Social Anxiety and ADHD

by Sharon Saline Psy.D.

Original Article

ADHD rarely travels alone, and social anxiety is one of its frequent companions. Whether you can’t eat in front of other people, avoid cafes or stores due to conversations with strangers or loathe public speaking, social anxiety can severely limit your academic and professional performance as well as your relationships. 

Many teens and young adults with ADHD are susceptible to social anxiety due to executive functioning challenges with emotional control, working memory, and self-awareness (metacognition). Sometimes folks who struggle with social anxiety avoid specific triggering situations such as in-person classes while others may feel intensely nervous and uncomfortable in any social environment. Social anxiety stems from an overwhelming fear that people will judge you so negatively you will be devastated by their reactions. When you worry so much about negative judgment from others, you can’t really be yourself, make rewarding friendships, or build a satisfying life. Instead, social anxiety blocks you every step of the way. 

What exactly is social anxiety? Social anxiety is defined as a distinct fear in one or more social situations where you are exposed to potential (negative) scrutiny from others. These worries about humiliation and rejection are persistent, often lasting six months or more, and restrict your activities, interests, and relationships. Social anxiety happens more frequently than you may think. Despite your belief that you’re alone with these struggles, studies have actually found that an estimated 12.1% of all adults experience social anxiety disorder (SAD) at some time in their lives and it’s one of the most common of all of the anxiety disorders. With the confinement we’re all experiencing due to COVID and the ways in which your preferred interactions with friends, professors, or co-workers have been dramatically changed and reduced, it makes sense that you may be feeling more nervous than usual about seeing and dealing with other people. 

There are many symptoms of social anxiety. One of the most important traits is a response to a trigger or a situation that is above and beyond the actual threat of that situation. For example, you are so freaked out that everyone is looking at you when you are in line at the cafe to get a muffin and a coffee that you don’t even try to stay and order. In reality, nobody is looking at you other than the server who takes your order. The worst part of social anxiety is that you know what you are doing makes no sense and you can’t stop it anyway. Many people with social anxiety feel badly about themselves and wish they were different. Wanting to change is your first and most important step. You can manage social anxiety effectively with the right support. 

Let’s look at the symptoms of social anxiety disorder and then some practical tools for reducing its frequency and intensity. Some of these symptoms overlap with the characteristics of ADHD which makes diagnosis and treatment particularly complicated. Sometimes they vary: You can be anxious about talking in class but be comfortable with working out at the gym. People with ADHD who already struggle with understanding or missing social cues and wrestling with big emotions are particularly vulnerable to social anxiety. It’s important if you think you have several of these characteristics that you talk to your prescriber, therapist or primary care provider. Untreated anxiety combined with isolation and low self-esteem can quickly lead to depression. 

Here are some of the common symptoms:

    • Feeling uncomfortable talking to people outside of your immediate family and/or keeping conversations very short.
    • Having trouble making or keeping friends.
    • Worrying for days or even weeks before an event.
    • Being intensely afraid other people will negatively judge you.
    • Avoiding experiences or places where social interaction will occur (parties, classes, stores, restaurants, gyms, grocery stores, etc.)
    • Feeling very self-conscious around other people and in front of them.
    • Embarrassed to eat in front of others.
    • Experiencing panic attacks including nausea, shaking, or perspiration in social environments.

How many of these do you experience daily or weekly? Once you’ve accepted that you deal with these symptoms regularly, you’re on your way to healing. Being honest and naming what’s really going on improves your willingness to participate in solutions for change. Tackling anxiety requires courage and patience—it’s a tough competitor that wants to keep you safe and secure. In order for you to address social anxiety effectively, you’ll have to set a goal that’s reasonable and within reach and be willing to experience some discomfort along the way. That’s how you’ll grow and develop the skills you need to build the social confidence and connections you really want.

Follow these tips to manage your social anxiety:

  1. Pick ONE thing to work on: Let’s face it, you’re not going to dismiss all of your social anxiety at once. It serves a purpose, albeit misguided, to protect you from discomfort. Despite your best efforts to erase it, you’ll fall flat because anxiety is a natural part of being human. Our goal is to reduce its influence on your life which is more realistic. To begin with, we’re looking for easy wins to build your sense of security and your self-esteem. What is the one thing you would like to do differently that’s a big struggle right now? You need to focus on this goal over and over again to summon the courage to expose yourself to what scares you. Find someone to support you in this process. You’ll need an accountability partner: a sibling, parent, therapist, or coach. You don’t have to do this alone and you shouldn’t.
  2. Start small: To avoid quick discouragement, start small. Master a change that’s within reach before taking on a bigger challenge. For example, if you are uncomfortable talking to anyone outside of your family but want to make some friends, expecting yourself to message someone from your class and ask them to get a latte is way too much. Instead, what is the first, very small step you could make to ask someone you don’t know a question or make a request? Perhaps you could contact a fellow student or co-worker with a question or ask them how they are doing? Do this several times until it’s easier. Then you’re ready for the next step which may well be sharing a quick coffee.
  3. Be kind to yourself: People with ADHD and social anxiety tend to be intensely self-critical. They’ve heard negative comments about how they’ve missed the mark or what they could do better for years. Now you probably say this to yourself. This negative self-talk is your worst enemy when tackling social anxiety. Start by coming up with a phrase that you could say to yourself that’s encouraging, something that you might say to a third-grader who’s skinned their knee. Write this down on your phone and on Post-its that you put in your room or your car. This sounds corny but you’ll need to know what to say to counteract that negative voice when it tells you that you can’t take a chance and do something different. Consider keeping a written journal or series of voice memos of one success related to your challenge per day.
  4. Use mindfulness to slow things down: When you are in a panic attack or lost in a shame spiral related to social anxiety, becoming aware of your physical body and your breathing is your ticket out. When people are feeling anxious, their breathing often becomes very shallow and their adrenaline is running the show. This is our fight or flight response. You’ve got to get grounded and slow your energy down: Try placing one hand on your chest and one on your belly. Breathe into both hands, noticing their weight, and imagine that, with each breath, you are breathing in a soothing color. Do this for several minutes. Or, use alternate nostril breathing from yoga for five rounds. As you take steps to address your anxiety, you may well experience discomfort and insecurity. Those are signals that you are moving in the right direction.
  5. Talk to someone every day: As much as you’d rather not, you’ve got to practice your social skills. Combat your natural tendency for isolation by having a three- to five-minute conversation with someone outside of your household at least three times a week. It can be over Zoom or FaceTime, on the telephone, or in person, but you need to make real-time contact with someone that isn’t texting, Snapchat, or Instagram. Make a list of who these people could be: distant or local friends, cousins, siblings who’ve moved away, grandparents, etc. You can’t improve how you connect with someone or read their emotional state via text and this is exactly the skill you need to develop. If you aren’t sure what to say, think of some questions in advance and/or ask your accountability partner for help and practice with them.



American Psychiatric Association. (2016). Social anxiety disorder (Social phobia). In Desk reference to the diagnostic criteria from DSM-5 (p. 118). American Psychiatric Publishing.

National Institute of Mental Health. (2017, November). Social Anxiety Disorder. Retrieved November 05, 2020, from

Anxiety and Depression Association of America. (n.d.). Facts & Statistics. Retrieved November 05, 2020, from

 About Sharon Saline Psy.D.

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