When Anxiety/OCD and ADHD Collide at School

By Rebekah Mennies, PhD

Is it anxiety/OCD, ADHD, or both?

On the surface, anxiety or obsessive compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) look similar sometimes. Students with anxiety/OCD or ADHD can both struggle with executive functioning. These are a set of skills that, much like an executive of a company, help us shift and manage attention, plan, start tasks, organize ideas and belongings, and put the “brakes” on doing less helpful things.

Trouble with executive functioning is core to ADHD. Although these challenges might be more noticeable when your student with ADHD has to do something they find boring, or when there is less structure, they are usually present to some degree no matter the child’s emotional state.

On the other hand, your student with anxiety or OCD might struggle with executive functioning for a different reason. They might be easily distracted or fidgety in class, slow to get started on tests, or take a very long time to make a decision, but only when feeling nervous or stuck on unwanted thoughts or rituals.

While we usually see at least some signs of ADHD early on in childhood, including hyperactivity and impulsivity, sometimes anxiety or OCD doesn’t start until later on for kids. That said, anxiety/OCD and ADHD often co-occur, so it’s possible for kids with executive functioning challenges to have both.

Accommodations for Anxiety/OCD and/or ADHD

Why does this matter? It’s important to understand whether a student’s challenges with executive functioning at school are more related to anxiety/OCD, ADHD, or a combination. Knowing what is driving the difficulty will help the school know how to best support the student.

Accommodation involves making some sort of adjustment for a child at school so they’re less impacted by their symptoms in the moment. These can include things like extended time on tests, seating in the front of class away from distractions, or extra time to turn in assignments.  Click here to read more about potential accommodations for students with anxiety/OCD.

Sometimes, accommodations are a helpful thing that help even the playing field. When a kid has ADHD, repeated exposure to facing executive functioning challenges without the right support will not make it easier over time. Instead, it could lead a student to feel frustrated or demoralized and even impact their self-esteem. In this case, accommodations like extended time can make it easier for the student to show what they truly know and reach their full potential in school. While we want to provide students with ADHD accommodations throughout their school years, schools should also be mindful to gradually prepare them to function as adults in a world where they may not always be available.

When are accommodations less helpful? Accommodations that make it easier for a student to avoid stress or do compulsions may protect them from discomfort, but only for a short while. At first, they get a quick burst of relief from, for example, using extended time on a test to compulsively reread or check their work. However, that relief only lasts for a little bit until the anxiety comes back full force for the next test. When we accommodate the anxiety or OCD, we teach students that they need to avoid or do compulsions to feel better, and they don’t get a chance to learn that with practice they’ll be better able to face challenges without these safety behaviors. By giving accommodations that feed anxiety or OCD, we might actually be making things harder for students in the long term.

At the same time, sometimes we need to accommodate anxiety and OCD temporarily if the student would otherwise struggle to engage at all. In this case, think of the accommodation as temporary while they gradually learn how to reduce avoidance or compulsions. For example, maybe their anxiety would be so high without extended time that they wouldn’t show up for the test at all, but we can gradually reduce the amount of extra time they get as they learn skills in therapy to reduce compulsive re-reading or checking. We also might want to consider accommodating anxiety or OCD in school if it is impacting their academic performance and the accommodation wouldn’t “feed” the anxiety or OCD. For example, a child with OCD might be easily distracted by intrusive thoughts during a test, and extended time could be used to help them reorient their attention to the task instead of giving into compulsions.

Now What?

I know my student is having trouble with executive functioning in school, but what can I do about it? If you haven’t already, the first step would be to recommend that the family seeks out diagnostic feedback. Does the student have long-standing challenges in this area no matter what emotions they’re feeling, or are the difficulties only present when they’re stuck in a loop of anxiety or OCD? ADHD, anxiety disorders, and OCD can all be evaluated and diagnosed by licensed mental health professionals, and collateral from a school professional who knows the student well can be an important part of this process. For more detailed information about the student’s child’s executive functioning and learning profile, a neuropsychological evaluation could also help provide clarity. From there, recommendations can be made about accessing medications or therapy.

Then, the next step is connecting with caregivers about setting up accommodations for their child if indicated. Schedule a meeting with the student’s caregivers and see if they are willing to connect you with their child’s therapist. As a team, consider which accommodations for the student might be helpful for them long-term or temporarily.

What do you do if your student has both anxiety or OCD and ADHD? We recommend being thoughtful about what accommodations might provide support without making the anxiety or OCD worse in the long term. Help your student and their caregivers understand that the most helpful way they can use the accommodation is to make up for time lost by executive functioning challenges rather than by avoiding triggers or using extra time to do compulsions.