ADHD And Cognitive Anxiety – Now 3 Types

Special Needs Children – Psychiatric Meds Need Attention
December 5, 2011
Brain Science and ADD/ADHD Coaching – Notes On The Rubber and The Road
January 30, 2012

ADHD Anxiety Is More Than Just A Feeling  

Cognitive abundance and ADHD

Thinking – Frozen by Erik Eckel via Flickr

To fully understand ADHD anxiety symptoms you/we must understand a new form of anxiety: unmanageable cognitive abundance. I've been speaking and writing about ADHD and cognitive anxiety for more than 16 years now, not just the OCD subset, with its focused obsessional topics, but counterproductive excessive thinking that ranges across the landscape of Everyman's everyday realities. The key operational word for ADHD diagnosis and treatment considerations: counterproductive.

If you're stuck in thinking, if you are thinking too much, it's counterproductive to your development, your work, your family, your education. Excessive stuck thinking can result directly from problems with working memory – the pre-frontal cortex becomes relatively frozen in time.

But before we cover those three new Cognitive Anxiety subsets, let's consider the background noise:

An Anticipated Retort: “No Problem”

At first you may say, as many do, ADHD itself is not a problem, everyone suffers from attentional problems. Quickly, following that first denial point, a reductionistic thinker, a label seeker, a 100% name caller looking for the “only” silver bullet – the categorical answer,  would say, “anxiety's not a problem – everyone thinks too much at times.” Since it's not a 100% a problem, even if anxiety is 99% active and debilitating, creating profound counterproductive time loss, it's not a categorically correct, all-the-time problem. [Notice how time and context keep sneaking in to the discussion?] If it's not a 100% problem, – it “looks like” it's not a problem. 😕

Yes, But…

My response: yes, quite so -everyone does think too much at times – but then permit a deeper question: do they suffer from the thinking problem, does that thinking problem create unmanageable circumstances for their lives, does it encumber their decision-making, does it arrest their development, does it put them out of sync with changing reality?

If so, consider ADHD. Consider the strong likelihood that Executive Function is disordered. Then consider these three presentations:

The Three ADHD Anxiety Subsets

1. Frozen Thinking – Unmanageable Cognitive Abundance – Without Worry: Without affect, not feeling constrained, but nevertheless stuck with thinking too much about inconsequential items – small stuff. These folks think so much they become exhausted, and with encumbered mental lives they often make untimely decisions. They are operationally too stuck, too often, for their own interpersonal comfort. They can still make decisions and often flip this presentation around to micro-managing so they can control – correct – the thinking.

2. Frozen Thinking – Abundance With Iindecision And Worry: These folks get overtly stuck – not a little stuck – and more often, not all the time, [but way too often] they either can't make that decision or make it too darn late. The indecision becomes relevant in their interpersonal relationships, at home or work.

3. Thinking With An Anxiety Feeling: In this ADHD presentation, the feelings arise as derivative from the mental/mind thinking too much, then move into indecision and worry, the appear going down into the body. They feel it in their chest, their stomach – it becomes somatic instead of, or in addition to, mental.

Two Essential Conclusions – Thinking Anxiety Is Different Than Feeling Anxiety

1. These three subsets, to the extent they are more cognitive than affective, more mental than somatic and emotional – most often respond to dopaminergic, ADHD medications. Yes, these can occur separately or all together, depending on circumstance and context – the realities of life.

2. Affective anxiety, feelings, somatic, chest and abdominal anxiety, sweaty hands and labored breathing, arise most often from more serotonergic origins – and often respond best to an SSRI/SNRI.  See the Video Playlist below on Dosing to break down those details.


See this Cognitive Anxiety and OCD Video – 6:29 Min:


ADHD Video Playlists For More Specific Medication Details:

ADHD Meds Tutorial – Overview:
ADHD Meds Dosage:
ADHD Meds Problems – Mind and Gut:
ADHD Meds & Allergies – Milk and Wheat:
ADHD Meds & Allergies – Street Immunity:


And By The Way – Attention “Deficit” Is Only The Default Appearance

Another Big Diagnostic ADHD Correction is in order: The problem dear readers, for both the informed practitioner and the informed patient is a functional one – “attention abundance” is the problem, not “attention deficit,” … too much thinking is the most prevalent cognitive abundance problem, not too little. It looks like too little if you aren't thinking correctly about the thinking process.

But if you know about Cognitive Anxiety it considerably changes your thinking about thinking. Think about it if you have ADHD, do you feel that the DSM missed you, and they you have had to suffer with a negative connotation of stupidity when your real problem is that you are smart and suffering with too much thinking, not too little?

The current ADHD label inaccurately describes the mental condition, it only punctuates what is observed, not what the Reality is. ADHD is static, categorical, reductionistic and inaccurate vs functional, data and brain-process driven.

This ADHD nomenclature problem is pervasive, global, and quite important enough to change the diagnostic code – but as you may recall, don't count on it for DSM 5, the Paleolithic “new” Diagnostic bible. The tenure seekers, the psychoanalysts charged with diagnosis, aren't thinking about brain dynamics, they are thinking only about observable behavior, not reported mind activity.

We really don't need affirmation from the DSM-5 to scrap the “deficit” and focus on this very real and correctable Executive Function Disorder – EFD, which embraces both deficit and abundance [not EFDD with the negative “deficit disorder” carried forward].


Do Tell Your Friends:

The new ADHD is now EFD. EFD is more accurate, less derisive, and sets more clear treatment targets. Please Tweet, RT and forward this important message with LinkedIn, or Facebook – the ADHD community can use a different Holiday gift – one that's done with outdated and ineffective name calling. [Recently at the national CHADD meeting Dr Russell Barkley agreed  😉 – …but he liked EFDD! – and btw, I sent him a note on this different perspective before sending out this post…] Russ is on the right track with the Cognitive Anxiety we have been seeing and treating in the office since 1996.

If you write, think, treat or otherwise reflect upon these ADHD matters, please do pass this along. The downstream effect will be constructive for those who suffer with Cognitive Anxiety and haven't yet been treated.

Please drop a comment here, and weigh in on your personal observations about cognitive anxiety from your personal experience.

Dr Charles Parker
Author: New ADHD Medication Rules – Brain Science & Common Sense
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Complimentary & New: 23 pg Special Report: Predictable Solutions For ADHD Medications




  1. DP says:

    Hi doctor. I have had trouble with figuring out what is wrong with me for as long as I can remember. I have a list of symptoms that I have listed over the past month or so to try to determine what I have once and for all. I posted this on another site to get some help, but now I will try here. I have narrowed it down to either ADD(ADHD) or Depression, but it could also be both. I have tried every kind of (legal) natural supplements for ADHD and I have had no luck. I have just recently found out that depression is almost identical to add in symptoms and a thought came to my head that I may have been trying to treat the wrong disorder, but I have also seen that if you have both that you should be treating both at the same time.(After figuring out which is the primary disorder in which case it is ADHD that is usually the one causing the depression) So, at the moment I am taking SAM-e to see if it will work and it has been 5 days and I don’t really notice a difference. I am going to up the dosage from 400(1 pill) to 800(2). Instructions say I can go up to 1600(4) a day. But anyway, here is said list from above.


    Very competitive(other students can vouch & so can my wife): I try to be first in everything

    Jump-in/Add-to other people’s conversations

    Difficulty reading(someone says something or a distraction happens I have to reread the whole text)

    Very poor concentration/focus

    No motivation

    Always thinking about everything going on around me and every possible thing that could happen. It drive me crazy how much I think about everything

    Always not paying attention to detail and even when I try, I always overlook things

    I can sit down quietly & often times I will get tired/spacey quickly or start rambling on in my head

    I have learned, by trying hard & it has become fairly easier to do, I always think before speaking, but since I have done this I over think and think of every single possible outcome of every thing I will say. Which makes me go crazy and I have to make myself stop thinking and clear my mind especially at night when I have to go to sleep.

    I have become very optimistic because of the above^. I have made myself consider everything I think of.

    I cannot master anything at all and try to do/be everything, but in the end I give up because of a lack of motivation because I can’t sit there and learn it.

    Learning literally hurts me. I strain myself trying to sit there and study but I just cannot get anything to stick. When I am reading I do not retain anything resulting in me getting frustrated easily.

    I have very poor memory and I have to get people to repeat what they say 2 to 3 times at least.

    Because of said symptoms I get depressed easily, but never show it. I build it up and when I finally say something to somebody about it they think I am making it up because I have always been trying to find out what is wrong with me. I have learned how to cope a little bit with this, but it really makes me upset because I feel like I am no good at anything and my current situation will not allow me to be diagnosed with something like add/adhd. I have had to deal with these problems since I could remember, but just coping with them knowing I wont be good at anything or have any talents just kills me inside. The only reason I am here still coping with this is because I don’t want to let my wife & daughter down by losing my job. I just hope I can something legal that will correct me and I can deal with my disorder for the little time I have in my job. Does anyone have any tips? I go to bed early to try to fight my symptoms, but in the end, I still lose.

    That list was for ADHD, now for depression here is some other symptoms.

    I get very negative thoughts all the time about the symptoms above: How I can never learn anything, How I can never remember anything, if my wife is cheating on me, if I am a bad husband, etc. But, deep inside I KNOW that I trust my wife and that I am a really good husband & father. I am eventually able to push those thoughts away for the time being.

    I have had about 6-7 moments where I have felt so depressed to where I was going to kill myself and I never got the courage to do so.

    2 of which were recent( over the last 2 years), I knew I couldn’t do that to my wife & daughter so I just made myself sleep it off.

    2 more were from before I met my wife & I literally felt like I had no reason to live. I was doing horrible in school & felt like I couldn’t do anything with my life. My wife & daughter are my only reason to live and I dedicate my life to doing what is best for them. Which is why I can’t get diagnosed AT ALL or I won’t be able to support them. With this information at hand, what can you help me with getting closer to a resolve for disorder?

    • DP,
      Even with all this excellent information it’s not appropriate to suggest a clear conclusion without even more specific questions. I can point you, however, in a direction that very likely could shed some additional illumination on your diagnostic quandary:
      1. Short term solution for immediate medical consideration with your doc: From a more traditional view it does sound clear that you’re working with a combination of serotonin and dopamine challenges. Just as with high blood pressure and diabetes each disorder requires a different agent for a faster turn around. Serotonin for the Touchy-Unhappy-Emotionally Vulnerable state, and Dopamine for the Cognitive-Executive Function-Attention challenges. One medication doesn’t treat the other, a combo is most often needed watching for interactions as discussed in detail in this playlist:
      2. Long term resolution very likely will involve one or two of the subtypes of Walsh Depression Biotypes I’ve written about on the posts here: – You sound very much like you’re suffering with undermethylation, so start by taking a look at those characteristics in the list of postings on that page and in the Walsh Video at the bottom. Undermethylation may solve both the serotonin and dopamine challenges over time. If you are overmethylated watch carefully for the fact that meds could make you worse. SAMe is helpful for undermethylation, but it does take time as spelled out on those referenced posts and downloads.

      Actually you should read the Walsh Book on that walsh-resources page to fully get what I’m talking about.

      Time on these homework assignments will likely prove instructive for your next evaluation and treatment steps. At CorePsych we provide specific biomedical testing to unearth more of those answers [and many others – candida, IgG, etc] as described here: – on the second page of that pdf.

      Hope this helps,

  2. Henry says:

    hi doctor, i’m a 24yr old male and ever since childhood i’ve always been an overthinker, quiet and very anxious. I was diagnosed with ADHD 2 years ago (i think its the inattentive type) my thoughts are the ones causing the anxiety because i cant seem to stop my mind from wandering into dangerous thought areas even when i know that what i’m going to think of will leave me extremely anxious. 3 weeks ago i was put on Bipolar meds because my psych thought i was bipolar. The first 2 days where wonderful, i could control my thoughts to a certain extent so i was convinced that maybe it was bipolar. However my doctor and another psych stated that my mood swings are too frequent and brief (change from high to low in minutes or hours) for it to be bipolar. I’ve been on ritalin modified release for 2 years but it only makes my thoughts go quicker with absolutely no control over them, however the anxiety isn’t felt physically. I was thinking that maybe there is another med which can be more helpful for my type of ADHD. I’m also on Citalopram which works but not too well i still feel anxious. I know this is not alot of information but what do you think? BTW i’m due for an appointment with an adult adhd specialist soon.

    • Henry,
      While I appreciate your consternation and empathize with folks with the same complexity of challenges everyday, it’s just impossible to form any conclusion on a brief comment. Effective conclusions often arrive over time – educated assessments and careful followups with the objective to correct not harm. Too many, even well trained psychiatrists think one should either jump on the previous diagnosis of other docs, or one should fix those imbalances right out of the box.

      Regrettably, the mind and body don’t work that way. Stick w your add specialist – and if treatments continue to remain unpredictable you might appreciate details from Dr Walsh on these measurable options: – 4 pages on his new book that discusses epigenetics, methylation imbalances and a variety of other biomedical factors that can gum up your works. Also can review this brief video:

  3. Brookelle Riley says:

    Dr. Parker;
    First off I would like to say that your insightful blog is heaven sent. Just as I was starting to loose all faith in the medical industry and that any medical professional would ever be able to relate/understand what I am going through… And, yet you summed in up perfectly.
    This is my experience.
    I took this last Spring semester off of school due to a rapid decline in my own mental health.
    Since January I have gone through the EXCRUCIATING ordeal of attempting to seek medical attention for my mental state of mind.
    Close to two thousand dollars, a new PCP, neurologist tests and consultations, counseling/psychiatric services and seven months later, I received a new diagnose to add to the list; long term ADHD….
    Finally the problem has been acknowledged!! but, with little to no relief…

    People who have known me since childhood/throughout adolescence know just how much sense this actually makes… The outbursts, the impulsivity, the hyper-activeness, the disruptions, the “trouble making (being put in the court system for being disruptive), and so SO much more.

    So, then… Why did my old PCP take one look at my 14 year old self and completely disregard the ADHD that very apparently ran rampant in my life, and instead diagnosed me with depression? Was it because of an unfair biased assumption based upon my “alternative/emo” style or just an act of sheer incompetence that all Jackson County medical professionals seem to share?
    Why did she continue, continue, AND CONTINUE to put me on anti-depressants (I’ve been on a minimum of seven) despite my protests and complaints in regards to how the side effects heavily outweighed the almost non-existing benefits of said medication…..?

    I started my low dosage ADHD medication two-three weeks before college resumed.
    But, because my Psychiatrist only sees me for fifteen minutes every two months, & has already decided, due to past medical history, that DEPRESSION is his main concern. And with ADHD medication being the most abused by college students, me being a college student (an ALTERNATIVE student at that), they are hesitant to even consider the real problem, leaving my overall mental state close to being the worst it ever has been.
    The combo of anti-depressants and the stimulant medication I am on has me loosing my shit. I have gotten to a point where I am having either “panic attacks”, manic moments, increased agitation, and worst of all when the stimulant medication that I take at 7 AM wears off at…like…. anywhere from 2pm to 5pm I experience an inability to even function properly,it is only comparable to being zombiefied. My head felt like there was a wet blanket draped over it before, separated from myself and the outside world with a layer of fog, before. But, this feels more like a thick soaked comforter, surrounded by an unpartable cloud of suffocating smoke….

    How is it that the people we entrust our very lives to are so oblivious or indifferent to the very things that weigh on us so heavily, that affect us so direly?????!

    I took a semester off to get this shit fixed. Spent so much time. So much money. So much energy that I did not even have in the first place.
    And NOTHING has really changed. These first two weeks back to school have been rough, to put it lightly.
    And, I am so tired of doctors. But, I have to get this shit fixed, otherwise my life legitimately is not worth living. I say this not to be melodramatic, but to be truthful.

    The only question that remains is rather or not I should just wait for my psychiatrist appointment Tuesday and hope he actually gives me the time of day, and that he takes my feelings and opinions that conflict with his own in stride and begins proper treatment. OR
    If I should use this weekend to go up to behavioral health center for an evaluation on the recommendation of my new PCP. This will cost much more money, as I will end up being admitted to the hospital for a few days… And, it will probably be REALLY unpleasant… But, I am tired of all of the what ifs and assumptions that medical professionals use when drawing their conclusions.
    And, I just want to be on a legitimate treatment plan devised for me specifically, not what works for other people, WHAT IS IN MY BEST INTERESTS.
    And, maybe that is something that takes days of observation for doctors to figure out….

    • Brookelle,
      Without actually interviewing you personally in detail, and even though you’ve sent some provocative details, it would be irresponsible for me to shoot at any of your cloudy target-symptoms. I clearly can’t fully understand your complex set of symptoms under these comment-circumstances. If you’re not safe, yes do the behavior center – pull your thoughts and feelings together within a safe structured environment. Having seen many with this type of experience I do want to offer you some well-reasoned hope: Don’t permit your frustration to turn into hopelessness.

      Quite simply: the reason for your consternation is a relative insufficiency of information that could take your work to the next step – and that is no one’s fault. If you aren’t trained in these matters it’s reasonable to not know about them. Indifference is knowing and not doing. Your presentation sounds much more like a situation of simply not knowing. Information is out there, testing is possible – hang on, and if you feel you need a second opinion, another viewpoint – take care of yourself. Your best interests: Do the positive, take the next shot, don’t even consider the negative – the quitting option. In the range of percentages you are very likely 90% likely fixable in a short time – with the right info.

      Also: It sounds like you’re young, so make sure you try to work with your parents so they understand what you’re going through.

      Continue your quest for help, press on. Safe travels,

  4. bob says:

    Im a male. I was diagnosed with ADHD in 7th grade and I took concerta for it up until the middle of 8th grade. I stopped taking concerta then and started taking vyvanse because that’s what my other friend was taking. For all of sophomore year in high school this is what would happen. Everyday I wake up eat 2-3 bowls of apple jacks and after near thirty minutes I will take a 30mg of vyvanse. I get to school and for the first hour and a half of it I’m some what lazy and some what working but not really paying that much attention to the teacher. After the first two hours I start needing to take a number two in the bathroom. After I have taken my number two in the bathroom I feel focused and ready to read or do multiple worksheets in whatever classroom I have next. After 2 and a half hours of doing work or just fidgeting not in class and being nervous and not able to really think that much because im so concentrated on drawing lets say an 8 because its two circles over and over again just to occupy myself I guess I get more of a dread feeling where I just wanna go home already. I usually don’t eat anything for lunch by the way. I then will get hungry and feel the need to eat whatever is sweet around me. I try to restrain myself from eating to much chocolate but it just is amazing and needed but it also makes me a lot more tired and lazy once I get home. If I don’t eat anything sweet and go home immediately all I want to do is be lazy and not do anything. I also run xc which I like the mental challenge after school sometimes. I also experience the over thinking quality as you describe in one of your videos and I get mad when people try to give me advice that I have asked for and basically my frontal cortex will freeze up in those first two hours after I have taken the number two at school. I was wondering how to get out of this predicament because I take honors and AP classes and I worry and try to clean my room but even after that I will still not do the homework. I would very much like to get rid of these feelings Asap.
    Thanks bob

  5. […] Problems: 50. Separation anxiety 51. Social Anxiety 52. Generalized Anxiety 53. Attachment disorders 54. Social Skills […]

  6. KB says:

    Hi Dr. Parker!

    I have followed the CorePsych blog for a year or so and it has helped immensely to understand some of the nuances and issues about ADHD medications. Reading your explanation of cognitive anxiety was a total revelation to me. I have suffered from the cognitive overabundance my entire life (was actually diagnosed as agoraphobic as a child) and have never had an accurate description of what it’s like inside my head until I watched your videos about cognitive anxiety and why it is different from OCD/Normal Anxiety.

    I am frustrated with my medications and can’t seem to get anywhere with my doctor(s). I am currently on Zoloft (200 mg), Abilify (5 mg), Vyvanse (60 mg) and Adderall (60 mg) daily.

    In the morning, when I take my first dose of Vyvanse/Adderall I feel great and things seem okay, but by about 12 or so I start to get “stuck” again and my emotions start to go all over the place.

    I usually try to hold off till about 2pm or so to take the 2nd dose of Vyvanse/Adderall, but by about 6 pm it seems like that is not working anymore either. I have tried taking more of the stimulants, which seems to work, but never for more than 4-6 hours or so (if I’m lucky).

    I had gastric bypass in 2005, so I don’t know how (if at all) this affects my absorption of the stimulant(s), but my doctor isn’t willing to try any higher of a dose on either med, so I haven’t really been able to see if a higher dose would work.

    I am wondering if the problem is the stimulant or something else? I’m just tired of feeling like I get 4-6 hours worth of decent function a day. When I’ve discussed the issue with different doctors the solution has been to add more/another medication, but I don’t want to keep adding medications, I want to know what’s going on!

    Any insight you can give me would be awesome. Thanks!

    • KB,
      You very likely suffer w a neurotransmitter imbalance and some changes in your trace elements downstream from your bypass… we see it all the time. Take a look at the dosage playlist as it hits the Roving and Narrow Therapeutic Window phenomenon you describe here:

      So, from a different perspective, it’s not the meds, but the neurotransmitters and trace elements themselves… and likely some immunity molasses thrown in. I would be happy to weigh in on these matters.. just call Desiree for a Brief Chat here on the Services Page and we can set up a way to get the most out of the time w a consult.

  7. Michele says:

    Agree with executive dysfunction – I struggle with making decisions; constantly overthinking; tend to be impulsive also. I take 15 mg of adderall XR in morning and 20 mg of regular adderall around 4:00. I am constantly chasing the ” perfect feeling” and feeling tired or low energy scares me. Am 44 yrs old; extremely active and athletic personal trainer. I take a number of supplements designed to empower or stimulant my brain. My father and everyone in his family tracing years back are alcoholic- probably self treat depression. I do not drink; tend to be a bit compulsive ( exercise): I am happy, easy going with some anxiety but it’s
    Manageable. 2 of my 4 children have bipolar; I clearly do not have BP. I suppose
    I manage my ADHD well; very health conscious and realize my tendencies. I find it odd however that I am constantly searching for that ” magic spot” where I feel ” good”. Am I unusual or just a person with ADHD? If I take too much of a stim I feel the buzzing of it being too much…. Perhaps I am off on meds range? Timing? I also follow an intermittent fasting method ( of a 13-16 hour fast overnight so usually eat my first
    Meal late am or noon…. Love the IF and find it increases focus, concentration and great for weight management .
    Love your site – you are awesome!

    • Michele,
      Thanks for your kind remarks, much appreciated. As a Personal Trainer w your family history you really do want to take some time and look at the IgG, Mind and Gut playlists on my YouTube Channel – down near the bottom of that page: I’ve seen so many who look like serious bipolar, depression and/or ADHD w food allergies and downstream problems w trace elements, yeast, etc. Testing tells the tale.

      Thanks again, be well!

  8. […] than one in whom nothing is habitual but indecision.  William James, Philosopher  -|| Indecision, unmanageable cognitive abundance, remains one of the single most overlooked characteristics of Executive Function Challenges. Video […]

  9. Jolene Nel says:

    I have 2children.One with ADD and one with ADHD. One with ADD is my daughter of 13 and shes got anxiety as well.They are only on Concerta.Anything naturally i can give for her anxiety to help?


    • Jolene,
      We have a product at our CorePsych store up there on the nav bar called PharmaGABA. If not there at the store it’s available at the office thru Desiree as Services. It’s natural, works about 80% of the time, can be given during the day and is chewable.

  10. Marjani says:

    This too much thinking is awful, you can’t concentrate at all, it’s like you feel SPD…

  11. Guy Anthony Martin says:

    Hey Charles, Is there any way that your most significant observation/papers/ writings, which are the finest example of what, how, and all the rest, should be the only methodology that is the legal form of addressing ADHD – this, firstly, to the parents, followed by the teachers, which no doubt would necessitate a meeting to justify what you were talking about, now the big tester, this into the normal GP’s surgeries, with a framed copy present to each GP, on the basis it had to be mounted so as it would simulate the “Mona Lisa”

    Charles, need I say more, your foresight, proactiveness, interactiveness, but most importantly your beautiful actions.
    I send a Big High Five with Xmas Greeting to you Charles, your outstanding team, and never forgetting those that keep us sane – wives, partners, parents, friends………
    From across the pond

    • Thanks so much Guy! It takes a team to turn this train around. Won’t happen without some serious missionary work. We need to get this info into
      those dark woods where the uninformed practice counterproductive rituals for false gods! 😉

      Best to you my man, together we can make a difference!

  12. Ashley Wells says:

    Informative post about ADHD. Thanks for the information!

  13. […] one in whom nothing is habitual but indecision.  William James, Philosopher  – Indecision, unmanageable cognitive abundance, remains one of the single most overlooked characteristics of Executive Function Challenges. Video […]

  14. Squatoo says:

    Wow. This is honestly the first reference I’ve found that accurately adresses the thinking anxiety side of EFD that is my presenting issue. I have been diagnosed by a specialist but even in that report I found something lacking. It is so much more outwardly behavioral in its diagnosis but much of my difficulty is thinking patterns that spiral into anxiety.

    Thank you so much for your thorough work in this arena. Besides your own writings which I am waiting for shipment, do you have other resources for those of us who need more in depth information on this specific branch of EFD?

    • Dr Charles Parker says:

      At this moment in time, 2013, I am the only person I know raising this cognitive anxiety flag. In my own opinion this is the most frequently missed, and therefore the most important subset of ADHD, – and because it isn’t recognized, because we aren’t thinking about PFC, Executive Function Working Memory, thousands are missed daily and mistreated repeatedly. Once aware of this cognitive target it really must be separated from affective anxiety, which arises with more somatic, body feelings, and is more serotonergic in origin.

      Thanks for your kind remarks. You may be interested in RSVP to my video chat coming up next week, if you can make it:

  15. Stuck in fog says:

    Dear CP,
    I hear that EFD/EFDD loud and clear. As a 50 yo woman, hot flashing out in the wazoo, I’m sure estrogen issues are at play in addition to my baseline highly inattentive type (but mentally over busy and definitely impulsive) brain. Feel I see things in aerial view, difficult to put things in sequence (biggest challenge to/subtracts from initiative gain of ADD meds). brain just doesn’t work – stops – with multiple “highway lanes” as above poster mentioned. So definitely an executive dysfunction if not total malfunction. GFather had Parkinson’s, so I wonder about a connection there, though asymptomatic (other than (congenital) anosmia).

    Have had excellent success with Vyvanse, though every 6-7 days need a day on Concerta since Vyv interferes with sleep so much (even taking it at 6am, mind still awake and anxious @ midnight). Conc. cuts out hours earlier but can sleep better. Problem is one of maintenance and would appreciate your suggestions for other inputs I should consider: Everything I eat, everything I do, how/when I exercise (high HR cuts med benefit) I do with an eye to staying mentally there. Feel like the pts in “Awakenings”. before meds: stupor; after meds: function, movement, alive, awake.
    After Vyv kicks in I can see what needs do be done more clearly and am actually interested in doing.. Vyv not as immediately or highly initiating/motivating as Adderall but lasts longer, and smoothly. But sometimes I mess up, I think with diet bloopers I know better not to do (sleep interrupted by hot flashes gives similar result): red wine at night, even a couple sips, cuts Vyv benefit severely next day. If I use .1mg (1/3 .25 mg tab) Benadryl or clonazepam as sleep aid, same. Worse is taking clonazepam (.25-.5 mg to cut anxious rumination) and having, really, only a swig of red wine – then I’m totally brain dead for 48 hours. Cant even focus on what i want to do, butt glued to couch. Question: other than caffeine (not good for sleep), or some exercise (difficult to start and then to titrate) what approach will offer immediate counter to that druggy, groggy feeling on the days (usually busiest, w/biggest deliverables due) resulting from the stupid human trick of a little (really!) red wine, or combining a little red wine with Clonazepam? Can’t afford to be out of commission so long but don’t want to do rx drug-counter drug approach. Obv. answer is no red wine, less benzo but problem is bigger, since so many things shut down barely awake brain even on meds (sugars, grains – I avoid to extent possible). Executive lack of function is base state.
    Very grateful for website, blog, pubs, and your overall continued circumspection. will appreciate any thoughts you can offer my situation.

    • Stuck,
      With every complexity that requires so much chasing of one’s tail out there in the woods I have found that
      1. measurement and correction of neurotransmitters can significantly help feed the synaptic ranch,
      2. some folks do have comorbid trace element issues, especially with your estrogen symptoms [copper], and could be corrected if
      measured – not a high cost item, no guarantee, but often helpful
      3. make sure to measure IgG because if allergenic foods contribute they will always create roving and
      narrow therapeutic window outcomes.

      The biomedical details make ADHD meds frequently almost completely unpredictable.

  16. E.Thrasher says:

    Dr. Parker,

    You were brought to my attention by both Dr. Patrick Thrasher and by my nursing instructor, Dr. Debra Murray. I really enjoy looking at all the interesting thoughts you have about ADD/ADHD/EFD . . . sometimes it is hard to follow the info and have to reread multiple times. In any case, I have been dx with ADD since I was a child, and most definitely had the hyperactivity as a child, but as an adult really just have attention issues. In my day to day life it is not that bad “living” with ADD and not taking meds, but I have been in nursing school for the last 2 years and am in my last year now, and have had to turn back to medication to help focus and get things done on time. I took Adderall in the past, but found that it wasn’t lasting long enough and gave me severe headaches almost every day that were not relieved with excedrin (the only medication that works on my “non” med headaches). I then switched to Vyvanse started low and now on 40mg daily. I watched your videos and read up a little and found you suggested taking after a high protein breakfast. That actually does seem to help my headaches much of the time, but there are many days or even weeks that a terrible headache/migraine begins to creep in around 1 ish and then continues to worsen throughout the day and is unrelieved by pain relievers. I guess I am getting a little off the topic here, but reading about the cognitive anxiety, I can see I am almost always in one of those categories. I have always been a “thinker,” and it used to bother my family because I wouldn’t want to talk much, but I am thinking now as an adult it was because thoughts were going 1000 miles per minute, and was already “talking” to myself in my mind. I do talk to myself aloud quite a bit (which I am fine with at home), but sometimes when I am in public and it is not “normal” to talk to yourself, I question whether or not I talked aloud or the thoughts in my head were so loud it seemed like I did. That explanation is not great, but I’m trying. I notice a lot of memory problems as well, names of people, names of procedures, forgetting vital sign values I literally just took a few minutes prior, just random forgetting. Being in nursing school, forgetting is really not something I can afford to do. If you are focusing on the prefrontal cortex & cognitive anxiety being involved in ADD, what types of treatments are available to help with forgetfulness, memory problems, overactive thinking? When I take Vyvanse on a normal, low stress, everyday kind of day, it feels like instead of being on 100 lane highway, I am on a one lane highway in my mind. But while in school I am almost always living in an elevated stress & anxiety situation and there are still probably 10 lanes on my “highway” so to speak. Any thoughts? I do realize this is a very large amount of info, but was just trying to give you some current & background info. I do live in Virginia Beach and would be interested in possibly making an office appointment. Does your office take insurance?

    • E.
      Very likely that multiple issues are at play – the first one that comes to mind is estrogen, and had to reread to see if you are female! These kinds of complicated presentations do require more specifics and even some more labs, but the history would tell the tale. Stay with protein for breakfast, Vyvanse is my favorite stim, but it’s clearly not for everyone, and we may have to try other options.

  17. Genaro Carrero says:

    Great article, how does one treat this issue with a 10 year old who was recently diagnosed with (formerly ADHD). His reading has improved but the writing is still a struggle. (no medication, changed his diet and we are now more aware of distractions in his surroundings). I am not a fan a overmedicating let alone a child who is still growing. The side effects of Strattara list liver. Nervous parent.

    • Genaro,
      Totally with you on micro titration, – if he has the cognitive anxiety you only need to find a doc experienced with the meds who will work with you comprehensively on all the contributory factors – and simply start slow. See the water titration recipe for Vyvanse elsewhere here [Search] – then go low and slow and watch the cognitive anxiety markers as targets.

  18. OCDnightmare says:

    Hi Charles,
                                I think its great the study and the information is providing. With this current article here, l think l can see whats happening to me. I have been diagnosed with OCD but even though l take antidepressants l still get all the symptoms plus the ones you have mentioned here. The forgetting peoples names and getting confused all the time and one problem l always have had is thinking to much to the state of being paralyzed and exausted from thinking, going going around in circles. I haven’t been diagnosed with ADHD and l don’t think l have this because l am a lazy bugger really not full of energy like they say running around etc,, but with thinking yes. But this article has got me thinking m because l have got into predicaments with rash judgments and decisions.
    David Lynch

    •  @OCDnightmare Hey David, That very old view of ADHD, the hyper type, is rapidly loosing ground. Less than 20% of those suffering have the hyper subset. Mental exhaustion and thinking too much frequently reveal underlying cognitive challenges as you describe… and most often are correctable with stimulant meds if not associated with other disorders. Consider: Set up a time to chat to really take a look at this and get it done.

  19. Dan,
    I won’t be able to cover every detail here, but want to take a moment at the outset to compliment you on your work with your docs. Nothing as excellent as a well informed partner in the recovery process.

    1. I think you have what I call a more “political depression” than affective depression. So many folks are missed chasing affect and miss the point on vulnerability and sensitivity, two non-guy words which you appear to carry. “Political” is a process of sensitivity, confirmed on brain scans by the way, without outward depression, associated with an even pleasant demeanor, but with the feeling of living behind a 9 ft magnifying glass all the time. Need more info but that’s a consideration, and no your doc won’t get it because it’s not in the DSM book yet.

    2. Following that line without knowing you and going over this in detail I would consider a small dose of antidepressant to cover the basal ganglia seesaw that sounds associated with stim meds for you.

    3. I do think you are likely neurotransmitter deficient as you manifest the roving therapeutic window [search for that term here], and appear to be chasing your tail with meds for some time – often a key “metabolic” giveaway.

    4. Regarding testing: not popular yet, but will be in another 10 yrs. Why should a smart guy like you go around chasing dragons when you could simply measure. Yes, we can do that long distance if you want to jump on a consult call, and ask yourself, no need to reply here, how your GI system is working. Do the Transit Time test [search here] and even before that: “How many times a day do you go #2? 😉 no answer expected here!!

  20. Meta,
    Sorry don’t have a name, but hope to as we move forward with CoreBrain Training. We can do a phone consult and review records long distance, just can’t write specifically for meds without an office visit. Usually one or two consults can turn the tide for your local docs.

  21. […] by Dr. Charles Parker, makes a pretty good case for using EFD as an “umbrella term” in ADHD And Cognitive Anxiety – Now 3 Types, an article in which explores what he distinguishes as three different types of cognitive anxiety, […]

  22. Sloth,
    You have to change your name! 😉 and on top of all that I disagree emphatically with your dear mom.

    From my perch on the passing scene you are absolutely a candidate for a stimulant med and just because you are smart you are overlooked. If you are good looking the situation immediately worsens.

    Some of my most overwhelmed and pressured clients are both great looking and smart, and because they aren’t slovenly the world overlooks them.

    Do take a few mins and sit down with my ADHD med tutorial up there on the nav bar, especially the 3rd vid on anxiety and ADHD. You are most likely suffering from Attention Abundance Disorder, and because you don’t have a “Deficit” you are overlooked.

    Actually those with intelligence are so often overlooked we should almost create another subset.. Find a doc in your area who get’s ADHD and try a stim – it will very likely help you get back on your train.

    If you are still wondering book a time with me on the phone or Skype and we can get this ironed out more explicitly – and really investigate other comorbid issues that may confound your presentation.

  23. Hey!  I just linked this article to the first two posts of a series I’m writing: “When Beloved Has ADD . . . altenatives to murder and divorce.  LOVE your new look, btw.
    Madelyn Griffith-Haynie, SCAC, MCC – (blogging at ADDandSoMuchMore and on ADDerWorld – dot com!) “It takes a village to transform a world!”

  24. […] ADHD And Cognitive Anxiety  (at CorePsych, Dr. Charles Parker’s information-dense blog) […]

  25. […] ADHD And Cognitive Anxiety  (at CorePsych, Dr. Charles Parker’s information-dense blog) […]

  26. Anonymous says:

    Dr. Parker,
    Thank you for replying. I’m very sensitive to pain meds, anesthesia, and Alcohol. 1 glass of wine and I slow way down. I have regular BMs 12hrs apart. I had a thyroidectomy for Hashimoto’s back in 1995. My TSH is always normal.
    I’ve never felt good on any antidepressants/anxiety drugs. At least not the euphoria or the lifted feelings people describe on the depression forums.

     I get anxious because I know when I’m in meetings and people are talking over each other I can’t follow one conversation. I get anxious because I fumble with words while speaking, lose my train of thought, can’t remember peoples names or terminology, or go off on tangents. I see them drifting or becoming uncomfortable. I often get dismissed like my point isn’t valid, or interrupted without getting to the point.

    I’m also looking into HRT because I’ve entered the PHASE in a woman’s life where hormones begin to fluctuate. My PC does not want order any hormone test. She just wants to prescribe birth control pills.

    My Psych wants me to switch to Viibryd.

    I keep checking for your book. Please make it available at My reading comprehension has degraded. 

    • Not,
      Thanks for the suggestion on, will have to chase that connection down.

      Even tho you don’t meet criteria for overt symptoms of bowel dysfunction, encouraging a clear path to IgG issues, I am quite certain you nevertheless do suffer either 1. from an immune dysfunction secondary to foods, or 2. trace element/toxic element compromise.

      Life is short, the cost for the testing is less than a small fender bender. Likely you, as others would tighten up and fix your car, but hesitate to spend the money on assessments. Nothing in medicine is 100%, so can’t blue sky this, but I am quite certain you would find good data for improvement, and you don’t have to do both, start with one and move on. If you are in a hurry, want to be done with it, do both test: IgG with Neurotransmitters, and trace/toxic elements.

      I can read them wherever you are, if you want me to manage the whole biz, come on down. If you want to talk briefly for no charge write to Sarah at patient.corepsych at corepsych dot com.

      Let’s chat – yes, I do think I can help.

      • Anonymous says:

        Dr Parker,

        I have lots of fender benders too. I get lost in your website jumping from link to link with my head in research mode. I remember seeing the link to your office to call Sarah because I would like to talk briefly. I don’t think that I could come down for a scan. But I’m interested in the IgG and Neurotransmitters. Would it change the choice in medications and would it validate what I’m feeling?

        Hope to chat soon.

        • Not,
          I still do scans for even more complexity, if these easier and less costly testings for neurotransmitters and IgG [and some other lab tests] don’t pan out. Scans are just too expensive and don’t render the precision as well as the less costly lab testing.

          I have not seen a test yet that didn’t give us significantly more info. I’ve had a very few [maybe 3 in many years of work with these labs] that surprised us with no results… but no results sends us down a different path – many options and yes, very likely will significantly change your treatment strategy for the better.

  27. Pat,
    This is where a consult comes in. We often do consults on a one or two time basis just to make recommendations – often to an informed, more workable GP. Psychs, as a rule, simply don’t want to hear it from another psych.

    Using Skype is jut like in the office, but we can do a phone consult without the tech, and just work thru the problems. That small investment in time can change the situation for years,

  28. Herding Squirrels,
    Daytrana is certainly an alternative, works well, and has the added advantage of longer DOE. Take a look here on CorePsych Blog at the Daytrana post with details on the Post Patch Time to dial it in most effectively.

  29. Anonymous says:

    Dr. Parker,
    I totally struggle with all 3!
    I was diagnosed in Nov ’11 with ADHD. I looked into it because after the 2nd half of 1st grade, my 8 yr son was continuing to have behavior problems in school and home. Homework was frustrating for him & he cries over little things all the time. I think we’re dyslexic too. When he’d struggle, all the mean words and looks my parents would say to me came flooding back. I couldn’t keep myself from crying. I was searching for parenting programs and I heard a discussion on Dr. Radio about Mom’s getting diagnosed with ADHD after their son’s were and decided to investigate.

    I had both of us evaluated. He was diagnosed in September before me. Schoolwork and Parenting have improved. When I tried to get tested (May 2011), it was difficult. A psychologist gave me the Barkley form and diagnosed me with Depression. She also said I had PTSD. They gave me Sertraline (Zoloft). 50mg did not make me feel calmer or stop my crying. They increased it to 100mg. She said she wouldn’t test me for ADHD because of my insurance. But the Zoloft should help.

    After educating myself about ADHD through the summer and fall I kept pushing my PC and got a Psych consult he put me on Concerta 18mg for a week and I would increased my dose every week. He said I might need to increase Zoloft to 200mg if I started to feel anxious or depressed. At 54mg I started to forget what I was doing, lose my train of thought and forget words. At 4 pills I got agitated and couldn’t put sentences together. So I started to take the 200mgs Zoloft. Then everything at work made me sad. I couldn’t stop crying at work. I couldn’t make decisions and started overspending. I was really cranky at home. I started yelling at my brother and husband. I would get extremely cold and then sweaty. I even missed my Dr. appt which I never do. When I had my follow up visit, I could not stop crying. I wanted to explain what happened at work and he interrupted with “would you like to try Adderall?” I felt terrible on Zoloft and Concerta. My family said I was scaring them.

    As I started I Adderall XR found your you Tube video I dropped my Zoloft back to 100mg. I felt bad at 3, 15mg Adderall  and 100mg Zoloft. I feel even more unmotivated an my leg and arm are twitching and I keep running into things. I talked to my PC and Psych about dropping the Zoloft. Psych highly disagrees. I’ve found several people in med discussions complaining of the same thing. I mentioned that my Anxiety was from always being worried that I forgot something, made a careless mistake, or missed what was said in a meeting. Cognitive anxiety. My sadness in May was PTSD and my uncertainty about my child’s future. But I am no longer sad about our ADHD. It explains all my quirks. I learned how to use my strengths.

    I am currently employed as a product designer. The reason I want to manage my ADHD with medication is I have so many ideas for concepts that I can’t finish one. Before I’m done with sketches, I get a better idea and scrap what was doing. I struggle sitting still and listening in meetings and talking about concept ideas. I feel like I stumble with the same problem over and over. And I most certainly don’t want to be caught crying.

    The combo of Zoloft and Aderall XR are listed on as having severe interactions like “additive risk of serotonin syndrome.” I checked with my pharmacist and he said I was just worry too much.

    I need your advice.

    • Not depressed,
      As you already well know something isn’t right – so here are some thots:
      1. Agree with your pharmacist, no interaction in the lit, likely not the problem.
      2. The titration thing almost always requires considerable detailed thinking. I am not a fan of Zoloft, as it’s a potential weight gainer, would suggest your doc consider Venlafaxine ER generic but it may cause probs too, – just need to get that trial out of the way.
      3. Dial in the XR carefully, use the DOE, works almost every time.
      4. Main point, the first thot in my mind on reading your notes, good doc, good patient, bad metabolism, ask the #2 question and look at Transit Time.
      5. I am adding a Naturopathic Doc to my staff to look at trace elements like copper and heavy metals, that one would be important to pursue. We’ve had excellent outcomes looking at IgG, changing the diet after, and modifying neurotransmitters – failing those interventions we’ve had some remarkable turn arounds with discovery of bismuth and significantly imbalanced trace elements – go to for more info.

      If in a jam where ever you are, we can test and consult long distance if that would be helpful.

  30. Jbrees,
    Quite agree! No confusion intended, clarification is the objective. You are quite right on the way you have sorted it out – and I use the same principle: organization around one thought, one pattern [e.g. counting numbers on signs]= more OCD. But, and this is a big but, it doesn’t work that way in the office all-of-the-time. Suggested and best meds for more pure OCD are SSRIs.

    But as I have repeatedly pointed out, hoping not to bore anyone, that treatment recommendation is not universally workable as many, repeat many with even pure OCD, single thought challenges, still suffer from more PFC ADHD mediated anxiety.

    My intervention here: look for the real comorbidity of the three types of depression [new post coming on that one soon] as the vulnerability, the underlying sensitivity is a key to the effective reconciliation of the SSRI and the ADHD/stimulant Dopamine reuptake inhibitors.

  31. Mer,
    Having had gastric bypass you obviously qualify for having suffered with, and likely continuing to suffer with, a metabolic challenge. Those with slowed metabolic times, based upon liver slowing not demonstrable on liver studies of the superficial, readily available and often-ordered *liver profile8 genre almost always have trouble with any ADHD meds either slow or immediate release – doesn’t matter.

    The facial tic problem with any stimulant is addressed in this first-in-a-series tic disorder posts here at CorePsych Blog: We see tic in our offices as a metabolic challenge, and your history argues significantly for that likely explanation. Metabolic testing will likely be helpful in understanding what will work best to treat the ADHD, but won’t necessarily become the final answer for tic disorder – as tic could be encouraged by other subsets of problems.

    The short answer is no. My experience is extensive with ADHD and bypass, and my own experience is one that disagrees with that common admonition to bypass patients: forego the long term XR meds. Why? Because most often it doesn’t create a problem when common sense indicates that it might/could.

  32. Thanks OCD, stay tuned for more careful breakdowns on the interface between cognition and affect regarding anxiety!

  33. Paul,
    Evidence exists that chiropractic treatment is helpful for ADHD, and just as any casual reader here will see we support every piece of the ADHD puzzle that works, and argue regularly against reductionistic, simplistic only “medical” solutions. It takes a village, and teamwork in treating ADHD complexity is always recommended. We have see significant improvement with cranial sacral interventions as well, and appreciate your weighing in on these matters here at CorePsych Blog.

  34. […] it is worse for some ADHDers who have an excessive amount of thoughts, what Dr. Parker refers to as cognitive abundance (there’s more to this concept of cognitive abundance so you’ll need to read his […]

    • Hey Jeff, Big thanks for the mention… stay tuned for the cognitive depression piece coming as soon as I get further along with the upcoming presentations. Happy New Year!

  35. […] it is worse for some ADHDers who have an excessive amount of thoughts, what Dr. Parker refers to as cognitive abundance (there’s more to this concept of cognitive abundance so you’ll need to read his […]

  36. Sherri L. says:

    Haha Dr. P sounds like you were talking about me in some of that….lol  As usual you are the bomb!!!

  37. Brook,
    Love your blog, and agree with the simplicity – the real deal breaker, the point of differentiation: no longer to those with working memory problems have to be relegated to the swamps of “deficit.” EFD is both deficit and abundance depending on place, time, and specific functional issues.

  38. Mother2,
    SPECT images would be helpful, and we do see them especially helpful for specific interventions – to drive the biologic point home in a general way for those who are locked in the challenge of over-thinking and denial.

    Your son is quite right, however, to remain suspicious of the usual med interventions, as the mistake most often made with folks who present with his probs – dependence on SSRIs that simply make the situation much worse – that would make him feel like a treatment failure. OCD is not just cingulate gyrus as Amen often implies, nor is it always ADHD, but frequently needs a combination of meds.

    The other very important point: biomedical measures of other contributory conditions… all of which we can to long distance in LA. Have him take a look at this video that goes more down the ADHD path, but highlights the importance of brain function as opposed to appearances:

    We can consult by FaceTime, iChat or Skype and easily point him in the right direction, just can’t treat with meds without an office visit. – and yes, TCM could be helpful, but for my take on the current science: use it, don’t overlook the basic cellular physiology for advanced diagnostic accuracy.

  39. Robert,
    Completely agree, and many thanks for weighing in on the importance of dealing with the multiple variables of ADHD treatment including the importance of sleep. I added a separate chapter in “ADHD Med Rules” on sleep for that very reason.

    I thought, as I began to read your comment, that you were going to go down the path of diagnosis: “did not have ADHD.” Do remember that the criteria of studies, the diagnostic criteria for ADHD are amorphous at the very best. So many more children have significant executive function challenges but don’t meet the outdated criteria present in the DSM 4 or forthcoming DSM 5 – Search here and in Rules for more on this ‘missed diagnosis’ subject… including this last post here on the oft overlooked functional presentations of simple anxiety that lives downstream from corrupted PFC/working memory dysregulation.

    Thanks for your links and remarks, so true!

  40. scottthutson says:

    Dr.P., You have done it again! EFD is right on target! A great example (maybe?) could be, the way EFD’ers are so easily distracted by, lets say, a broken limb hanging crooked on a tree that is visible from the garden. The task at hand is to work on the garden, but the world(working on the garden) screeches to a halt for at least 10 min.’s. Not the mind/brain or thinking, that’s going full speed, but it’s focusing on that broken limb? Same thing with driving down the road @ 70 mph. ……That’s a major disorder there.No? 

    • Scott,
      You got it – the functional component gives us more precise targets. The new questions arise from what is functioning and what is not – and in what context do they deteriorate. SPECT dramatically shows that ADHD is not a 24×7 diagnosis.

  41. Justdowhatisay says:

    Thank You for the mention above!

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