ADHD and Trauma

I've just read a very interesting article on the association of ADHD and trauma called Towards an understanding of the ADHD-Trauma connection. (Littman 2009).

I became more interested in this connection through involvement in our ADHD support group and also working with families affected by domestic violence. It became clear to me that there were similarities and I began to think about some of our families in our support group where trauma was also  present and to ask myself "Is it ADHD, or is it trauma/domesticviolence related?"

There are similarities between the behaviours of children with ADHD and trauma. According to Littman, in response to repeated trauma, the child's brain will try to protect itself, leading to hypervigilance. This hypervigilance can mimic hyperactivity and inattentiveness because the child becomes more focussed on distractions. Littman says that since both ADHD and trauma result in similar cognitive and behavioural manifestations, this can lead to misdiagnosis and the wrong treatment.

A child experiencing trauma has increased levels of adrenaline and norepinephrine and the goal is to reduce these levels. If a child is misdiagnosed, and treated with stimulant medication used to treat ADHD (increasing dopamine levels), a further increase in these neurotransmitters occurs, exacerbating the behaviours.

ADHD and trauma both affect the executive functions of the brain. According to Littman, the manifestations of early trauma are extremely difficult to distiguish from those of ADHD, and a differential diagnosis based on behavioural  assessment is therefore challenging.

This is clearly an area that requires more understanding and research. There are children misdiagnosed with ADHD who have experienced repeated trauma. And of course, there are also children with ADHD who experience trauma. This is an area fraught with difficulty for those who diagnose because of these similarities.

I believe we need to show understanding to parents whose children have been diagnosed with ADHD even if it turns out to be a misdiagnosis. Having fostered a child who experienced repeated trauma, and raising a son with ADHD and no trauma involved, I know first hand how similar the behaviours can be and how difficult it is for parents and the medical fraternal in those situations.

But it is food for thought. If we are concerned about the level of ADHD diagnosis in our society, maybe we need to look further into this and also ask ourselves if we are as concerned with the level of violence and trauma our children experience, and if this is exacerbating the situation.

Children with ADHD and children affected by trauma deserve to receive the right diagnosis and the appropriate treatment so that they are given every chance of growing into adulthood as responsible and productive members of society who have much to offer.