ADHD or Trauma?

Over the last few decades, many children and adolescents have been receiving a diagnosis of ADHD at alarming rates.  ADHD, which is typically understood as a brain or nervous system disorder which tends to be genetic in nature, is often identified when a child shows symptoms of inattention, distractibility, hyperactivity and/or impulsivity.  What unfortunately often gets missed with a diagnosis of ADHD, however, is the possibility that traumatic events may be the source of these symptoms.

Even if a formal diagnosis of PTSD (Post-Traumatic Stress Disorder) is not given, traumatic events can still cause similar symptoms to those which characterize ADHD. 

Traumatic events can cause what looks like symptoms of inattention or distractibility – such as daydreaming or ‘spacing out’ – but which actually might be dissociation.  Dissociation is typically characterized by a feeling of numbness or disconnection from thoughts, feelings, memories and one’s surroundings and, when it impacts one’s functioning, is often caused by trauma.  In addition, hyperactivity or impulsivity might actually be hypervigilance. Survivors of trauma are often looking for dangers or threats and might anticipate impending trouble.  This can cause a “fight or flight” response which can be interpreted by the environment as hyperactivity or impulsivity.

Unfortunately, a diagnosis of ADHD is often given without taking a thorough trauma history.  This can cause many practitioners to offer medication and therapy that may not be suited to the needs of individuals who either in the past or are currently experiencing traumatic events.  This misdiagnosis can be catastrophic and can prevent trauma survivors and sufferers from receiving appropriate treatment. 

Stimulant medications are typically prescribed to children and adolescents with ADHD, while these types of medications may actually be contraindicated for individuals with PTSD or similar symptoms.  Furthermore, behavioral therapies for ADHD focus on time management and organizational skills, but won’t be effective in addressing the fear and anxiety which trauma-informed therapy can offer individuals who have experienced adverse life events.              

Research has now been able to show that trauma profoundly affects many different parts of the brain.  Trauma can rewire and affect the development of a growing brain, thus stunting the growth of areas that deal with emotional regulation, impulse control and self-awareness.  This may explain why, once traumatized, an individual may eventually meet the criteria for ADHD, even though ADHD was not present in his or her early development.  Some professionals in the fields of ADHD and trauma are now hypothesizing that ADHD could be caused by both a congenital change in the nervous system as well as a response to severe stress and trauma. 

For parents of children and adolescents who have received a diagnosis of ADHD, it is critical to request that practitioners treating your child first rule out any past or current trauma that might be negatively impacting your child’s behavior and functioning.  A differential diagnosis is important in order for your child to receive the appropriate treatment that will optimize his or her functioning and allow for healing from traumatic life events.

 Aviva Zahavi-Asa, M.S.W., L.C.S.W., is a clinical social worker and a certified couples and family therapist who specializes in ADHD and trauma, especially in complex PTSD.  She provides individual therapy to adolescents and adults, couples therapy, and family therapy to families with children of all ages.   Aviva maintains a private therapy practice in Efrat and Jerusalem and can be reached for consultations and therapy appointments at 072-3971383.  Services are provided in both English and Hebrew.