Neuroscience evidence changes thinking.

ADHD Insights: Social Anxiety Revisited

Cognitive Anxiety Overlooked – ADHD and EFD Matter

Two easy ways to consider social anxiety have to do with the thinking involved based on numbers of people and intimacy, having to talk and therefore think. Thinking compromise is common with ADHD, and those with prefrontal cortical slowing, suffering with Executive Function Disorders [EFD] prefer to avoid more thinking when thinking is out of control in the first place.

Social anxiety, more often than not, is a thinking problem associated with cognitive challenges, less emotional or affective, more likely dopamine related, not serotonin. Antidepressants treating serotonin imbalance can, and often do, aggravate social anxiety.

And that context, each size of the crowd can create different perceptions, different social anxiety, thinking, contexts.

Why Avoid The Big Crowd: Social anxiety

  1. Social anxiety based upon thinking about the numbers and the variables increased with more people.
  2. More things can happen.
  3. Some prefer the big crowd because they don’t have to think or talk.
  4. Big crowds offer either 1. anonymity and reassuring distractions from intimacy, or 2. much more proximity and intimacy depending on each ADHD person’s perspective of variables and control.
  5. Remember: Increased variables, decreased structure and no focus create cognitive anxiety.
  6. Some perceive a large crowd as having a focus, as at a concert – the focus is on the band, not on them – and reassuring. Some perceive the crowd as more structure.

Why Avoid The Small Crowd Small group social anxiety

  1. Social anxiety increased due to more conversational possibilities, and thus more spontaneous thinking which would reveal cognitive imbalances.
  2. If you can’t think in an orderly fashion, if cognitive anxiety is already overwhelming, social anxiety for small groups can become more troubling.
  3. Sometimes small groups are reassuring: If – you know everyone and you know you don’t have to think and talk.
  4. Some small groups work if you can go with someone you know, diminishing the pressure for thinking.
  5. Small crowds sometimes involve other variables that would reveal cognitive compromise: like eating, dancing, discussing books in a reading club.
  6. Even at a business meeting, “I have to talk.” On the other hand, if it’s my meeting I control it, no problem.

My Take on Social Anxiety

Take a look at my YouTube Video on ADHD and Cognitive Anxiety over 15,000 views, for a quick overview.

Remember: dopamine related prefrontal cortical problems cannot successfully be treated by serotonergic, antidepressant meds. Antidepressants make ADHD worse.


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  1. Other drugs that can cause anxiety are stimulants such as amphetamines,
    cocaine or crack. When people constantly feel anxious and stressed,
    their bodies respond in physical ways such as shutting down, stomach aches, and headaches.

    • Dr Charles Parker

      Yes, absolutely correct. Regrettably none of these medical issues, either with diagnosis or treatment, becomes absolutely predictable every time. And yes, meds can cause problems. The simple reason for this post: some can demonstrate anxiety that derives from PFC dysregulation and can often be quickly addressed with even low doses of the correct medications.

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