Many things can contribute to what we understand as ‘trauma’. For many, adverse childhood experiences (ACE's), whether this be neglect, abuse, a particularly bad split or divorce, a parent with an addiction or mental illness, can all lead to developing some kind of trauma disorder later on in life. ADHD is understood as a developmental neurodiverse disorder, but can trauma inform how we identify and treat it from an earlier age?
Firstly, to understand ADHD’s links to trauma disorders it is important to distinguish between post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD)
PTSD, often but not always, develops as a result of a particularly traumatising event. NHS mentions events such as an attack or assault, vehicle crash, serious health problems, childbirth. PTSD UK also links the likelihood of developing the disorder to natural disasters. PTSD is also frequently associated with military service, as it was first recorded in war veterans, known then as ‘shell shock’.
According to Mind, common symptoms of PTSD include, ‘vivid flashbacks, intrusive thoughts or images of the trauma, nightmares, easily upset or angry, hypervigilance, lack of sleep, irritability’. Another important aspect of PTSD is actively avoiding thinking about the trauma or avoiding reminders, these include: ‘keeping busy, avoiding, feeling emotionally numb, feeling physically numb or detached from your body’.
CPTSD includes many of the same symptoms of PTSD with some important additions, especially as they relate to ADHD. CPTSD is frequently related to those who have experienced early childhood trauma, multiple traumas, and ACE’s. Mind lists some of the following symptoms:
- difficulty controlling your emotions
- feeling angry or distrustful
- feeling as if you’re damaged or worthless
- feeling like nobody can understand what happened to you
- avoiding friendships and relationships, or finding them very difficult
- dissociative symptoms such as depersonalisation or derealisation
- headaches, dizziness, chest pains, stomach ages
- emotional flashbacks.
When discussing the similarities between PTSD and ADHD, an article by ADDitude, a publication focusing on the experiences of people with ADHD and raising awareness around it, said that “Seasoned professionals struggle to decipher the differences and overlap between the two conditions”.
The same article also notes how specific symptoms such as poor impulse control, lack of focus, irritability, poor memory, anxiety, and sensitivity to sensory stimuli are all common across PTSD and ADHD.
How are ADHD and PTSD/CPTSD similar?
ADHD is a neurological disorder that specifically impacts the area of the brain that regulates emotions, self-awareness and impulsivity. PTSD and especially CPTSD, as its most commonly a diagnosis given to people who have experienced trauma in their childhood, rewires neural pathways and especially in cases of childhood trauma, affects brain development.
Interestingly, the area of the brain that is impacted by early childhood trauma is the same area involved in ADHD: the prefrontal cortex, which means many PTSD and especially CPTSD survivors experience the same problems with emotional regulation, self-awareness and impulsivity.
As Amanda Scriver, who wrote on her experiences with the ADHD like symptoms of CPTSD for Healthline said, “While one doesn’t cause the other, studies showcase there is some link between the two conditions. While it’s uncertain of what that connection is, it’s there.”
- See also: 'Are autism and ADHD symptoms of the same underlying condition?'
- See also: 'MDMA and its potential in unlocking the answer to trauma'
- See also: 'EMDR: the “hyperspace” of processing traumatic memories'
So, what does the science say?
Dr Nicole M. Brown, author of a body of research from 2016 titled, Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity said:
“If clinicians aren't routinely discussing exposure to traumatic experiences and identifying ACEs, particularly among children with behavioural concerns such as ADHD, there may be a heightened risk of missing an underlying trauma history or misattributing some of the symptoms of traumatic stress as solely those of ADHD…We sought to examine the link between ADHD and ACE’s in an effort to improve ADHD assessment and management”
This research also found that children who experience socioeconomic disadvantages such as familial mental illness, neighbourhood violence and familial incarceration were more likely to have an ADHD diagnosis that was moderate to severe. As mentioned above, ACE’s are tightly linked to early childhood trauma.
Being the child of a parent with mental illness isn’t guaranteed to result in experiencing trauma, however children who have one or more parent with a mental illness or addiction are more likely to experience neglect, emotional abuse and physical abuse.
A study published in the Journal of Clinical Psychiatry found that “lifetime prevalence of PTSD was significantly higher among adults with ADHD” and that those with PTSD and ADHD had higher rates of major depressive disorder, generalised anxiety disorder and oppositional defiant disorder.
What both bodies of research show is that traumatic experiences, PTSD and ACE’s are hugely impacting the lives of people with an ADHD diagnosis.
Recently the discussion around ADHD, PTSD and CPTSD has been picked up on TikTok, by people with professional experience, personal lived experience but also by those who aren’t quite as experienced as they may seem.
Many of the trending videos on this matter on TikTok are too quick to equate ADHD as simply, a trauma response. This negates all of the solid research that suggests that many children with ADHD have that diagnosis as a result of genetic predisposition; usually because one or both parents also have the diagnosis.
The similarities between PTSD, CPTSD and ADHD, namely executive functioning, attention and emotional regulation - are undeniable. However, it is important to acknowledge that the process of diagnosing trauma disorders and ADHD must be different, due to the neurological implications of ADHD.
Just as the symptoms of CPTSD from early childhood trauma can seemingly trigger ADHD, ADHD can also feedback through to trauma. For a child with an ADHD diagnosis, it can lead to feeling as though they don’t fit in, many are more frequently bullied and find academia and socialising difficult. This can all trigger a stress response in children.
Cortisol rushes through our sympathetic nervous system when we are stressed and gets us ready to fight, flight or freeze. For people experiencing trauma or chronic stress the body and brain becomes unable to regulate this response and therefore the body is always in a state of stress. This then leads to many behaviours and symptoms that people with a PTSD or CPTSD diagnosis will find familiar.
Why trauma informed care matters
How can being more trauma informed when treating children with behavioural dysregulation help increase the likelihood of them getting the correct diagnosis?
ADHD is also chronically underdiagnosed in women and girls. The cultural stereotype of a child with ADHD is a young, hyperactive boy and as with spectrum disorders, much of the outdated diagnostic criteria is based on how the disorder presents in boys and men.
A not very well-known fact is that ADHD falls into two distinct types: predominantly hyperactive, predominantly inattentive. The hyperactive type is more common in boys and men; however, the inattentive type is more common in girls and women and is as ADDitude said, “largely misunderstood and misdiagnosed by medical professionals who mistake them for mood disorders”.
This means many women and girls are living lives of distress and uncertainty, not getting the help they need and deserve.
Until the links between ADHD and trauma are more widely studied, as well as increased understanding of the inattentive type of ADHD, it is too generalising to label ADHD as a trauma response.
However, work from reporter Rebecca Ruiz for The Atlantic and research in the Journal of Infant, Child, and Adolescent Psychotherapy (as well as the two scholarly articles previously mentioned) indicate that identifying the link between ADHD and trauma disorders, will be essential in ensuring adults and children are receiving the correct treatment.
With a holistic, trauma informed approach that doesn’t make assumptions about how a disorder such as ADHD is ‘supposed’ to present in someone, less of these people will fall through the cracks.
Treating ADHD as it might relate to trauma can give practitioners a broader understanding of the disorder itself, and as proven by the research and studies mentioned previously, might make the difference between a person suffering with one or both disorders undiagnosed, misdiagnosed and therefore untreated.