ADHD vs anxiety in women: How clinicians tell the difference in midlife
- Kiesa Kelly
- 5 hours ago
- 8 min read
If you’re wondering about ADHD vs anxiety in women in midlife, you’re not alone. Many women reach their 40s or 50s feeling newly “scattered,” more reactive, or stuck in racing thoughts at night, and they’re left asking: Is this anxiety mistaken for ADHD, ADHD driving anxiety, perimenopause, or all of the above?
In this article, you’ll learn:
Why these conditions overlap (and why it’s not your fault)
The patterns clinicians use for differential diagnosis of ADHD and anxiety
What perimenopause can add, especially around sleep and body sensations
How a good adult ADHD evaluation looks in practice, including what to track first
How to ask for ADHD testing for women without feeling dismissed
ADHD vs anxiety in women: Why ADHD and anxiety overlap so much
ADHD and anxiety share surface-level symptoms because both can disrupt attention, sleep, and executive function. They also commonly co-occur, meaning you can have ADHD and generalized anxiety at the same time. In adults, a careful differential diagnosis looks for patterns over time, not just “how you feel this week.” [1,2,5]
💡 Key takeaway: Overlap does not mean “it’s all anxiety” or “it’s all ADHD.” Clinicians look for timing, triggers, and lifelong patterns to sort out what’s primary and what’s secondary. [2,3]
Restlessness, sleep issues, concentration problems
A few shared symptoms can make ADHD and anxiety feel identical on the inside:
Restlessness or feeling “on edge”
Trouble falling asleep, staying asleep, or waking unrefreshed
Concentration problems (especially when stressed)
Irritability and low frustration tolerance
Mental “noise,” including looping thoughts or internal chatter [2,7]
Sleep is a big confounder. When you’re sleep-deprived, attention, working memory, and decision-making tend to worsen, which can mimic or amplify ADHD-like executive dysfunction anxiety. [4]
The “which came first?” question
Clinicians often start with developmental course. ADHD is a neurodevelopmental condition, so symptoms typically begin in childhood, even if they weren’t recognized or were masked by high effort, high structure, or perfectionism. [2,3] Anxiety, on the other hand, can start at any point and often intensifies with life stress, health shifts, or a specific trigger. [7]
That said, “late diagnosis” is common for women. Many girls and women show more internalized symptoms (inattention, overwhelm, shame) and fewer externally obvious behaviors, which can delay recognition into adulthood. [6]
Patterns that often point more toward anxiety
Anxiety is not just “stress.” Clinically, it tends to pull attention toward threat, uncertainty, and what might go wrong. That attention shift can look like distractibility, but the engine underneath is usually worry.
🧭 Key takeaway: Anxiety-driven attention problems often improve when worry decreases. ADHD-related attention problems tend to show up across stress levels, even though stress can still make them worse. [7]
Worry-driven attention problems
A classic anxiety pattern is attention hijacking. You sit down to write an email, but your mind keeps snapping to a worry: “What if I mess this up?” “Did I offend someone?” “What if I forgot something important?” The focus problem isn’t random, it’s tethered to a threat story. [7]
A practical clue is the content of your distraction:
Anxiety: “I can’t stop thinking about the outcome.”
ADHD: “I keep losing the thread, even when I care about the outcome.” [3]
Practical example: You wake up at 3 a.m. with racing thoughts at night and immediately start mentally scanning: bills, kids, work, your health. You feel urgency to solve it now. That “problem-solving at 3 a.m.” is often worry trying to create certainty, not ADHD hyperactivity. [7]
Avoidance and reassurance cycles
Anxiety often creates avoidance (not going to the meeting, not opening the email, not making the appointment) and reassurance seeking (asking others to confirm, checking repeatedly, Googling symptoms). Avoidance brings short-term relief, but the cycle teaches your brain that the situation was dangerous, which can keep anxiety strong over time. [7]
This is one reason anxiety can look like procrastination or “executive dysfunction.” If the task is tied to fear (fear of criticism, fear of failure, fear of being “found out”), the brain resists starting it.
Misconception #1: “If I procrastinate, it must be ADHD.” Anxiety can cause procrastination when the task feels threatening, especially in perfectionistic or high-responsibility people. [7]
Patterns that often point more toward ADHD
ADHD attention challenges are often less about fear and more about regulation: regulating what your brain locks onto, how you start, and how you sequence steps.
Clinicians look for a lifelong pattern of time, organization, and follow-through issues that show up across settings. [2,3]
🧠 Key takeaway: With ADHD, it’s common to care deeply and still struggle to initiate, organize, or finish. Effort does not always translate into consistency when executive function is taxed. [2,3]
Lifelong organization and time challenges
ADHD patterns often include some version of “I’ve always had to work harder than other people to stay on top of life.” Signs can include:
Chronic lateness or time blindness (“I didn’t realize it was 20 minutes later”)
Losing items, forgetting deadlines, or underestimating how long tasks take
A history of messy “systems” that work briefly, then fall apart
Difficulty with multi-step tasks and follow-through, even for neutral tasks [2,3]
In a good adult ADHD evaluation, clinicians often ask about school history, report card comments, early organization skills, and whether symptoms were present before age 12, even if you were academically successful. [2,3]
Misconception #2: “If I did well in school, I can’t have ADHD.” Many women compensate through intelligence, structure, and over-preparing, until life becomes more complex and the scaffolding collapses. [6]
Interest-based attention and task initiation
A hallmark of ADHD is interest-based attention. You might:
Hyperfocus on what’s novel, urgent, or personally meaningful
Struggle to start tasks that feel boring, ambiguous, or low reward
Get stuck in “I want to do it, but I can’t start” paralysis [2]
Practical example: You can focus for hours on research you enjoy, but you cannot start a simple form you’ve filled out 20 times. You don’t feel afraid of the form, you feel blank, irritated, or oddly stuck. That pattern leans more toward ADHD than worry vs distractibility. [3]
If this resonates, skills-based supports like executive function coaching can help, whether the root cause is ADHD, anxiety, or both.
Misconception #3: “If I can hyperfocus, it’s not ADHD.” Hyperfocus can be part of ADHD, especially when interest and novelty are high. [2]
What perimenopause adds to the picture
Perimenopause can add a third layer, and it’s not “all in your head.” Hormonal fluctuations can affect sleep, mood, and perceived cognitive efficiency, which can amplify both anxiety and ADHD-like symptoms. [8,9]
🧩 Key takeaway: Perimenopause does not cause ADHD, but it can unmask or intensify symptoms by increasing sleep disruption, emotional reactivity, and cognitive load. [8,9]
Sleep and nervous system sensitivity
Midlife sleep changes can be driven by multiple factors: insomnia, night sweats, early-morning waking, and a more sensitive stress response. Sleep disruption is strongly linked to “brain fog” experiences like word-finding problems, slower processing, and reduced attention. [8,9]
If sleep is a main driver, treating it directly can change everything. Evidence-based approaches for insomnia can be very effective, and we outline options on our insomnia support page.
Physical symptoms that drive anxiety
Perimenopause can bring physical sensations that mimic anxiety: palpitations, hot flashes, dizziness, and gastrointestinal changes. When your body feels unpredictable, your brain may interpret it as danger, which can increase panic-like symptoms or generalized worry. [10]
This is a common setup for perimenopause anxiety vs ADHD confusion: the body sensations create anxiety, the anxiety disrupts attention, and the attention problems feel like “I’m losing it.”
How clinicians evaluate both without blaming you
A careful differential evaluation does not assume you are “overreacting” or “lazy.” It treats symptoms as data, and it looks for impairment, context, and alternative explanations (sleep, depression, trauma, medication effects, thyroid issues, and more). [3]
✅ Key takeaway: A high-quality evaluation asks “What’s the pattern across time and settings?” not “Why can’t you just try harder?” [3]
History, impairment, and context
A strong adult ADHD evaluation typically includes:
A clinical interview that covers development, school, work, relationships, and health history
Standardized screening tools and symptom rating scales (self-report and often informant report)
A clear assessment of impairment (what is harder because of these symptoms)
Consideration of alternative or co-occurring conditions (including anxiety disorders) [3]
If you want to get organized before an appointment, our Adult ADHD Self-Report Scale (ASRS) screener and GAD-7 anxiety screener can help you notice patterns, but they are not diagnostic tools.
For Tennesseans seeking clarity, an evidence-based route is a comprehensive evaluation through psychological assessments rather than a quick checklist.
Why co-occurrence is common
ADHD and anxiety frequently co-occur. Some people develop anxiety after years of coping with missed deadlines, social misunderstandings, or feeling chronically behind. Others have primary anxiety that makes attention and working memory worse. Often, it’s bidirectional. [5]
When both are present, treatment planning usually becomes more tailored: you might address sleep and anxiety loops while also building ADHD supports for time, organization, and task initiation.
If you are looking for adult ADHD evaluation in Tennessee, it’s reasonable to ask directly for a differential diagnosis of ADHD and anxiety rather than assuming it must be one or the other.
Practical next steps: what to track before an appointment
You do not need perfect notes. You need a few clear examples that show pattern and impact.
🌙 Key takeaway: The most helpful notes are specific: what happened, in what context, how often, and what it cost you (time, sleep, relationships, confidence). [3]
Examples that show pattern and impact
Try tracking for 2 weeks:
Sleep: bedtime, wake time, awakenings, naps, caffeine, and how you felt the next day
Attention: when focus drops (during worry, during boredom, during multi-step tasks)
Task initiation: what you avoid, what you start easily, and what only starts under deadline pressure
Emotions: irritability, overwhelm, panic sensations, and what helped
Cycle or body shifts (if relevant): hot flashes, night sweats, mood changes [8,10]
Two quick templates you can copy into your phone:
“Worry loop”: Trigger → worry thought → reassurance/avoidance → short-term relief → longer-term cost.
“Executive function snag”: Task → where you got stuck (start, plan, switch, finish) → what got you unstuck.
How to ask for a differential evaluation
You can be direct and collaborative. Here are a few scripts that often work well:
“I’m noticing attention problems, but I’m not sure if this is anxiety, ADHD, or perimenopause effects. Can we do a differential evaluation?”
“My focus problems feel different depending on worry. I’d like to explore ADHD and generalized anxiety together, not as a quick either-or.”
“I brought examples of how this affects work, sleep, and home life. I want to understand the root pattern so we can choose the right support.”
If you’d like help taking the next step, you can contact our team to schedule a free consult and ask about evaluation options and fit. Whether it turns out to be anxiety, ADHD, perimenopause-related sleep disruption, or a combination, the right assessment can move you from self-blame to a targeted plan that actually helps.
About the Author
Dr. Kiesa Kelly, PhD, is the founder of ScienceWorks Behavioral Healthcare and a psychologist with training in neuropsychology. She has 20+ years of experience in psychological assessments and completed an NIH-funded postdoctoral fellowship focused on ADHD in both research and clinical settings.
ScienceWorks is based in Tennessee and provides evidence-based, specialized care for adults and teens. Learn more about Dr. Kelly’s background and services at Kiesa Kelly, PhD.
References
Centers for Disease Control and Prevention. Diagnosing ADHD [Internet]. Atlanta (GA): CDC; 2024 Oct 3 [cited 2026 Feb 3]. Available from: https://www.cdc.gov/adhd/diagnosis/index.html
American Psychiatric Association. Attention-deficit/hyperactivity disorder (ADHD) [Internet]. Washington (DC): APA; 2013 [cited 2026 Feb 3]. Available from: https://www.psychiatry.org/getmedia/0d2fd19b-08d4-42c1-8871-9e8fd8f5db23/ADHD-Patient-Fact-Sheet.pdf
U.S. Department of Veterans Affairs. Identification and Management of Attention-Deficit/Hyperactivity Disorder (ADHD) in Adults: Quick Reference Guide [Internet]. 2023 [cited 2026 Feb 3]. Available from: https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/508/10-1659_ADHD_QRG_P97097.pdf
Alhola P, Polo-Kantola P. Sleep deprivation: Impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3(5):553-567. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2656292/
Fu X, Wu W, Wu Y, et al. Adult ADHD and comorbid anxiety and depressive disorders: a review of etiology and treatment. Front Psychiatry. 2025;16:1597559. doi:10.3389/fpsyt.2025.1597559. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12179154/
Attoe DE, Climie EA. Missed diagnosis: A systematic review of ADHD in adult women. J Atten Disord. 2023;27(7):645-657. doi:10.1177/10870547231161533. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330/
National Institute of Mental Health. Generalized Anxiety Disorder: What You Need to Know [Internet]. Bethesda (MD): NIMH; 2025 [cited 2026 Feb 3]. Available from: https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad
The Menopause Society. Perimenopause [Internet]. Pepper Pike (OH): The Menopause Society; [cited 2026 Feb 3]. Available from: https://menopause.org/patient-education/menopause-topics/perimenopause
Metcalf CA, Duffy KA, Page CE, Novick AM, Rubin LH, Maki PM. Cognitive problems in perimenopause: a review of recent evidence. Curr Psychiatry Rep. 2023;25(10):501-511. doi:10.1007/s11920-023-01447-3. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10842974/
National Institute on Aging. What Is Menopause? [Internet]. Bethesda (MD): National Institutes of Health; 2024 Oct 16 [cited 2026 Feb 3]. Available from: https://www.nia.nih.gov/health/menopause/what-menopause
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment.