By Dr. Tamara Zach MD — June 14, 2026
If your child is struggling in school, having emotional meltdowns, or seems constantly distracted or on edge, you've probably asked the same question thousands of Phoenix-area parents wrestle with every year: Does my child have ADHD, anxiety, or both? We hear this constantly at Rose Medical Pavilion, and the answer matters. These two conditions can look nearly identical on the surface, but they often need very different treatment.
Dr. Tamara Zach MD has evaluated hundreds of children across the Phoenix metro area who came in with a suspected ADHD diagnosis, only to find that anxiety was the real driver, or that both conditions were present at once. Getting this distinction right can change the entire trajectory of a child's development, education, and emotional wellbeing.
why they look so similar
The overlap between ADHD and anxiety in children is real, well-documented, and confusing even for experienced clinicians. Both conditions can produce:
- Difficulty concentrating and staying on task
- Restlessness and an inability to sit still
- Emotional dysregulation and frequent meltdowns
- Poor sleep quality
- Avoidance of schoolwork or social situations
- Complaints of stomachaches or headaches before stressful events
A child with anxiety may look inattentive because their mind is flooded with worry, not because of a neurological attention deficit. A child with ADHD may look anxious because years of academic failure and social friction have produced secondary stress and low self-esteem. Research suggests roughly 50% of children diagnosed with ADHD also meet criteria for an anxiety disorder. So the question often isn't either/or. It's how much of each.
what pediatric neurologists look for
The source of inattention
Watch when and why a child loses focus. Children with ADHD struggle with attention almost everywhere. They can't concentrate even on activities they enjoy, especially anything that demands sustained mental effort. Children with anxiety lose focus specifically in situations tied to their fears. A child who can spend two hours building Legos but can't sit through a five-minute classroom test is probably dealing with performance anxiety, not a true attention deficit.
Hyperactivity vs. hypervigilance
The restlessness of ADHD, the fidgeting and the impulsive jumping from task to task, is neurologically driven and stays consistent across environments. Anxiety produces a different kind of restlessness: hypervigilance, a state of heightened alertness where the child constantly scans for threats. An anxious child may seem "hyper" at a birthday party full of kids they don't know, then turn calm and focused at home where everything feels safe and predictable.
Behavior in low-stakes situations
Dr. Zach often asks parents a simple, revealing question: does your child struggle equally during low-pressure, enjoyable activities? A child with ADHD shows impulsivity or inattention even during a favorite video game or a beloved hobby. A child whose troubles come from anxiety often performs remarkably well when the stakes feel low and the environment feels safe.
Physical symptoms
Anxiety in children frequently shows up as physical complaints: recurring stomachaches, pediatric headaches, muscle tension, or nausea before school. Children with ADHD can certainly have stress-related physical symptoms too, but a pattern of complaints tied to specific triggering situations points more strongly to anxiety. A careful neurological evaluation documents these patterns and weighs them against the child's behavioral history.
why the evaluation matters
You can't reliably diagnose ADHD or childhood anxiety from a brief office visit or a single questionnaire. Dr. Zach's evaluations pull together developmental history, school and behavioral rating scales from both parents and teachers, cognitive observations, and a detailed neurological exam. When there are added concerns like staring episodes, unusual behavioral shifts, or significant learning regression, a pediatric EEG can help rule out neurological causes behind the attention or behavior problems.
Other conditions can complicate the picture, including tics and Tourette syndrome, which can co-occur with both ADHD and anxiety. That's exactly why a specialist evaluation beats a primary care screening alone.
what Arizona families should know
Phoenix families have several resources worth using. Arizona's Early Intervention Program (AzEIP) serves children under three who show developmental delays, and connecting with it early helps when behavioral or attentional concerns appear in toddlerhood. For school-age children, Arizona's public schools must provide evaluations and accommodations under IDEA and Section 504, and a formal neurological diagnosis gives families much stronger footing to advocate for services.
Families enrolled in AHCCCS, Arizona's Medicaid program, should know that pediatric neurology evaluations and many related diagnostic services are covered benefits. The Phoenix heat matters here too. Extreme summer temperatures cut outdoor activity and push up sedentary screen time, which research links to worse symptoms in both anxious and ADHD-prone children. Dr. Zach raises this with families during the warm months.
what happens if both are present
When a child has both ADHD and anxiety, and that's more common than most parents realize, the order of treatment matters. Stimulant medications that work well for ADHD can sometimes worsen anxiety if the anxiety isn't addressed at the same time. A good care plan brings together the neurologist, a pediatric psychologist or therapist, and the child's school team. Dr. Zach works closely with Phoenix-area mental health providers so treatment addresses the full clinical picture, not just the most visible symptoms.
get the right evaluation
If you've been wondering whether your child has ADHD, anxiety, or some combination, you're asking exactly the right question, and it deserves a thorough, expert answer. Misdiagnosed ADHD in children happens more often than families realize, and treating anxiety as ADHD (or the reverse) can set a child back during years that matter most.
At Rose Medical Pavilion, Dr. Tamara Zach MD brings specialized pediatric neurology expertise to every evaluation, taking the time to understand your child's full developmental history and build a diagnostic picture of who they actually are, not just how they look on a checklist. To learn more about Dr. Zach's approach and credentials, visit our about Dr. Tamara Zach MD page.
If you're ready to get clarity for your child, schedule a consultation at Rose Medical Pavilion in Phoenix. Your child's path to the right diagnosis, and the right support, can start today.
Schedule an Appointment
Questions about your child's neurological health? Dr. Tamara Zach MD at Rose Medical Pavilion is here to help. Call (623) 257-ROSE (7673) or schedule online.