The Misinterpretation of Anxiety Symptoms as ADHD in Children: A Systematic Review

AbstractAttention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in children, frequently co-occurring with anxiety disorders. Extensive research shows that anxiety symptoms such as restlessness, difficulty concentrating, and irritability can closely mimic ADHD behaviors, complicating accurate diagnosis. Misdiagnosis not only leads to ineffective treatments but may also exacerbate anxiety symptoms when stimulant medications are prescribed without proper identification of underlying anxiety. This systematic review examines studies published between 2013 and 2025 that evaluate the impact of anxiety treatment on reducing pseudo-ADHD behaviors. The findings indicate that psychological treatments, including Cognitive Behavioral Therapy (CBT), mindfulness, and neurofeedback guided by advanced tools such as Quantitative EEG (QEEG), significantly reduce inattention and hyperactivity associated with anxiety. Non-pharmacological treatments such as CBT, mindfulness, and neurofeedback are not only effective in reducing anxiety but also significantly decrease hyperactivity and inattention related to anxiety. These methods are especially recommended as safe and efficient alternatives to medication in settings where access to advanced diagnostic tools like QEEG is limited. The review highlights the substantial overlap between ADHD and anxiety symptoms and emphasizes the critical need for thorough anxiety screening before confirming an ADHD diagnosis. Failure to distinguish these disorders can lead to inappropriate medication use, worsening anxiety and threatening children’s mental health. This review advocates for the implementation of integrated diagnostic protocols and increased application of psychological therapies to prevent unnecessary pharmacological interventions. Ultimately, improving diagnostic accuracy is essential to enhance mental health outcomes in children and avoid the negative consequences of misdiagnosis and mistreatment, particularly in resource-limited environments.