ADHD in Children, Childhood Trauma, or PTSD in Children?
By psychotherapist and counselor Eualalee Thompson, MSc, PGDip
The emerging literature is coalescing around the view that children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) could very well be exhibiting symptoms of another mental health condition, Post-traumatic Stress Disorder (PTSD). The research is pointing towards an overlapping symptom profile for ADHD in children and PTSD in children, in a way that may be difficult for clinicians to separate.
One in nine US children or about 6.4 million children have been diagnosed with ADHD, which can have both a genetic link as well as physical and environmental causes. Children with symptoms of ADHD usually exhibit inattention, hyperactivity and impulsivity. However, it is not uncommon for children exposed to early trauma to become inattentive or become hyperactive as they re-experience the trauma, avoid trauma stimuli, or undergo hypervigilance. Re-experiencing, avoidance, and hypervigilance are the three subcategories of a PTSD diagnosis, and this can especially be evidence for PTSD in children.
Studies indicate children diagnosed with ADHD often have had adverse childhood experiences
A recent study presented at last May’s Pediatric Academic Societies annual meeting in Vancouver, Canada, revealed that a large percentage of children with an ADHD diagnosis also indicated exposure to many adverse childhood experiences (ACEs) such as divorce, poverty, family substance abuse, and violence. In that study it was determined that children exposed to four or more traumatic experiences were three times more likely to use medication for ADHD.
The study led by pediatrician Nicole Brown analyzed data for about 65,680 children ages 6 to 17, with data taken from the 2011-2012 National Survey of Children’s Health. In this survey parents answered questions relating to their children’s ADHD diagnosis as well as to exposure to adverse events. The association between ADHD and PTSD symptoms in children could indicate that while the children do meet the threshold for an ADHD diagnosis, trauma therapy might more-fully realize an overall improvement in ADHD and PTSD symptoms that are common to both. Dr. Brown hypothesizes that what might be interpreted as ADHD may be symptoms that are the result of “externalizing behavior as a result of family dysfunction or other traumatic experience.”
Brown is not the first researcher to point to a possible link between ADHD symptoms and trauma. In a presentation entitled, “Differentiating PTSD and ADHD”, by Elizabeth Risch, Ph.D.and Melissa Hakman, Ph.D., commonalities between ADHD and PTSD symptoms in children include, “psychosocial risk factors”, “impulsivity”, “hyperactivity”, and inattention as a result of “trauma reaction”. They also note that “trauma reaction may increase social difficulties”; social difficulties are common for children with ADHD as well as those with PTSD symptoms.
ADHD is a more popular diagnosis than PTSD
Dr. Kate Szymanski, a trauma expert and an associate professor at Adelphi University’s Derner Institute, has also been interested in the trauma-ADHD-PTSD in children link. Szymanski and colleagues have been exploring whether trauma is a risk factor for ADHD or whether trauma symptoms are misdiagnosed for ADHD. Szymanski found that in earlier research of a sample of children in foster homes, most had experienced physical abuse or other trauma events, but that a third of the children were diagnosed with ADHD, while only eight-percent had been diagnosed with PTSD. She questions whether there might be “confusion or over-eagerness–or both” in the preference to label children with ADHD rather than diagnosing PTSD.
Some clinicians express concern of how a child suffering agitation or hyper-vigilance as a result of PTSD might react to ADHD stimulant drug treatment. Rather than favoring an ADHD diagnosis in children, trauma needs to carefully considered by clinicians as a possible cause of symptoms. One therapist teaches traumatized children how to deal with fear and anxiety, as well as providing training and therapy for parents who might better learn to defuse a child’s anxiety and trauma rather than contribute to it.
Less than adequate treatment for children with PTSD and ACEs results
The clinical implication in sifting through the conundrum could mean the difference between adequate or less than adequate treatment for children who display the systems typically interpreted as ADHD, but that are also inherent as a reaction to trauma and in PTSD in children.
About the author:
Eualalee Thompson, MSc, PGDip, is a trained and practicing psychotherapist and counselor, in private practice since 2005. She works with clients experiencing general emotional and behavioral issues, and most commonly assists her clients with anxiety, depression, post traumatic stress (PTSD), and surviving sexual abuse. She works with adolescents experiencing behavioral issues and is a PhD candidate in Psychology. Ms. Thompson also is an award-winning health editor and journalist.
References for “ADHD in Children, Childhood Trauma, or PTSD in Children?”
1. Ford, J., Racusin, R., Ellis, C., Daviss, W., Reiser, J., Fleischer, A., & Thomas, J. (2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with Oppositional Defiant and Attention Deficit Hyperactivity Disorders. Child Maltreatment, 5(3), 205-217.
2. Risch, E., Hakman, M. Differentiating PTSD and ADHD. Oklahoma University of Medicine. Retrieved March 14, 2015. http://www.oumedicine.com/docs/ad-pediatrics-workfiles/ptsd-adhd_presentation_0902091.pdf?sfvrsn=2
3. Ruiz, R. (2014, July 7). How Childhood Trauma Could Be Mistaken for ADHD. The Atlantic. http://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328/
4. Study Finds ADHD and Trauma Often go Hand in Hand. (2014, May 6). American Academy of Pediatrics. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Study-Finds-ADHD-and-Trauma-Often-go-Hand-in-Hand.aspx
5. Szymanski, K., Sapanski, L., & Conway, F. (2011). Trauma and ADHD – Association or diagnostic confusion? A clinical perspective. Journal of Infant, Child, and Adolescent Psychotherapy, 10(1), 51-59. doi: 10.1080/15289168.2011.575704
Photo: “Stressed Out Primary Girl Child Holding Her Head” by stockimages – www.freedigitalphotos.net/