ADHD and OCD Co-Occurring in NJ: Bergen County ERP and Executive Functioning Help
By Dana Colthart, LCSW – Clear Light Therapy, Englewood, NJ
It’s common for people to struggle for years thinking they “just have ADHD” or “just have OCD,” only to find out later that both conditions are present and that their symptoms are interacting in ways that make life feel chaotic, confusing, and overwhelming.
As a therapist working with ADHD, OCD, anxiety disorders, and executive functioning concerns in Bergen County, New Jersey, I see this pattern often. In fact, research suggests that about 25% of young people with OCD also meet criteria for ADHD, and around 11% of individuals with ADHD have OCD as well, a significant overlap that clinicians need to pay attention to.
When ADHD and OCD co-occur, it’s not just having two diagnoses, it’s how the symptoms interact that shapes someone’s lived experience and determines what treatment is effective. In this blog, I’ll explain:
what ADHD symptoms look like in adults,
how OCD presents differently,
why co-occurrence is common,
and what to do when both conditions are present.
This is written from my experience as an ADHD therapist in NJ and an OCD specialist with Clear Light Therapy, with real clinical insight and practical guidance rather than surface-level definitions.
What ADHD Symptoms Look Like in Adults
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects attention, executive functioning, emotional regulation, and impulse control. While ADHD is often first diagnosed in childhood, many people aren’t diagnosed until adulthood, especially those who learned coping strategies early on or who are high-achieving but internally overwhelmed.
Here are the most common ADHD symptoms I see in adult clients:
1. Time Blindness
Difficulty estimating how long tasks will take, losing track of time, and under- or overestimating deadlines.
2. Executive Function Challenges
Trouble initiating or organizing tasks, planning, remembering information, or completing projects.
3. Inattention and Distractibility
Trouble maintaining focus on tasks that don’t provide immediate stimulation or “dopamine hits.”
4. Hyperfocus
Intense, sustained concentration on activities that are intrinsically rewarding, sometimes to the point of losing hours unintentionally.
5. Trouble With Tasks You Dislike
Tasks that feel boring, unrewarding, or unstimulating often remain undone despite good intentions.
6. Overstimulation & Sensory Sensitivity
Crowded spaces, loud environments, or too many inputs can feel overwhelming.
7. Talking Fast or Interrupting
A common feature of ADHD is impulsive speech or difficulty waiting one’s turn.
8. Emotional Regulation Issues
Quick emotional shifts, frustration, irritability, or sensitivity to perceived criticism.
9. Trouble Waiting in Line or Delays
Low tolerance for delays or waiting, often linked to impulse control.
10. High-Risk Activities for Dopamine Seeking
Tasks that provide novelty or reward may be pursued impulsively or repeatedly.
11. Eating and Food-Related Issues
Some clients report impulsive eating, disordered eating patterns, or using food to manage attention or reward.
All of these symptoms are tied to underlying executive functioning deficits, problems with working memory, inhibitory control, planning and sequencing, and sustaining attention, which are hallmark characteristics of ADHD.
As an ADHD therapist in NJ, I help clients understand these patterns and develop strategies to manage them (like dopamine anchoring, task buddies, time management skills, and executive functioning coaching).
What OCD Symptoms Look Like
Obsessive-Compulsive Disorder (OCD) is a different kind of struggle. Where ADHD involves executive functioning differences and attention regulation, OCD involves intrusive thoughts and repetitive behaviors aimed at reducing distress. These thoughts are not wanted, they are ego-dystonic, meaning they run counter to what the person wantsor believes.
Typical OCD symptoms include:
Intrusive thoughts that are disturbing, unwanted, or graphic
Rumination — repetitive thinking over and over
Compulsions — behaviors or mental acts done to reduce anxiety
Contamination fears and avoidance
Relationship OCD — constant doubt about the quality or “rightness” of a relationship
Sexual or religious intrusive thoughts that feel shocking
False-memory OCD — where a person fears they did something they can’t remember
Health OCD — fear of illness despite reassurance
Money or financial OCD — fear of wasting, losing, or making mistakes with finances
Fear of social embarrassment or doing something inappropriate
Harm OCD — intrusive thoughts about causing harm accidentally (e.g., hit-and-run fears)
OCD involves what we call the four-step cycle:
Intrusive Thought (Obsession)
Anxiety or Distress
Compulsive Response (checking, reassurance, mental reviewing)
Temporary Relief — which reinforces the cycle
This cycle continues because the brain learns that the compulsive behavior reduces anxiety, even though it only does so temporarily. Unlike ADHD, where attention and impulsivity are the central problems, OCD symptoms revolve around certainty seeking and reducing distress linked to very specific themes.
Why ADHD and OCD Often Co-Occur
Although ADHD and OCD might appear very different on the surface, one involving impulsivity and inattention, the other involving intrusive thoughts and compulsions, they often appear together.
Research indicates that people diagnosed with OCD are much more likely than the general population to also have ADHD, and vice versa. In youth samples, approximately 25% of individuals with OCD also have ADHD, and about 11% of those with ADHD have OCD.
This means:
Nearly 1 in 4 young people with OCD also have ADHD
More than 1 in 10 people with ADHD also experience OCD
Comparatively, children and teens with ADHD have notably higher rates of comorbid psychiatric conditions overall — including anxiety disorders, than the general population.
The co-occurrence also means symptoms can overlap in ways that make diagnosis tricky. For example:
Someone with ADHD may struggle to sustain attention and then ruminate obsessively about having “failed” because of that distraction.
Someone may impulsively do something (ADHD) and then spend hours replaying whether it was “wrong” (OCD).
Emotional dysregulation and executive dysfunction (ADHD) can intensify distress from intrusive thoughts (OCD).
When both disorders are present, it’s not a simple add-on — it’s an interaction that affects how symptoms show up and respond to treatment.
Signs You Might Be Experiencing Both ADHD and OCD
When ADHD and OCD co-occur, certain patterns tend to emerge:
Conflicting internal experiences: impulses to act and then intense rumination about consequences
Overactive mind + intrusive thoughts: the ADHD mind jumps, but the OCD mind gets stuck
Difficulty initiating tasks due to fear or perfectionism: executive function issues amplified by avoidance
Time lost to rumination despite distractibility: a common paradox people describe
Hyperfocus around intrusive thoughts: you may be able to lock onto some things for hours but struggle with everyday tasks
Emotional dysregulation + anxiety flare cycles that feel uncontrollable
Because both conditions affect cognitive control and emotional stability, it’s easy to see why many people self-diagnose using TikTok, Reddit, or Google only to find the experience overwhelming and confusing.
Do not self-diagnose yourself using social media or online forums. These platforms can be relatable but not accurate in distinguishing ADHD from OCD or other conditions. The only reliable way to know what’s truly going on is through a thorough assessment by a qualified clinician, especially when more than one condition might be present.
What Treatment Actually Helps When ADHD and OCD Co-Occur
When both ADHD and OCD are present, treatment needs to address both sets of symptoms without inadvertently making either worse.
The Right Approach for OCD
For OCD symptoms, Exposure and Response Prevention (ERP) is the gold standard. ERP works by:
Helping you face feared thoughts, sensations, or situations
Teaching you to resist compulsive behaviors (including mental checking)
Allowing anxiety to naturally rise and fall without reassurance
Reducing avoidance over time
ERP changes the brain’s fear response and teaches that certainty is not required for safety — even when the thought feels incredibly threatening.
The Right Approach for ADHD
ADHD treatment focuses on executive functioning skills and symptom management. This often includes:
1. Executive Functioning Support
High-yield strategies like structured routines, external reminders, and visual schedulers.
2. Dopamine Anchoring
Connecting tasks to immediate incentives to increase motivation.
3. Time Management Skills
Learning to break tasks into smaller steps, use timers, and minimize time blindness.
4. Task Buddies and Accountability
Working with someone to stay on task and reduce distractibility.
5. Medication Where Appropriate
Stimulants or non-stimulant medications can improve attention and reduce impulsivity.
Medication can be useful when ADHD and/or OCD co-occur. Many clients benefit from SSRIs to help regulate OCD and anxiety symptoms, and stimulants to support focus and executive function — always under medical supervision.
The Power of ACT
Acceptance and Commitment Therapy (ACT) complements ERP and ADHD skill building by teaching:
acceptance of uncomfortable internal experiences
cognitive defusion (distancing from thoughts)
value-based living despite anxiety or distraction
ACT helps reduce the struggle against thoughts, both intrusive (OCD) and distracting (ADHD).
When to Seek Professional Help Instead of Relying on Social Media
It’s becoming more common for people to try to diagnose themselves using TikTok, Instagram, Reddit, and posts that seem relatable. While connection can be validating, these platforms cannot provide reliable diagnosis or individualized treatment planning.
Self-diagnosing based on trends can lead to:
misdiagnosis
inappropriate coping strategies
increased anxiety or confusion
reinforcement of symptoms that should be treated differently
The best pathway is a professional assessment by a therapist experienced in both ADHD and OCD evaluation — not an online quiz or viral clip.
Clear Light Therapy: Our Approach and Support
At Clear Light Therapy in Englewood, NJ, we specialize in treating clients with complex presentations, including ADHD, OCD, anxiety disorders, and co-occurring conditions.
Here’s what makes our approach distinct:
We assess both ADHD and OCD thoroughly to capture overlapping symptoms.
We provide personalized treatment plans that integrate ERP for OCD and executive functioning coaching for ADHD.
We use ACT to help build flexibility with thoughts and emotions.
We partner with clients in long-term skill building, not quick fixes.
Our team includes clinicians like Angela Matus, who offers virtual therapy nights, mornings, and weekends, and is specially trained in both ADHD and OCD assessment and treatment. Clients consistently describe her as warm, supportive, and deeply knowledgeable.
When you begin treatment with Clear Light Therapy, you also receive our 35-page ADHD/OCD workbook, which is a practical tool to support learning and accountability throughout your therapy journey.
We work with adults from across Bergen County, including Englewood, Ridgewood, Tenafly, Fort Lee, Paramus, Mahwah, Saddle River, Upper Saddle River, and beyond. Virtual sessions are available throughout New Jersey for those who need flexibility. Reach out for a free 15-min consult HERE.
FAQ – ADHD & OCD Co-Occurrence
What is time blindness in ADHD?
Time blindness refers to difficulty sensing the passage of time, underestimating how long tasks take, losing track of time, or struggling with deadlines.
Can ADHD and OCD occur together?
Yes. Estimates suggest about 25% of individuals with OCD also have ADHD and around 11% of people with ADHD have OCD.
Do anxiety disorders commonly co-occur with ADHD?
Yes. Anxiety disorders, including OCD, are more common in individuals with ADHD than in the general population.
Is hyperfocus a symptom of ADHD?
Yes. Hyperfocus is intense, prolonged focus on tasks that are stimulating or rewarding, which is common in ADHD.
Should I self-diagnose from TikTok or Reddit?
No. Social media content can be relatable but not accurate for diagnosis. Always seek a professional evaluation.
What is ERP?
Exposure and Response Prevention is an evidence-based therapy for OCD that helps reduce compulsions by facing fears without performing rituals.
Can medication help with both ADHD and OCD?
Yes. For ADHD, stimulants or non-stimulants can improve focus. For OCD, SSRIs can reduce intrusive thoughts. Medication should be overseen by a psychiatrist.
What treatment do you recommend for co-occurring ADHD and OCD?
A combination of ERP for OCD, executive functioning coaching for ADHD, ACT for cognitive flexibility, and potentially medication is most effective.
