During the pandemic, were you one of the many people home all day with your children and begin to notice behavior issues that you hadn’t seen before? Did you begin to think that your child possibly might have ADHD (Attention Deficit and Hyperactivity Disorder) symptoms? You probably didn’t think about how childhood trauma could be mistaken for ADHD.
You are not alone in noticing child behavior problems this past year. There has been a large increase in the number of ADHD cases diagnosed since the spring of 2020. I have to wonder, though, if many of those cases actually could be misdiagnosed ADHD. That is because many common psychiatric symptoms are easily misinterpreted in children, leading to kids being misdiagnosed as having ADHD.
Studies Addressing Misdiagnosis of ADHD
One of the most common conditions that can cause ADHD-like behavior is childhood trauma or PTSD (Post Traumatic Stress Disorder). It is estimated that PTSD may be misdiagnosed as ADHD in up to a million children per year in the United States.
A study that looked at the overlap between the symptoms of ADHD and the effects of traumatic stress on children caused by maltreatment and abuse was based on a survey of 65,000 children. The results showed that those who had been diagnosed with ADHD also had a significantly higher than average chance of coming from a background of divorce, poverty, violence, and/or families who misused drugs or alcohol.
Another study involved the analysis of 701 children’s medical records. The children involved came from violent and economically deprived neighborhoods. Two-thirds of the children had experienced at least one ACE (Adverse Childhood Experience). The more ACEs the children had experienced, the more likely they were to display behavioral problems. The researchers involved in the study were concerned that many of these children were receiving diagnoses of ADHD when a diagnosis of PTSD or other stress-induced condition would be more appropriate.
I will be the first to admit that mental health diagnosis is not easy, especially in children. It is not unusual for mental health providers to misread symptoms. They may mistake signs of anxiety or mood disorder for ADHD. They also may misdiagnose a learning disability, sensory processing disorder, or autism spectrum disorder as ADHD. To complicate matters, ADHD may also co-exist with any of these disorders. All of this can lead to childhood trauma being mistaken for ADHD.
Medical experts note that ADHD is a more likely diagnosis when your child has shown a long pattern of symptoms. You should obtain a thorough evaluation that will rule out other causes for some of the symptoms. When sorting out ADHD and PTSD, or a combination of both, a provider should approach a case like a detective without a lead, open to any possibility.
To better understand these two disorders, let’s break them down.
ADHD is a neurological and developmental disorder. If you have ADHD, you have less developed, smaller, and less active areas of the brain that deal with emotions, self-awareness, and impulsivity. This causes significant functional impairment in many areas of life such as learning, decision-making, organizing, and relating to others. ADHD is typically present from birth although its symptoms may not present until later in childhood.
ADHD symptoms can include:
• Problems following instructions
• Fidgeting and squirming
• Poor organizational skills
• Excessive talking
• Interrupting or intruding on others
• Losing items that are necessary for tasks and activities
• Difficulty concentrating
• Difficulty with waiting and taking turns
PTSD results from a traumatic event or series of events in a child’s or adult’s environment that causes changes in the brain. Traumatic events lead to physiological, cognitive, and emotional changes in how you process stressful incidents and worries. You feel chronically unsafe, which in turn, causes you to produce higher than normal amounts of the stress hormone cortisol. So you respond easily and often to the fight/flight part of the brain, becoming so focused on personal safety that you can’t pay attention in daily life.
Related Reading: Why Understanding what Trauma Does to the Brain Helps You Heal
Some symptoms specific to PTSD are:
• Feelings of shame and guilt
• Risk-taking behaviors
• A tendency for aggressive behaviors
• Avoidance behaviors
• Outbursts of rage/anger
Presentation of Symptoms
The presentation of PTSD may appear similar to that of ADHD and either can be easily mistaken for the other. The presentation may change as children become adults, but neither condition is likely to disappear entirely. The symptoms of either may stay steady or even increase as the affected person encounters new stressful situations. Therefore, many trauma survivors struggle beyond childhood with symptoms that look like ADHD and vice versa.
Symptoms that ADHD and PTSD have in common:
• Sleep problems
• Difficulty with concentration
Childhood Trauma and ADHD
If a child has witnessed trauma, for example, sporadic violence and excessive levels of aggression, their brain will “hardwire” itself to remain in a constant state of alert. Because of the unpredictable nature of traumatic events, a child doesn’t know when the next event is likely to occur. The only way of self-protection is to remain alert and hypervigilant.
A child showing hypervigilance in a classroom may appear to others as being fidgety and distracted. If their brain unconsciously tells them they must scan their environment for potential threats and danger at all times, it can be difficult to give their full attention to a particular task. In addition, if a teacher tries getting the child’s attention by shouting at them, the child may unconsciously interpret the body language and facial expressions to be threatening.
So in cases like these, what looks like ADHD actually is trauma. The child’s attention is directed to threat, rather than things like learning. The effects of childhood trauma can greatly affect attention span and executive functioning of an individual. It looks like ADHD, and too often, that is the quick, go-to diagnosis, instead of considering the possibility that a child has been mistreated or witnessed trauma and might actually have PTSD. This is how childhood trauma could be mistaken for ADHD.
You might be wondering if trauma causes ADHD. To be clear, there is no evidence of that. And conversely, ADHD can not cause PTSD, although people with ADHD are more prone to high-risk behavior and negative habits of self-medicating, making them more vulnerable to traumatic events. Unfortunately, when these conditions do occur together, each worsens the effect of the other. People with ADHD are usually less resilient than others. When they face trauma, they may be more vulnerable to its effects.
For ADHD, medication (usually stimulants) combined with behavioral and cognitive therapy has proven most effective in treating symptoms. However, stimulants can worsen agitation, a symptom of PTSD. It can also make a person with PTSD more anxious and hypervigilant. So again, it is critical that a comprehensive evaluation for ADHD be done.
For PTSD, psychotherapy is typically most effective, and body-based therapies including EMDR (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing have shown lasting results. When medication is used, it is usually prescribed to help mood disorder symptoms associated with PTSD.
Ready to start?
If you’re in northern Illinois, the counselors at Life Care Wellness are ready to help you and your child by starting with an appropriate assessment and diagnosis. And we can suggest ADHD psychiatrists near you if medication would be a helpful addition to treatment. Contact us today to get started.
Rhonda Kelloway, LCSW, SEP
Rhonda Kelloway is a co-owner and principal therapist at Life Care Wellness, a group psychotherapy practice in Glen Ellyn, Chicago (Jefferson Park neighborhood), and Sycamore, Illinois. She is a trauma specialist utilizing a Somatic Experiencing framework to utilize the body’s wisdom in healing. She also uses EMDR and a variety of traditional psychotherapy approaches in her work. In addition to being a psychotherapist, she is a trained divorce and family mediator.