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. People 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 a kid with ADHD might find these challenges to be bigger when they have to do something boring or there are a lot of distractions around them, they are usually present to some degree regardless of what emotions they’re feeling.

On the other hand, someone with anxiety or OCD might struggle with executive functioning for a different reason. If you have anxiety or OCD, you 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, 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 your challenges with executive functioning at school are more related to anxiety/OCD, ADHD, or a combination. Knowing what is driving the difficulty helps your team of caregivers and teachers know how to best support you!

Accommodation involves making some sort of adjustment for a kid 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.

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 someone to feel frustrated or demoralized and even impact their self-esteem. In this case, accommodations like extended time can make it easier for a student to show what they truly know and reach their full potential in school. While we want to provide kids with ADHD accommodations throughout their school years, we also want to make sure they’re prepared to do well in a world where they may not always be available once they’re an adult.

When are accommodations less helpful? Accommodations that make it easier for a kid to avoid stress or do compulsions may protect them from discomfort, but only for a short while. At first, you 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, your brain learns that you need to avoid or do compulsions to feel better, and you don’t get a chance to learn that with practice you’ll be better able to face challenges without these safety behaviors. By seeking out accommodations that feed anxiety or OCD, we might actually be making things harder for you in the long term!

At the same time, sometimes we need to accommodate anxiety and OCD temporarily if otherwise you wouldn’t be able to do anything at all. In this case, think of the accommodation as temporary while you gradually learn how to reduce avoidance or compulsions. For example, maybe your anxiety would be so high without extended time that you wouldn’t show up for the test at all - which would cause all sorts of other problems! - but we can gradually reduce the amount of extra time you get as you 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 your academic performance and the accommodation wouldn’t “feed” the anxiety or OCD. For example, a student 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 I’m 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 seek out some diagnostic feedback. Do you have long-standing challenges in this area no matter what emotions you’re feeling, or are the difficulties only present when you’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. Talk to your caregivers or school professionals about how to get connected to these services. From there, recommendations can be made about accessing medications or therapy.

Then, if professionals recommend that you access accommodations, the next step would be to get them in place. Ask your parents to schedule a meeting with your school and see if they are willing to connect your therapist to the school.

What do you do if you have 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. The most helpful way you 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!