ADHD or/and Trauma?
Jessica Chang, MHC-LP.
ADHD is a neurodevelopmental disorder involving symptoms such as difficulty focusing, impulsivity, and hyperactivity. It impacts children and adults alike. As of 2024, over 5 million U.S. children (approximately 8.7% of children in the U.S. ages 3-17) are currently diagnosed with ADHD. In adults worldwide, approximately 366.3 million (6.8%) have symptomatic ADHD and have been diagnosed with ADHD, regardless of age of onset. The research is ongoing, but possible causes of ADHD include genetics, injuries to the brain, use of substances (e.g. alcohol) during pregnancy, and low birth weight.
Adult ADHD (attention deficit hyperactivity disorder) has been receiving a lot of attention on social media and amongst queer and neuro-atypical communities. In general, ADHD has long been a somewhat controversial and often stigmatized topic involving race, gender, and income disparities, although diagnoses can also bring validation and understanding to a person’s schema, both self- and world-. It can also foster a sense of community for neurodivergent folk. The topic of ADHD-diagnosis is commonly paired with discourse on medication and can feel like an opportunity to stop living life on “hard-mode”. However, a topic often overlooked and left out of ADHD conversations amidst misdiagnoses and comorbidities is the intricate overlap of ADHD symptoms with trauma-related symptoms pertaining to PTSD (post-traumatic stress disorder) or complex trauma. It is important to accurately diagnose these symptoms in order for those to receive the best care and avoid further harm and health complications.
ADHD and Trauma
Studies have indicated childhood trauma or ACEs, adverse childhood experiences (e.g. abuse, violence, neglect, poverty, witnessing violence, etc.), as a significant marker for developing ADHD later in life. Evidence has also shown that children with ADHD who have a disturbing experience are four times as likely to develop PTSD than kids without ADHD. Additionally, it is likely that those with ADHD experience more severe trauma symptoms than kids without ADHD. Causes of ADHD are still not fully known, but it is clear that early life stress can impact the shape of a child’s brain. Further, stress can disrupt brain development as well as how the brain regulates thoughts, actions, and feelings. Brain imaging has revealed ADHD and PTSD to be associated with similar irregularities in brain functioning, which could explain the increased risk. Regarding diagnoses, those being evaluated for ADHD should also be screened for PTSD and vice versa.
“Venn Diagram” of ADHD and Trauma-related Symptoms
Both ADHD and Trauma may include the following symptoms:
Being distracted, inattentive, or spacey
Children who have experienced trauma may be mentally elsewhere, re-experiencing, remembering, or attempting to process traumatic events, which can appear as an inattentive type of ADHD.
Hyperactivity or hyperarousal, being fidgety or restless
Children who have experienced trauma or have been exposed to repeated trauma are hypersensitive to signs of danger or threat. Stress hormones course throughout their body, making it difficult to sit still, be calm, or pay attention, similar to symptoms of ADHD.
Impulsivity and oppositional behavior
Kids who have experienced trauma tend to have a more negative worldview and perceive people as a threat/hostile/someone who assumes negative intentions towards them. Their fight or flight system is activated and firing even in the absence of danger. This may cause kids to act out in similar ways that may be seen in kids with ADHD.
Difficulty completing tasks, being organized, planning, managing emotions
Executive functioning is commonly challenging for those who have experienced trauma. The brain region responsible for executive functioning tasks is most affected by ACEs and is also associated with ADHD symptoms.
Trauma symptoms (not typically associated with ADHD)
Physiological symptoms: headaches, racing heartbeat, digestive issues, etc.
Emotional responses: fear, sadness, anger, denial, shame, confusion, etc.
Intrusive, disturbing thoughts
Nightmares and flashbacks in response to the traumatic event
Avoidance of things which may be a reminder of the traumatic experience: avoiding going home or getting in a car, lingering in school hallways
ADHD symptoms (not typically associated with trauma)
Interrupting others in conversation
Excessive talkativeness
The Cycle
The nature of ADHD and trauma symptoms is often cyclical:
Children experience symptoms of ADHD such as hyperactivity or impulsivity. This leads to getting into trouble more so than children without ADHD symptoms. Stressful events ensue, i.e. being reprimanded, violence, punishment, accidents which involve physical harm. These stressful events may register as trauma. Trauma symptoms emerge and exacerbate ADHD symptoms. Cycle repeats.
Alternative cycle:
Children experience a traumatic event which leads to an inability to regulate or make sense of their emotions. Trauma symptoms manifest as or exacerbate common ADHD symptoms, i.e. lack of focus, disruptiveness, impulsivity. See cycle above.
Intersectionality
These cycles can be especially dangerous for some children and have lasting effects into adulthood. Kids who are most at risk of ADHD diagnoses and various types of trauma are those in communities where there is a high level of violence. Additionally, poverty is associated with high levels of trauma, fewer education resources, and overburdened teachers. It has been known that students of color are more likely to be treated as behavior problems than white students, which has historically led to misdiagnoses. Further, BIPOC students are more likely to be referred and suspended for disciplinary reasons than their white peers, and there is a higher likelihood of them experiencing traumatic events, e.g., racial trauma, poverty, community violence, police violence.
Thorough and accurate evaluation and diagnoses of ADHD and PTSD or complex trauma is extremely important. Consequences of misdiagnosis or undiagnosis/unrecognition can be experienced throughout life in various aspects of life, such as: in relationships with others, how one sees the world, how one views themself or their future, difficulty managing thoughts and feelings, exacerbation of existing symptoms, etc. It is imperative that those with ADHD and/or trauma-related symptoms receive appropriate care. Some ADHD medications may increase the level of hypervigilant anxiety often felt by those who have experienced trauma. As a general rule of thumb, people should always consider the full picture of a person’s background and experiences and recognize possible comorbidities when it comes to diagnoses and medication. Speaking with a therapist may be particularly helpful in processing and elucidating pertinent information related to ADHD and trauma.
Sources:
Effa, C. (2024). The link between ADHD and Trauma. MedicalNewsToday.
Miller, C. (2023). Is It ADHD or Trauma? Child Mind Institute.
Wirth, J. (2023). ADHD Statistics And Facts In 2024. Forbes Health.