🎥 ‘Worried & Wiggly’ – Understanding ADHD + Anxiety with Dr. Natasha Burgert

If you’ve ever wondered whether your child’s struggles come from ADHD, anxiety, or both — you’re not alone. And now you can watch the recording of our most recent ADHDKC Parent Group talk:

🎥 Wired & Wiggly: Understanding Anxiety and ADHD in Kids with pediatrician and childhood mental health advocate Dr. Natasha Burgert

Sara Whelan, our ADHDKC Parent Group volunteer coordinator, opened the evening by welcoming families and sharing a reminder of ADHDKC’s connection to CHADD — our national parent organization dedicated to evidence-based ADHD education and support. Then Dr. Burgert guided us through an engaging, fast-paced, and practical discussion designed with busy parents in mind.

💡 What You’ll Learn About Anxiety and ADHD in This Recording

Dr. Burgert shares real-world insights from her work as a full-time pediatrician caring for children with ADHD, anxiety, and everyday pediatric challenges. In this talk, she explains:

• Why ADHD and anxiety often show up together — and how easily they can be confused

• How similar behaviors (like inattention, restlessness, or avoidance) can come from very different causes

• What’s happening in the brain — including executive function challenges vs. perceived threat responses

• Questions parents can use to better understand the why behind behaviors

• The importance of comprehensive evaluation and working with your pediatrician as a first step

• Evidence-based supports including therapy approaches, school accommodations, lifestyle foundations, and medication considerations

• Practical strategies for co-regulation, routines, sleep, and everyday family functioning

As Dr. Burgert reminds us, we aren’t treating “alphabet soup” — we’re supporting kids who are trying their best in a fast, loud world.

🧠 Want to Keep Learning?

Dr. Burgert also writes about ADHD, anxiety, and child mental health for parents and caregivers. You can explore more of her work in her Substack, starting with the article with this talk’s resources.

💬 Stay Connected

We encourage you to explore upcoming ADHDKC events and parent group meetings — a welcoming space for learning, connection, and support. Use the menu above to find the Event Page.

Chapters

00:00 Introduction to ADHDKC and Event Overview

02:06 Understanding ADHD and Anxiety: A Pediatrician’s Perspective

11:53 Diagnosis and Treatment: Navigating ADHD and Anxiety

19:12 Comprehensive Treatment Plans for ADHD and Anxiety

25:56 Treating ADHD and Anxiety Together

28:27 Understanding SSRIs and Their Role

33:09 Monitoring Medication and Adjustments

35:16 Common Questions About ADHD and Anxiety

39:31 Practical Strategies for Parents

45:38 Community Support and Resources

Transcript

AI generated, excuse the mistakes

Welcome, welcome. If you're just coming in, we are very excited to have you joining us tonight. My name is Sara Whalen and I am a volunteer coordinator parent of their parent group here at ADHDKC. We are a chapter that is part of CHADD and CHADD is our parent organization.

I just have a little bit of business tonight before we get down to why you're really here. But before I talk about some of the CHADD requirements, at the end of this presentation, I'm gonna pull up our ADHDKC events page and share some more information with you all. And also just wanna point you to that as a resource. Lots of

aren't aware of CHADD, it's the national organization for children and adults with ADHD.

That's what it stands for, but extremely reliable and go to resource for information. All things ADHD research supports evidence-based information, which we know is important.

Now, CHADD just has some participation agreement requirements. I will not read every single thing on here, but we always promote respect and inclusion at all of our events and want to support anyone who's here in terms of their own identity and authenticity, things that are presented here. We want to maintain confidentiality and privacy. And so we won't be talking about necessarily specific

situations about either clients, patients, or it's just really hard, our own individual children's exact situations. But we also just asked for, and CHADD does as well, self-management in terms of the community space here tonight. And again, we are extremely excited to have Dr. Natasha Burgert here. Yay! Who is

a pediatrician, author, parent, anxiety, ADHD, all things in that area expert. And she's gonna share with us Worried and Wiggly tonight. So welcome Dr. Burgert. Thank you so much. It's such nice to be invited to an active and local and important organization.

Tonight we're gonna unpack a little bit about what happens when ADHD and anxiety are sharing the same brain. And if you're here tonight, I'm gonna guess that you either have ADHD and or anxiety that also live in your brain. So I'm going to be intentionally fast to try to keep your attention.

But I am thankful that you're here. I'm a busy parent as well and I understand how valuable your time is. So thanks for spending a few minutes with me and I hope to be helpful for you tonight. My lens is that I am a full-time pediatrician. So I am not an ADHD specialist per se. So please forgive me if there's any nuance in this research that I'm not reflecting because I'm caring for kids with ADHD as well as influenza and constipation and concussions.

but I do have a special interest in mental health and anxiety, and I certainly care for kids with ADHD and anxiety every day. That interest led me to becoming an author. I wrote a book called Managing Childhood Anxiety as part of the iconic For Dummies series that you're very familiar with, but you mostly find me online as a childhood advocate and digital creator. I also work with AAP, Baby Center, Forbes Health, has new projects on the horizon, but really what's most important here is my pediatric.

that I am someone with a long-standing relationship with a family that often brings them to me as a first-line person of help to direct a plan of care, and that is my perspective coming into this problem. So here is our roadmap for tonight. I'm going to start by comparing ADHD and anxiety brains. We're going to see what's the same, what's different, maybe examine a bit of how those look in the brain and a little bit of the neurobiology, talk about some diagnosis, certainly comprehensive planning.

for support and care. I wanna spend a bit of time on medication with a special focus on SSRIs, cause that's my voice ear anxiety medicine piece. And then my favorite part, which is the rapid fire Q and A of the most common questions that I get in the office for kiddos with this problem. So right from the beginning, we have to recognize that ADHD and anxiety are BFFs.

These conditions love to show up together about, depending on where you read, about 20 to 40 % of kids with ADHD also have anxiety, but that overlap can lead to missed or mistreated symptoms, which leads us a challenge because ADHD and anxiety can look exactly the same. Symptoms like inattention and difficulty concentrating, or restlessness and physical tension, poor sleep, emotional dysregulation,

dysregulation, irritability, avoidance behavior, certainly trouble completing tasks, and most important, parents running on empty. So when parents come to me with these symptoms, and this particular list, I have to tell them that just because we see we observing these behaviors, we still don't know the primary diagnosis. And we really have to dig a little bit deeper because the primary diagnosis between ADHD and anxiety are so similar.

So I remind my families that we can see behaviors, but unfortunately we cannot read our little people's minds. So what that behavior or the what can look the same, but figuring out the why, why they're behaving the way that they are, that's what really changes everything. So what's actually different between ADHD and anxiety brains? We have this list of common symptoms, but in a kid with an ADHD brain,

Those symptoms are caused by executive function challenges. And most of you on this call fully understand this. Their distraction is scattered. They're jumping from thought to thought. That forgetfulness is really pervasive across multiple contexts. They're very impulsive with their lack of thought with the what ifs. And it's a lot of energy that's seeking stimulation. But anxiety causes the same symptoms.

but the core issue is different. I think about anxiety really as a perceived threat. And so the behaviors that I'm showing are seeking safety. The distraction is very focused. They're distracted because they are stuck on their worries. Their memory is working absolutely over time. They remember every worst case scenario. Their avoidance is definitely driven by fear and their energy is to seek escape or to seek control.

So in essence, with anxiety, really those parents and teachers are seeing the frustration, but we can't see the fear underneath. So for example, with the same behaviors and different causes more specifically, an ADHD brain is not finishing work because they're distracted by ideas and they have that executive functioning overload, but an anxious kid doesn't finish their work because they hate, they have a really low intolerance,

They have a really low distress level. They have a fear of failure that's totally paralyzed by perfection. And so they won't, so they'll stop their work. An ADHD kid might be interrupting because they're super impulsive, but an anxious kid might interrupt because they're very fearful that they're gonna forget what they wanna say. And an ADHD kid avoids tasks because they're bored. Well, an anxious kid is gonna avoid what they don't wanna do because they feel overwhelmed.

And in just and in most simplicity, I describe ADHD as being distraction because, it's a squirrel and anxiety distraction because, hey, does that squirrel have rabies? So it's very much the same behavior that we're seeing, but a very different cause. So we need to get under the hood. If the behaviors are the same and the underlying cause is different,

what is actually happening because there are neurobiological differences that are going to determine the most effective treatment path. So let's look at the brain and the emotional engines that drive these behaviors. For ADHD, our neurotransmitter, our very familiar neurotransmitters are going to be dopamine and norepinephrine. I know this is evolving science and we're learning more every day, but in essence for our ADHD kids that dopamine is under regulated and having poor signaling in

are areas of the brain of reward and motivation, but dopamine can really spike super hard in areas of novelty or urgency. That's what video games exploit and why kids can hyper-focus on, and ADHD kids can really hyper-focus on the things they like to do. The norepinephrine is really underactive and it's specifically in the attention networks. These neurotransmitters are gonna have impact in the pre-phenyl cortex.

both for those executive functions and that interest-based nervous system is not getting what it's need. Unless there's a deadline, unless there's something that's brand new, it really seems like those low activating signals of dopamine and norepinephrine are gonna result in sluggish focus and motivation, negative self-talk, emotional liability, and the other behaviors that we see. For an anxious kid,

We talk about serotonin, GABA, and again, norepinephrine, so a commonality there, but we talk about serotonin as being the regulator of mood and worry circuits. I like to think of it as like an emotional buffer. So if that buffer is too low, we don't have any buffer against the normal worries that we have as we go through our day-to-day life. GABA is the brake's brake pedal, which is often underactive.

So now we have an emotional system that has no emotional buffering and no brake pedal. And then we sprinkle on a little norepinephrine. That's going to make some over-activation in the threat detection part of the brain. That's so different than ADHD. It's often too high versus too low. So that safety-based nervous system is super red hot and anxious kids show their behaviors cause they're trying to avoid, avoid, avoid.

and that overactive amygdala is that threat detector on overdrive. It's important to know that both ADHD and anxiety involve norepinephrine, but in different ways, they both affect the prefrontal cortex. They're wildly affected by both acute and chronic stress and those hormones. But practically speaking, when we're actually looking at our little people in front of us, I think at the very simplest, we're just talking about when kids have both

They're putting a foot on the gas and a foot on the brake at the same time. These kids really want to do well, but the brain is just not cooperating with itself. And that's when we see a characteristic patterns on the outside that are similar in both conditions. So the bottom line is the diagnosis of ADHD and anxiety is tricky. We have similar presentations, very different root causes.

One can mask the other in certain situations and certain developmental phases. They genuinely co-occur quite frequently and there's developmental factors and overlapping neurobiology at play. But what's cool about my job is also the brain is still under construction. Like a four-year-old brain looks very different than a 10-year-old brain, looks very different than a 14-year-old brain. So during those years that we're together,

Our job is really to look at where the kid is today and ensure that we're providing the proper support, understanding that over time, things will change. We'll try to get to that root cause of the behavior so I can have an effective treatment plan to meet them where they are. And so what's my recommendation for these kids and especially for families who are thinking, does my kid have ADHD anxiety or both?

I'm exceptionally biased, but I think your pediatrician is where you should start. I think your pediatrician is very uniquely positioned because I've known your family for a really, really long time. I remember when Emma was a fearless toddler and climbing on everything, and now she's eight and she's so scared she won't sleep alone. That particular change tells me something. I have a good understanding about family context. I see siblings.

I understand family stressors and know your parenting style and your pediatrician is really looking for your whole child health, where physical development, physical health, school performance, emotional wellbeing all together. And we have the opportunity to be a coordination hub to work with all of the schools and specialists and therapists to see the complete picture. Now, of course, many of you know that not all pediatricians do the diagnosing and managing of these conditions themselves, but I still think that they're a really important first stop.

because we want them, I always want your primary care pediatrician to be involved in the process for behavioral health. And they will often have community partners in which they work with to be able to keep that coordination and communication going. What we're gonna do in that diagnostic process specifically is start to gather that developmental history. This is really what we're doing at every well child check. So a lot of this data is collected over time, but we're gonna start to kind of tease down more

specifically just like most of you experienced when you started your ADHD journey. So we're going to be using validated tools like your Vanderbilt's and your scared forms for anxiety. We're going to interview parents and teachers and get information across multiple settings. But most important or pediatric role, especially at the beginning when we're trying to tease these out is to ask really effective questions and to become really good detectives to help us figure out

Is this ADHD, anxiety or both? Now this is where I love families to really help me do that detective work because a lot of the times this is going to come slowly and a lot of time your kid obviously is going to act very differently in the office than they do at home and they don't want to talk about their feelings or they don't want to talk about school or they don't want to talk about what they're worried about, but you can get information, little bits of information over the course of time and bring that all together to us.

to be able to kind of help tease it out. So these are some of the questions for you and for them that I like parents to think about because that is gonna help your pediatrician or your clinician who you're talking about to be able to tease this apart and develop your comprehensive treatment plan. So at first, these are the critical questions for you to be thinking if you think that your kiddo has ADHD, do they have anxiety or not? I would think about when your child can't focus,

What are they thinking about? Are they thinking about everything and nothing? Are they thinking about a specific worry? How do they work in different situations? Is this an issue that is this is the behavior that you're seeing very consistent across all contexts or very worse with specific triggers like social situations or performance or separation? What happens when the pressure is removed maybe outside of the classroom or away from a fear that you know that they have?

Do they seem happier? Do they seem less distracted? Or is that idle mind just creating more worries? Is something else a problem now? And how does your child respond to new situations? Do they jump in or are they really hesitant and need more preparation? If your kid already has ADHD and is currently being treated, a couple of questions that I think about too is does the medication that you're using for the ADHD, is that helping some symptoms but not others?

And are there times when your kid seems stuck, that we've got effective ADHD treatment and their symptoms scores are low, but we're still hitting roadblocks that we just can't seem to get across, either in motivation or mood or the work that they're completing? Questions for them, we try to ask in the exam room. I really think that's important during this process for us to try to tease that out and talk.

them, but again, since they're acting differently in the exam room, sometimes these are ones that it's helped for parents to kind of be detectives in reconnaissance before they come into the office. So when you're seeing those kiddos, I think to myself, when you're supposed to be doing homework, what's happening in your brain? What are you thinking about when you're trying to do this task? Is it easier to focus on things that are fun or things that are boring? ADHD brains like fun things, anxious things,

Anxious brains struggle with both fun and boring things because they really get worried about performance. I ask about worries if things are getting, if there's things that's really sticky. Do things stick in your brain a lot? Do you think about the same thing over and over again? Like what if your mom doesn't pick you up from school or I keep thinking about tomorrow or I can't get comfortable? I just want to keep playing. And I often ask them what makes it hard to fall asleep at night.

Body feelings are important because we know that anxiety lives in the body and brain. Little kids do not say they're anxious. They say they have tummy aches. They say that their hands are sweaty. They say that they feel like they're going to puke. They have headaches. ADHD kids though will say that they really want to move. They need to move their body or they'll just answer the questions while they're spinning around in my chair in the office. I also say too, when you feel wiggly, why do you want to wiggle? Does your body just tell you you need to wiggle?

Cause anxious kids will often say, when I wiggle, helps me calm down. I ask about social situations, new stuff, why do you want to go to a friend's house? Why do you don't? And then I ask about mistakes. What happens when you make mistakes on your homework? ADHD kids often will say, I think I'm dumb. I think I feel bad. I don't like it. I don't want anyone to see it. ADHD kids may also say, I just really didn't...

didn't notice. just rushed through it until it was done. So I asked them about mistakes and how they're processing that. And then in all of these, I'll ask the magic follow-up question, which is, tell me more about that. If there's anything that those kiddos want to talk about, I really want to get them talking about what their brain is saying, because we have to remember, we can have all of the surveys in the world and we can talk about all of the different behaviors that we're observing.

But I really want to hear about that internal experience that a parent questionnaire and a physical exam finding cannot capture. I want a nine year old to tell me that their brain keeps changing channels or I want them to say that my brain keeps telling me that my mom's going to get in a car accident on the way to picking me up from school. Like these conversations really validate the kids. It's asking them what's inside their head and

It lets them know that the people who love them and the people who are trying to care for them are really trying to

If you start to ask all of these questions and are working with your pediatrician and you finally agree that, my goodness, kid, ADHD kid, certainly has coexisting anxiety, it's important to move to a very comprehensive treatment plan. Going through those questions will give us a flavor for what we want to address first. Because for kids that both carry ADHD and anxiety in their brain, we always want to follow the treatment golden rule.

And for me, that is we want to prioritize what's causing the most trouble where function is failing. And that includes behavioral supports, cognitive supports at school, and thoughtful use of medication. We are not treating alphabet soup. We are treating a kid who is really trying to do their best in a very loud, fast world. And I want to meet them where they are today, both environmentally and developmentally.

knowing that our diagnostic impression and our treatment goals may definitely change over time because from the beginning to the end, I guarantee you there will be a change. You know about therapy foundations for ADHD, you guys are experts in this. We're talking about behavioral parenting training, organizational skills training, definitely getting school accommodations and different environmental modifications. For anxiety, we expand that to consider

something called cognitive behavioral therapy, space training. DBT is also very powerful for these kids. We talk about teaching worry time and do time and relaxation techniques and use gradual exposure hierarchies and lifestyle modifications to help these kids. When you have them both together, we need to start with just educating ourselves about both conditions. And that's why organizations like this are so, so important.

and learning more about how the anxious brain works and other anxiety supports is super important too. Your pediatrician can get you started there. I think it's super important to continue to build those executive functioning skills that supports anxiety management. We are using our ADHD accommodations that we already have. We can use those to reduce anxiety triggers and we're gonna coordinate with the school for comprehensive support. So many things that are similar with our ADHD brains

And then we're going to expand that a bit for anxiety. Here's the one that stings a little bit. I always want my families to know that we want to have co-regulation over correction. What this means to me is parents getting their own anxiety under control. And I know this is spicy and I know this kind of stings, but if ADHD is the gas and anxiety is the break, the parents are the steering wheel. And many, many times if a kid has ADHD and or anxiety, parents see it in themselves.

Right? Cause it's not important. It's not uncommon for them to come. Hey, my kid got diagnosed with ADHD. my gosh. I think I have it too. You can't ignore this feeling. It needs to be pursued. Taking care of yourself matters because it affects your reaction, your response and your daily habits that steer the car. This starts when we talk about comprehensive treatment. We also talk about the foundation of lifestyle stuff. This is so boring and

It's so important. all of these things are super simple, but they're not easy. Especially if you guys have a kiddo that has a neuro spicy brain or has ADHD or anxiety. These are exceptionally important non-negotiables. And I know you can't do them all, but you got to focus on one. I think about sleep. Eight, nine to 12 hours for school-age kids. Both of these conditions worsen with poor sleep.

I am very aggressive to treat sleep issues. If you think your kiddo is having a sleep problem, please talk to your pediatrician about that. We can do lab work, there's supplements, there's environmental changes, there's even medications and sleep specialists to be able to help these kids sleep. We know anxious kids and ADHD kids sleep differently and we need to address that. Kids' bodies need to get sweaty every day, moms and dads too, and we gotta get outside all months of the year. Think about your screen time limits.

We have to reduce that stimulation overload and that emotional dysregulation that happens after that one hour time on Roblox that you just can't get them back. We also have to work with comparative anxiety. I think about a great breakfast, getting all the protein, carbs, and fats that really supports any medication effectiveness and mood stability, predictable routines and behavior management, provide external structure for ADHD,

and safety for anxiety. So if you need help with routines and behavior management, that can make a huge difference in your home. I also think about activities and over scheduling. I will be the first to raise my hand that my kids were exceptionally over scheduled and I am not happy about that. That was something I should have changed. But especially with your ADHD and anxious kids, I would look at that over scheduling. These kids really need some downtime and I'm pointing my fingers at all the team.

and club sports. We also think about communication and language and direction giving, how we're communicating what we want and need for our kids in order to give them the guardrails that they need to be able to be successful students and successful at home. And honestly, this particular section, including the neurobiology of why all of these things are so important for anxious and ADHD brains is the longest chapter of my book. So,

that it's that important, so many pages of time. Treatment for comprehensive planning can also include nutraceuticals. Nutraceuticals and supplements will never, never, never replace our evidence-based therapies. But we do have some support that using some nutraceuticals in a safe way and with guidance with a provider can make a difference, specifically helping with sleep,

helping provide co-factors for those development of the neurotransmitters that we want to support, making sure they have vitamin D and B complex for immune support. And then if needed melatonin, this is, I know can be controversial, so please don't do that without talking with your doctor, but for kids that don't sleep well, that can be an effective tool. I'm also hearing a ton about saffron.

I think the saffron industry has really crept into Instagram recently for some reason too. And to the point being, just be mindful that on the social media pages, these nutraceutical companies and supplements can be very predatory at times. And if you really want to use nutraceuticals and supplements effectively, talking to your pediatrician first is always advised. Then we wanna talk about

⁓ Medications briefly, you guys are the ⁓ experts of treating your ADHD with your stimulants as first line and on if that's not working, but stimulants can improve both your attention and anxiety when well-dosed and often when starting ADHD meds, you'll see a small uptick in anxiety, but for many kids that'll settle after a couple of weeks. If the anxiety does worsen with ADHD therapy, then we can move to a different agent often in on stimulant.

But when you have ADHD and anxiety equally together, if both of those problems are significant, I still, it's my path to still treat the ADHD first. I really like to have the kids have good ADHD control because better executive functioning will have better therapy engagement and help them with some of that emotional dysregulation that's amplified by an anxious brain. It's important to know that combining the meds is common.

and it can be exceptionally effective. when, so I'm assuming that you guys are fairly experts of the ADHD, so I'm gonna do a little bit more of a deep dive of the anxiety medications, because that's to expand your knowledge base there too, and how we use them together with the ADHD meds. So we consider anxiety medicines, most of our most common classes that we use and have the strongest evidence for use in kids are medicines called SSRIs.

commonly known as like Zoloft, Prozac, and Lexapro. Those are their common names up there. We use those when therapy, there's a few considerations that we consider, there are a things that we consider before we start medications because medications themselves for anxiety are not gonna be first line. First is going to be often therapy, but therapy may not be enough or therapy may not be sufficient after a few weeks or.

their coexisting ADHD makes therapy participation really difficult, or if their anxiety is so severe enough that it's really impeding with their daily function, we might consider adding an SSRI. The reason that we do is because we have increasing evidence that using medicines for anxiety plus therapy is better for each alone. When we reduce anxiety symptoms,

therapy progress is better. We have better sleep. We have better school performance. We have better social engagement. And by treating anxiety directly, we prevent long-term complications because anxiety breeds more anxiety. And not to discredit how important it is to preserve family functioning and sibling relationships and quality of life at home when we're dealing with an anxious kiddo.

The SSRs that have the strongest use in children, like I said, are gonna be Zoloft, Prozac, and Lexapro. How they work is they increase the available serotonin that is naturally made in the synapse or in that emotional center of the brain. It helps regulate mood and worry. These medications are very well tolerated. They are not addictive, and they can treat multiple anxiety types.

What I think about these medicines is that SSRIs just turn down the volume. They don't make anxiety go away. Pills are not skills. The work of therapy is required, but you have to turn down the volume of those worries in order for that therapy and those skills to start to work. So I want to dig just a little bit deeper here too, because we need to know if we're going to be, just like with our ADHD meds, we have to know what to expect with our SSRIs.

There's something very different about our SSRIs than our stimulants because they take a while. Like I know that if I put a kid on many of our stimulants, we're gonna know in one, even two days, whether or not we're on the right path. That's not so much the case with SSRIs. The rule is always to start low, go slow, and be patient, which is slightly different than our therapeutic kind of rules with the stimulants.

But when we start an SSRI, we're gonna basically start at the lowest dose. We're gonna increase every two to four weeks kind of based on the response. We will see anxiety start to decrease in these kids in about three to four weeks, but the range of how that works kind of varies from kid to kid. And some kids need lower doses and other needs higher. It doesn't mean the anxiety is worse or better. It's just particularly what their brain needs that day. The side effects are the common side effects and the transient side effects, meaning they should go away.

over time includes some stomach upset. So we take it with food. We talk about headaches. We talk about a brief increase in anxiety that often is very temporary just after a few days. We talk about fatigue, sleep changes, appetite changes, and then to watch for attention because sometimes we will also see those increased attention with the start of this med. But then it's sometimes, but that often is not permanent. It will fade.

Less common but important when starting the SSRIs too is talking about behavioral changes if our kids, we're noticing concerning activation changes or hyperactive changes or behavior changes. Certainly some emotional blunting, right? We don't want that. And certainly if there's been no change at all after a couple of doses, sometimes we switch SSRIs and see if one of their cousins might work a little bit better.

Rarely there have been severe behavioral changes or extreme agitation, rarely suicidal thoughts. That's what led us to having a black box warning on these kids. The FDA did put a black box warning on SSRIs for increased suicidal thinking specifically in youth. It's important to know that the risk of that

When we start these meds is the highest in the first few weeks and then during doses changes, but that untreated anxiety also carries an important risk to to their health. So close monitoring is is key and benefits typically outweigh the way outweigh the risks here. So when I start any of these medicines on these families, we always want to remember that this is a marathon. It's not a sprint time is going to pass anyway. We are.

trying to retrain the brain's worry circuits with these medicines. The goal is different than it is with our stimulants, so we have to be patient. Beyond SSRIs, we have SNRIs, alpha-2 agonists, more alphabet soup here, but the important parts is with the same, we use them for the same reasons, the same when, the same why, but the how of these are slightly different. So we have medications that also

enhance the natural serotonin, but also work on norepinephrine. That should be familiar. That's one of the, one of our neurotransmitters that's alike in both of our, both our ADHD and anxious brains. So a lot of times we're using medications that are also going to help us regulate the expression of norepinephrine will help both when ADHD and anxiety coexist. There's also alpha two agonists, which really help with kids that are

get very reactive and a very sensitive body alarm system. I think about these kids that have crazy like physical symptoms with their anxiety. Those are kids that sometimes have better effect with the alpha-2 agonists. And BuSpar is one that we don't commonly use, but it's absolutely elegant. just helps some of the, it can be added to SSRIs to help with background worries and steady that signal.

while we're getting the therapeutic help that these kids need. So all of them can work together safely. There's no dangerous pharmacological interactions between stimulants and SSRIs. We try to start one before we start the other. Again, golden rule kind of focusing on what is our primary place of deficit that we really wanna help first. And we really wanna work with someone who's gonna have regular followups to monitor for our response and side effects.

Most common combinations are gonna be stimulants and SSRIs, non-stimulants, SSRIs, unstimulants, and guanfacine. So those are gonna be the names that you hear most familiar to be able to have those complimentary effects, less anxiety, and better focus. So when you are starting these medicines too, this is why your pediatrician wants to see you so often. We really want to monitor your weight. We're monitoring blood pressure.

We're monitoring for mood and behavior changes, corrections of your anxiety symptoms, and most importantly, how function is returned. How are we doing at school? How are we doing at sports? How are we doing at home? Are we headed in the right direction? I think that it's important really to know that millions of children can safely take both medications type. There are millions of children that have both of these issues happening in their brain. The key is really partnering with someone who knows your kid, who's going to monitor them carefully.

and adjust thoughtfully, because it's a bit of a journey. Anxiety treatment is not forever. think a lot of parents worry that they're going to be on these medicines forever and ever. I usually try to challenge them if they've had really good therapy response and gotten hooked in with a good therapist and good educational plan.

Most kids with anxiety on SSRIs, if they've had sustained improvement for about 12 to 24 months, it's time to start the discussion of, you think that we can start backing down? If we know we have good coping skills, it's developmentally appropriate, usually during the summer when there's less academic pressure, and we wanna do it really, really slowly. Some kids will need medication through adolescence or longer if they need that.

then they need that. It's okay. It's like glasses for vision. We're going to give them the support that they need. But periodic trials off the medication to kind of reassess where we are is always particularly helpful, but that decision is made based on individual response and level of impairment. Okay. Now my favorite part of the presentation. Here are the top questions that I get when we start talking about combining ADHD and anxiety meds. Okay. Question number one.

My child's anxiety got worse when I started them on ADHD meds. That can happen, that is true. But it's not always the medication's fault. Sometimes when kids can really focus, they become more aware of their worry. And so if that anxiety persists, we talk about the particular agent, we talk about the dosing, but I'm never just going to assume.

that that medication, that ADHD medication is not part of the solution, because it often helps to have both. Should I tell the school? Yes, they are part of the team.

Why does my child's anxiety look like anger? We remember these are having a lot of neurobiological factors that are crossing in these emotional centers. And when you start to have a fear based system start, that alarm starts to go off. It is the same body alarm. It is a fight or flight avoidance resistance. is the same. It is a different expression of the exact same problem.

And I know a lot of families get really frustrated when their kids, their anger, when anger looks like, or when their anxiety looks like anger, but it's still the same solution. What about fidgets? What about fidgets and other tools? Co-regulation is foundational in child neurodevelopment and a calm adult presence reduces cortisol and improves executive function. Fidgets,

are great, but a calm presence works better than a fidget spinner ever could, so please work on that. Will your child outgrow this? We know that ADHD persists, but symptoms evolve as kids age with anxiety that will improve with treatment, but it can recur during different stress or different transitions. Again, it's neurobiologically part of the brain, but when we have early comprehensive treatment,

The outcome is 100 % better. We have to just adjust our understanding of the problem and adjust our treatment as the kiddos grow. Is this diagnosis permanent? A diagnosis can and should likely evolve as we learn more about your child. Like an eight-year-old who can't sit still may have grown.

out of hyperactivity by the time they're a teenager, but they probably are still inattentive. Or an anxious six-year-old may develop more clearer ADHD symptoms when academics get hard in middle school. So sometimes what looks like anxiety was actually ADHD and vice versa, right? So our role is to revisit and regularly reassess, but I am not attached to being right.

about a diagnosis that we had three years ago, I want to know your child as they are today and support them as they are today. So we're not gonna get busy and dig really into those semantics because we are dealing with an ever-changing and evolving young person in brain who is gonna need different things as part of their support, regardless of what their diagnosis is. Is it my fault? Absolutely not. These are neurobiological.

These are neurodevelopmental issues. Parenting can help, parenting can hinder, but it never causes. Your awareness and your action in being here tonight is now what matters most. Should I tell my kid about their diagnosis? Absolutely. This is part of who they are. This is part of how they need to know how their brain and body is working. It reduces shame. We amplify self-understanding. It empowers them to advocate. And if you need help,

for ideas on how to tell your kid in an age appropriate way. Ask your pediatrician, ask your therapist. There are tons of resources out there, but their child absolutely should know. Will the medication change my kid's personality? Good medication support reveals your child by removing the barriers that are inhibiting them from being the best person that they are. So if a personality seems dull,

the dose isn't right or the medication isn't right because the goal is to see a calmer, more focused version of the same kid that you know in

How do you know if it's working? Teacher feedback, improved relationships, more willingness to try new things, less reassurance seeking, maybe getting out of your bed at night, but most importantly, your child seems happier and your child is more confident.

What small daily things make the biggest difference for ADHD and anxiety kids? I will give you five. Number one, predictability, not rigidity. Know the difference. But a preview of what is next. Anxiety craves predictability and ADHD needs structure. So predictability, not rigidity. Number two, empathy. We want to validate before we redirect.

and use process focus praise. Whoops.

Number three, movement, body breaks. Movement is a treatment. It is not a reward. These kids need to move. Number four, great sleep. If you think that your kid has an issue with sleep, please talk to your pediatrician. I've seen it in a million times over that improving a kid's sleep, they get less medicine, they get better effects from it, they just feel better. And to remember that kids with ADHD and anxiety are not lacking discipline, they're lacking

a support for a nervous system that is working overtime. So we will address with compassion, we will address with love, and we will heal ourselves first to be the support that they need. You will find a lot of details and a lot of links to all the stuff that I talked about on this QR code. It leads you to my sub stack, which is totally free. You don't need to sign up, but this is where all of the links will be including my top 10 things.

as well as linked to my book and further essentials for your anxiety management. So please snap that if you're interested. And I really think that with the right support, these kids with anxious ADHD brains, they don't just manage, they thrive. And your awareness and your advocacy makes all the difference and you do not have to do this alone. And you're here with this great community right now in order to be able to be the best parents you can be for the little people you have been given.

And I hope this was helpful to you.

see. If people have maybe a few minutes, questions in the chat possibly.

throw out a question. I'm kind of curious also with the overlap between ADHD and anxiety. And then I get a lot of people that also happen to have a high IQ and how much that the ADHD and anxiety maybe masks some of the ADHD in the school setting. So then they're like, well, they can't have ADHD because in the school setting, we're not seeing things.

I'm kind of curious about how the interplay between all those are. Hi Dr. Danda, by the way. Great talk. Thank you. think, you know, it's challenging and you know these kids best. But I think as we're learning more about these ADHD and anxiety brains, at least in my 20 year career, it's becoming a lot more evident to me that we're clearly working on a spectrum here.

Like what environments are these kids going to be able to thrive in versus ones they really decompensate. And especially for kiddos that have gifted learning, they also have exceptional strengths and other skills that kind of almost redefine what a kind of brain might look like. So that's why when a parent comes to me with a Vanderbilt form and it's already filled out and they're like, they have ADHD, that's why I think the

The follow-up questions and the more comprehensive evaluation and looking at these kids with their teacher supports become much more valuable because a lot of these kids have exceptional emotional dysregulation, really difficulties at home, a lot of problems with their peer support, even though school is so easy for them that their grades are fine and they're not that disruptive, they still benefit from.

interventions that are going to help that emotional regulation and help their symptoms outside of the classroom.

is a question in the chat about if medication needs change as kids get older, do they need more medication dosages as they get older? I am assuming that is going to mean the anxiety piece. Absolutely. Medications definitely change as kids get older. And I find too just ⁓ anecdotally like what I use on kids before puberty and after puberty is entirely different because they have different brains and they have, they need different supports. So I also remind

parents too that medication dosage should often changes, but it doesn't mean it's linear. Like just because you get older doesn't mean it goes up. The dosage may periodically come down. If you have an environment that's very supportive of how your brain works in a classroom that might be a little bit more quiet or different kind of stresses, you may need less medication that year.

You go into next semester, you may need more because the environment is so much different. So that's why it's not to be tedious or to waste your time to come into all these appointments for follow ups to make sure we're doing the right thing. It's literally because there are so many things changing around a kid growing up in this with so many expectations, demands on them. Those supports should change as they age, but for more reasons, just their age alone.

seeing other questions in the chat. Let's see. here we go. Do we have another one? Do different SSRIs cause different side effects? They're cousins of each other. So we may have, I would say that some work better in some kids than others. When I talk about side effects, I usually have,

I usually talk about the same things, but if we're seeing an undesired side effect, it doesn't mean the whole SSRI class we're throwing out. That usually means a cousin might work better. I usually try at least one or two before moving on to a different class. And remember that some of those side effects we know are transient. So the more consistent we are after two or three weeks, they're going to subside.

as long as they're not significantly impeding with our ability to do our life skills in between. So I talk about the SSRIs as a class, but that's where our expertise about knowing your family history, especially like if you have one SSRI that works really well through multiple members of your family, that could be a good clue that it's gonna work with you too if you're sharing the same pharmacogenetics, or is...

This could also be something where it's revealing something new about your neurobiology that requires something different. So that's all part of those follow ups, but the class as a whole should be generally the same.

Excellent.

Yes, this has been so helpful and thorough, informative. I can't wait to get on your sub stack, by the way. Thank you. is in the chat for anyone who might have missed the QR code earlier. Thank you so much.

Thank you all for joining us and I'm gonna share our ADHDKC site as well just to share some information.

You guys have a lot of fun things coming up, so that's awesome. Absolutely we do. OK, so just kind of wanted to orient those of you who are still on to our page in ADHDKC .org and I'm on our events page and this is where we have Dr. Burgert's information again.

Fantastic talk and we will be, we did record this tonight with her permission. Thank you very much and we'll be providing that for those who have registered, correct, or RSVP for the event. But in terms of things that are coming up, we have a newsletter you can subscribe to. All of this is free of charge, by the way. And in terms of like, maybe you're an empty nester, maybe you're looking at like.

Hey, my own ⁓ mental health and wellbeing and want some support. have a fantastic group probably that's for you. Medication Shad, ⁓ that's the topic of this month's women's group. That one particularly meets all over the city, Kansas City Metro area in person. I know some people are really kind of craving that now since we've gotten away from, we went to so much telehealth or tight Zoom meetings.

⁓ Our next, let's see, we've got all sorts of things. Dr. or Kristen, do you want to highlight anything specifically next? So for any of you who have teens, I think I noticed one name at least in here where the teen was signed up for last week's time management strategies. I had car trouble, had to wait for the tow truck, had to cancel.

And instead of moving it till tonight, moved it to next week. So if you guys have any teens who need some time management strategies, I welcome them to join me next week. And then I actually happen to be doing the parent talk next month. And we're going to be talking about all the pressure that parents have, especially parents of neurodivergent children. We're going to talk about a lot of the things that happen in our body that affect our physical health as well as our mental health, and then what we can do about it.

So I hope you guys can join. It'll be online and that one is going to be also at the J. Any of you who are local and familiar with the Jewish Community Center about 115th and Nall it will be on location there. And I'm excited to have an in-person event. We haven't done that in a while, so that'll be nice.

We'll see how the hybrid thing goes. Right. yeah. ⁓ that's interesting. OK. Well, feel free to come back, visit our site for information. And thank you again, Dr. Burgert, so much. My And ⁓ we look forward to connecting again next month to everyone who's joined. Thank you so much. Good night. Good

everyone.