compare the difference between the reward and our prediction (Schultz, 2016).That difference is what determines our future behavior (Schultz, 2016). If the reward was better than our prediction, then we will continue with that specific behavior or even do that behavior more, but if the reward was less than our prediction, then we will eliminate that behavior (Schultz, 2016). This is essentially the definition of LEARNING (Schultz, 2016). If our prediction was exact, then we learned nothing so our behavior will not change at all (Schultz, 2016). 

ADHD is the misfiring of dopamine, which is usually lower production levels, which means that the ability to predict a reward is inaccurate (Medghalchi et al., 2025). So why would you finish cleaning out your closet when the reward of an organized closet is so much more work than you predicted? One clear manifestation of ADHD is struggles with impulse control because someone with ADHD gets such a higher level of reward than predicted with something impulsive. Fast paced videos, video games, and background noise gives you a predictable reward that takes minimal effort where one’s geometry homework has absolutely no reward compared to streaming 3 hours of YouTube videos. 

Another hallmark of ADHD is struggles with emotional regulation. In the world of screens, those who play interactive games can just leave a game when they don’t like what is happening while playing (Haidt, 2024). You can also have a tantrum in the privacy of your own home without the socially negative responses of peers. I have seen many of these tantrums first hand, but without the social norms telling you that your tantrum is a radical and unnecessary response, you can have your tantrum without social death. Parents and caregivers take the brunt of this emotional dysregulation. You can’t just run away from your parents when they finally realize you didn’t ever finish clearing out your closet or the geometry homework, but the reward of the 3 hours of YouTube is immediate. The angry parents are a later problem.  

Anxiety comes from the learning part of this dopamine process. If someone with ADHD is not getting anywhere with their predictions, why wouldn’t they stick to what they know gives them a positive return? And why wouldn’t they consistently seek out that positive return, even if the 3 hours of youtube needs to become 4 to get the same level of reward. Also, CLEAR connection between ADHD and problems with working memory, which would indicate that the learning part of the reward prediction error could also be problematic (Mallo, 2025). In addition, the stimulant medications used to treat ADHD actually can increase the symptoms of anxiety, especially if those medications are not taken regularly leading to withdrawal symptoms (Medghalchi et al., 2025). 

So what do we do? The easy answer is to work with a team of professionals, read as much as possible, and parent with a very specific purpose to help with the learning part. Be prepared to have to reteach things over and over. Finding an immediate reward for task initiation and completion can also help, but know that you will have to consistently change the reward as the brain gets used to that reward it becomes less appealing. 

Creating Structure and Predictability:

• Establishing consistent routines
• Visual schedules and clear expectations
• Preparing for transitions and changes
  
  

Building Emotional Regulation Skills:

• Deep breathing techniques for kids
• Mindfulness practices adapted for ADHD brains
• Creating calm-down spaces and sensory breaks

Academic Support Strategies

Breaking tasks into smaller chunks

Using timers and movement breaks

Celebrating small wins to build confidence

Social Skills Development

• Explicitly teaching social "rules"
• Role-playing common scenarios
• Building confidence through structured activities

While the scientists work on learning more and more, those of us in the trenches have to keep encouraging each other. Insight is working diligently to create resources and courses that can help you and your child on this journey. Sign up for the newsletter and make sure to follow us on social media. In the next year, we will be releasing courses on emotional intelligence, executive function, and goal setting for parents and kids.

Stay tuned and just keep learning.

Centers for Disease Control and Prevention. (2024, November 19). Data and statistics about ADHD. https://www.cdc.gov/adhd/data/index.html

Ford, C. (2024, May 22). Dopamine, explained: Dopamine detoxing, hacking, and fasting: Is any of it real? Vox. https://www.vox.com/future-perfect/24159087/what-is-dopamine-hacking-fasting-does-it-work-science

Haidt, J. (2024). The anxious generation: How the great rewiring of childhood is causing an epidemic of mental illness. Penguin Press.

Mallo, G. (2025). Differences in working memory in attention-deficit hyperactivity disorder [Undergraduate research abstract]. University of North Carolina at Chapel Hill, Office for Undergraduate Research. https://our.unc.edu/abstract/mallo-differences-in-working-memory-in-attention-deficit-hyperactivity-disorder/

Medghalchi, N., Hassanzadeh Rad, A., & Zavar Mousavi, M. (2025). The Interrelationship Between ADHD and Panic Attacks: A Case Study and Comprehensive Literature Review. Iranian journal of child neurology, 19(1), 135–141. https://doi.org/10.22037/ijcn.v19i1.46995

Pavlov, I. P. (1927). Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex (G. V. Anrep, Trans.). Oxford University Press. (Original work published 1927)

Schultz W. (2016). Dopamine reward prediction error coding. Dialogues in clinical neuroscience, 18(1), 23–32. https://doi.org/10.31887/DCNS.2016.18.1/wschultz

University of Michigan Department of Psychology. (n.d.). Dopamine, explained. https://lsa.umich.edu/psych/news-events/all-news/faculty-news/dopamine--explained.html