
Attention Deficit Hyperactivity Disorder (ADHD) is defined by three primary characteristics: inattention, hyperactivity, and impulsivity. However, the presence and severity of these symptoms can cause problems in other domains. Indeed, many individuals with ADHD report higher rates of depression and anxiety. More specifically, ADHD has been linked to social anxiety, often making symptoms of both disorders more pronounced. According to Dr. Thomas Brown, the prevalence of social anxiety among people with ADHD is around 33% compared to 10-13% in the general population. Research has begun to explore the connection between the two conditions. This has been an important step towards helping individuals find the right kind of treatment for their unique symptoms.

What is Social Anxiety?
Put simply, anxiety involves an overestimation of one’s problems and an underestimation of one’s ability to handle them. In context of social anxiety, the problem is the specific fear of scrutiny by others. This fear can lead to a debilitating condition known as Social Anxiety Disorder (SAD), characterized by an intense fear of judgment, humiliation, or rejection in social situations. Unlike introversion or shyness, SAD is not a personality trait. Rather, it is a mental health condition rooted in a core sense of deficiency – a belief that one is not enough and will be excluded by others for being different. This often results in a disconnect between how individuals perceive themselves and how they actually appear to others.
When exposed to social situations, individuals with social anxiety may withdraw, avoid eye contact, or show overly rigid body posture. In addition to their fear of being perceived negatively, people with social anxiety often worry they will act in a way that exposes their anxiety (e.g. blushing, trembling, sweating, or stumbling over their words). Other common symptoms of social anxiety include immense discomfort when meeting and conversing with new people, panic attacks before public speaking, or avoidance of public places.
Both ADHD and social anxiety can involve issues with attention, concentration, and social functioning, leading to co-occurrence and exacerbation of symptoms. Effective treatment often requires a combined approach to address both conditions simultaneously and determine the root cause of symptoms.

How Are Social Anxiety and ADHD Connected?
Firstly, research illustrates that pre-existing social anxiety can aggravate symptoms of ADHD. Intense emotions associated with social anxiety negatively impact overtaxed executive functions in the ADHD brain. Executive functions are mental processes that help us prioritize important tasks, filter out distractions, and regulate our behavioral responses. According to ADHD expert Dr. Russell Barkley, executive dysfunction is a fundamental feature of ADHD, impacting 90% of individuals with the diagnosis. When people with ADHD are under high emotional stress, their weakest executive functioning skills are hit first and hardest, which can cause social, emotional, and occupational problems.
For example, people with ADHD often struggle to regulate their emotional reactions to situations. They tend to experience emotions very intensely (particularly in response to rejection or perceived criticism), which leads to a flooding of emotions in the nervous system. Consequently, individuals with ADHD often over-identify with their feelings. As one woman with ADHD explains, “the feeling becomes who I am rather than something I am experiencing.”
This makes it challenging to take a step back and view a situation through a more neutral lens. Instead, emotional flooding overwhelms the capacity to think rationally and assess the consequences of one’s actions – the emotional brain wins out over the rational brain. In the context of social anxiety, fear surrounding potential scrutiny and humiliation opens the emotional floodgates in the ADHD brain. It then becomes all the more difficult to manage social anxiety symptoms as they arise.
Additionally, weaker working memory in ADHD affects one’s ability to remember and then utilize effective coping strategies for social anxiety. Working memory is an executive function that allows one to hold incoming information in mind and use it in real-time. For instance, when you are given multiple instructions and asked to complete them consecutively, you are engaging your working memory. In addition to helping you perform multi-step tasks, working memory is what allows you to retrieve positive memories that often ease anxiety.
For example, a neurotypical person experiencing social anxiety before a speech might only need to think of their past successes in public speaking to calm their nerves. However, working memory deficits in ADHD make it difficult to access good memories and use them in the present during times of high emotional stress. As such, the emotional experience of social anxiety tends to be more intense and harder to cope with in people with ADHD.
Research has also shown that ADHD can cause problems socially, which sometimes triggers social anxiety. Impulsive and hyperactive symptoms of ADHD can lead individuals to frequently interrupt or talk over others. Symptoms of inattentiveness and poor working memory can also make it difficult to pick up on social cues and recall important information in conversations. Consequently, people with ADHD may be perceived as awkward, distracted, or rude in social settings. Such negative perceptions can reinforce a sense of personal deficiency that fuels social anxiety. Thus, the higher prevalence of social anxiety in ADHD might also stem from years of internalized criticism and stigma surrounding neurodivergence.

To address the challenges of social anxiety and ADHD, several strategies can be employed:
Challenge Negative Thoughts and Recall Past Successes
Our thoughts and beliefs are like fuel to the fire for our subsequent feelings and behaviors. To combat the big emotions that often accompany social anxiety and ADHD, practice finding evidence that contradicts your negative self-talk, and talk back to your inner critic. You can do this by first slowing down and noticing what happens in your body when you start to experience social anxiety. Acknowledge the emotions you may be feeling, breathe, and then take a moment to consider alternative ways of looking at the situation. For instance, pause and recall a time when you felt uncomfortable, but had the courage to act anyway. This can provide you with a real-time confidence boost that will encourage you to make healthier choices.
Set Achievable Social Goals
It is unrealistic to expect that you will completely eliminate your social anxiety all at once. Change happens slowly over time and requires practice to maintain. Start by setting small, achievable goals for yourself aimed at increasing your tolerance for social interactions. For example, you can set a goal that you will talk to at least one new person each week. Once you have achieved this goal and feel ready for more, increase your goal to one new person every three days. Continue building on your goals and watch your social fears gradually disappear.

The APPLE Method
The APPLE Method is a helpful tool to guide you through new social interactions:
- A – Ask relevant questions in social situations – who, what, where, and when?
- P – Physical proximity and volume – position yourself appropriately near people, notice and mimic their volume, and pause to observe when entering a room.
- P – Participate with curiosity – use reflective statements like “I understand that” to show that you are listening.
- L – Listen and lay off self-criticism – listen without taking comments as direct judgments of you.
- E – Enjoy connecting – share what is special about you and appreciate what is interesting about others.
ADHD Tip: Write down the APPLE Method on a post-it or in your phone so you don’t forget it.
Practice a Mantra
When faced with an anxiety-inducing situation, our overwhelming emotions can make it hard to remember the positive (especially if you have ADHD). When you are calm, try developing encouraging self-statements that you know will ease you in moments of high stress. Repeating mantras such as “I’m stronger than I think” or “I can make mistakes and still be a good person” can help reduce social anxiety as it arises in the moment.

Try Mindfulness
Practicing mindfulness three times a week – whether through deep breathing, guided meditation, mindful eating, or mindful walking – can help you accept your thoughts and experiences without judgment. Mindfulness practice teaches you to be “with” your emotions rather than “in” them, which instantly gives your emotions less power over a situation. Over time, mindfulness will start to free you from your “worry mind” and allow you to live more calmly in the present.
In Conclusion
Understanding the intricate relationship between ADHD and social anxiety is crucial for effective management and treatment. Both conditions can significantly impact one’s quality of life, especially when they co-occur, as they tend to exacerbate each other’s symptoms. Research highlights that social anxiety is more prevalent among individuals with ADHD, with potential links to executive dysfunction, emotional regulation difficulties, and social challenges. However, with the right strategies and support, individuals can work towards reducing anxiety, improving social interactions, and enhancing their overall wellbeing.
We understand that different aspects of your life may be affected by ADHD. Our team is happy to offer a variety of services to support you in coping with ADHD symptoms. This includes therapy for ADHD-related anxiety and depression, group therapy, ADHD-focused therapy, testing, and neurofeedback options. At ATTN Center of NYC, we do everything in our power to treat ADHD without the use of medication, but we understand in some severe cases additional measures may be needed. As a result, we also maintain close relationships with many of NYC’s best psychiatrists as well. Feel free to learn more by visiting our blog or FAQ page today.