https://www.pexels.com/photo/spider-web-34225/ Imagine the intricate complexities of a spider’s web — one thread attaches to dozens of others; pull just one of those silky strands and the entire web collapses. Living with attention deficit hyperactivity disorder (ADHD) and trauma can feel similar — the symptoms are so intertwined a single tug may cause the whole tangled web to cave in.
Studies show that experiencing trauma increases a patient’s chances of being diagnosed with ADHD. 1 What’s more, teasing out the origins of a patient’s trauma — and assessing its impact on the brain and body — can be complicated since many symptoms of trauma overlap with those of ADHD. 1 These symptoms include: Difficulty concentrating
Impulsivity and/or restlessness
Problems connecting with others
ADHD or Trauma? It’s Complicated
Typically present in early childhood, ADHD is a brain-based disorder often diagnosed after a child struggles in school, or even later in life. Trauma is the result of exposure to stressful events or experiences that can occur at anytime during a person’s life. If trauma occurs during childhood, when the brain is developing, it can lead to cognitive and emotional changes that may resemble ADHD.
According to the most recent statistics from the Centers for Disease Control and Prevention (CDC) , ADHD impacts 9.4 percent of children and about 4.4 percent of adults in the United States. Around 64 percent of children with ADHD also have at least one additional mental health diagnosis, such as post-traumatic stress disorder (PTSD) , anxiety, or mood disorder. 2
Trauma is also prevalent in the U.S., where up to 70 percent of adults report experiencing at least one traumatic event in their lifetime. 3 The death of a loved one, divorce, car accidents, caregiver abuse or neglect, living through a natural disaster, experiencing racism, being the victim of a crime or witnessing one — these can all impact the way a person thinks or feels. If left untreated, the problem may become debilitating.
Each person has their own unique response to trauma; what’s traumatic for one person may not be for another. Not all trauma has lasting effects, but it may become chronic with persistent symptoms. Nightmares, frightening flashbacks, intrusive thoughts, avoidance of things associated with the trauma (traveling in a car, for example, if a car crash triggered your trauma), emotional dysregulation, and hypervigilance are all associated with PTSD.
However, you can have trauma-based nervous system dysregulation and not have PTSD. Other trauma-spectrum symptoms (which are also common in PTSD) include anxiety , low mood, difficulty concentrating, numbing (lack of emotion), and feelings of shame and guilt . Trauma symptoms also include physical manifestations, such as, headaches, nausea, shaking, chest tightness, shallow breathing, and lightheadedness. 3,4
Because symptoms of ADHD and trauma present similarly, accurately assessing and treating them requires skill and experience. Here’s an example to illustrate the complexity: Poor working memory is associated with ADHD, but consider how the mind can avoid thinking about a distressing experience. Practitioners must suss out whether poor memory stems from ADHD or trauma, and treat accordingly. When the Body Carries Emotional Stress
You may have heard of the chronic stress response before. It is commonly referred to as the “fight or flight” response. Another name for it is “sympathetic arousal,” because it is an activation of the sympathetic nervous system . Sympathetic arousal is our body’s involuntary response to danger.
[ Do You Have a Working Memory Deficit? Take This Self-Test Now ]
Think of a time when you came into contact with a threat, like a fast-approaching car as you were crossing the street. Your “ fight or flight ” response probably went into high alert, causing adrenaline and cortisol to rush through your body, your heart rate to increase, and all of your muscles to tense up.
If this response happens repeatedly — on a less intense level — for many months or years, the body learns to treat everything it encounters as a dangerous threat. Over time, it creates fixed action patterns in the body’s tissues, such as habitual muscle tension (think of a clenching jaw or raised shoulders), digestive distress, and neurons that fire the same way over and over (defensive behavior patterns). All of these are signs of dysregulation. The nervous system has learned to respond to past events as if they are happening in the present. How Growing Up with ADHD Causes Trauma
Co-occurring ADHD and trauma are more common than previously thought. People with ADHD are often bullied, feel like they don’t fit in, struggle academically and socially in school, and are admonished by adults for behaviors over which they have little control. It’s easy to see how all this adds up to trauma for some people and how the two disorders become entangled.
Think of the nervous system as our body’s version of a building’s electrical wiring. The brain is the fuse box. The nerves are the wires that extend throughout the body. Our wires contain billions of neurons that communicate via neurotransmitters much like electricity — jumping from one neuron to the next.
In people with ADHD and trauma, the neurological functioning becomes altered and dysregulated, causing the wiring to fire differently. This begs the question, was the neurological functioning impaired by nurture or nature? ADHD and trauma are so interrelated, we may never be able to tease them apart. So how do we move forward? We treat both. Untangling the Web: Treating Both Conditions
If we only treat one condition or the other, the untreated condition will mask any significant progress in the treatment of the other. People with both ADHD and trauma need strategies for executive functioning , but in order to regulate the nervous system, they must also process the trauma.
Medication is a good place to start because it is a well-researched treatment for both disorders. If pharmacological interventions are successful, life becomes more manageable, and therapy more effective. True healing can begin.
For example, when a stimulant medication improves sustained focus, behavior treatment can […]