Is it ADHD? Or Could it be Trauma

Is it ADHD? Or Could it be Trauma

We see kids all over the place that act wild, hyperactive, and excessively energetic, and we often assume they have ADHD. We need to realize, with great compassion, that the symptoms of ADHD and trauma look very similar.

Problems with concentration, angry outbursts, sleep disturbances, and socially withdrawn behaviors are all examples of symptoms of children who have experienced a significant event, or trauma. The symptoms for ADHD include difficulty sustaining attention, difficulty organizing tasks, hyperactivity, impulsivity, and difficulty following through with instructions. They sound pretty similar, right?

When a child has experienced domestic violence, drug addicted parents, neglect, and an unstable home environment we would expect them to struggle. What about if they had a surgery (or surgeries) at an early age when they did not comprehend what was happening? What if a child felt helpless as he watched his family fall apart and he blamed himself while his parent’s divorced? What if there was unknown sexual abuse that a child feels unwilling (or unable) to talk about? Are we as parents, physicians, and mental health providers missing the possibility that our children may have been traumatized, and treating it as ADHD?

The treatments for Trauma and ADHD are very different. If a clinician, teacher, or parent observes a child’s hyperactive behavior, or distractibility, they might conclude that the child has ADHD without realizing that the real problem could be unresolved trauma. Giving a child who has been traumatized stimulant medication can wreak havoc on their nervous systems. Teaching them coping skills for their inattention is pointless if they need to process a traumatic event (or events.) 

Taking a thorough history is the first step for proper treatment. Exploring events such as surgeries, difficult dental procedures, sudden changes in behavior (which might signal sexual/physical abuse or bullying), and significant life changes (such as moving to a new school) is essential in teasing out the differences between ADHD and trauma.

The brain stores traumatic events that are unresolved in the mid brain. When a child is triggered by a similar event later on, or is excessively stressed, his behavior can mimic ADHD. Picture it like someone who is carrying a backpack of experiences. For most of us, the “backpack” has a few things that were challenging in it, but we trudge on because it’s not overly significant. When a child has traumatic experiences his “backpack” is “fuller and heavier” than other kids, and his brain is working overtime to manage the load.

Normally, when everything is working well, we use our prefrontal cortex (PFC,) which is in the front of the brain, to help us make important decisions. When trauma is present, or is triggered, the child is often flooded with the survival skills he was born with and may not have access to his prefrontal cortex. The memories in the midbrain (the backpack of traumatic experiences) sabotage the brain’s ability to use the “thinking” part of the brain, or the PFC. Instead the need for “fight or flight” shows up due to the trauma history, and the child can act like he is distracted, hypervigilant, and inattentive. He is not a behavior problem, he needs help.

One solution to this challenge is allowing a safe place for the child to process any significant events to rule out trauma. There are treatments available today to release trauma such as EMDR, somatic experiencing, and brainspotting.

Often with traditional talk therapy, a child processes using the “thinking” part of their brain. This can be very difficult and cause the child to not want to continue with therapy. With brain-body trauma therapy using the above-mentioned methods, the child processes in the mid-portion of the brain and it releases the “stuck” event which causes the ADHD-like symptoms to release.

Using Brainspotting and bilateral sound with a simple headset, the therapist can guide the child to remember a “medium sized” event so they can feel what it is like to release it. Rapport is important for a child to feel safe enough to revisit the trauma. The difference in this type of therapy is that the child isn’t just remembering the event, he is releasing it from the “stuck” part of his midbrain. After the release, it is easier for the child to learn new skills that improve his behaviors.

I have seen children reduce their anxious behaviors, improve concentration, and change how they look at past events that previously overwhelmed them using brain-body trauma processing. The treatment is often much shorter than traditional treatments because it’s solving the underlying problem before introducing Cognitive Behavioral Treatment interventions. As parents, teachers, and health care professionals, let us be aware of the similarities of ADHD and trauma, and find out what will truly help our kids get better… and allow them to thrive.


About the Author: Helene E. Goble, MFT

Helene GobleHelene Goble a Marriage and Family Therapist practicing in Fair Oaks, CA. She specializes in treating individuals with ADHD, couples With ADHD, and people who have experienced trauma. She also volunteers with ‘The Soldier’s Project’, which is a volunteer organization working to help Veterans and their families adjust to their return to civilian life. Find out more about Helene at www.helenegoblemft.com.

20 Comments

Sue

Thanks for the really interesting article, I read it with interest and wonder if this could be perhaps my daughter’s problem.
She has been school refusing for 6 months now. This started after a number of events in her primary school where she developed a phobia of vomiting when someone vomited and it splashed onto her skirt and she wasn’t allowed to wash it.She coped with this phobia(just about) for a couple of years but it was brought to a head just over 6 mths ago when she was forced to stay in the classroom where somebody vomited. It was mismanaged after that with a couple more incidents of children vomiting and her being forced into the classroom. She has since joined secondary school but after 2 incidents (child feeling unwell and a boy pretending to be sick) she is school refusing to the point of self harm and threatening suicide.
Your thoughts would be gravely appreciated.

Reply
Karen - Hey Sigmund

Sue here are a couple of articles that might help. Your daughter’s fear is understandable given the experiences she has had with people vomiting around her. Memories can be very powerful. This article talks about how to help kids with fears and phobias https://www.heysigmund.com/phobias-and-fears-in-children/. Here is another article that will help to explain what is happening in her brain when she feels anxious. https://www.heysigmund.com/anxiety-in-kids/. It’s very possible that when she is in a situation that triggers a memory of vomit or people vomiting around her, her brain tries to protect her. This is the fight or flight response and it’s how anxiety happens. Explaining where it comes from can be very empowering for kids, so that when they get the feeling that there is something to be frightened of (as in when she has to go to school) she can understand that it is the work of her overprotective brain, and that it doesn’t really mean something bad is going to happen. Hope this helps.

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Emily

That’s really interesting, because I had a similar experience. I developed a phobia of vomiting (Emetophobia) that caused me severe anxiety while in grade school and high school. Any time I felt like burping, I was convinced I had to vomit and would have a full blown anxiety attack. I was CONSTANTLY anticipating being sick, and could never just enjoy life. I didn’t take school trips, go to sleepovers, or anywhere that might trigger being ill. The turning point came when my Mom noted that it was possible that I would never, ever vomit again (although unlikely… she didn’t mention that at the time of course). This helped me rationalize that I didn’t have to fear it constantly, since it may never happen. Eventually I forced myself to stop letting the anxiety interfere with enjoying my life – when the anxiety came I resigned myself to just riding it out. Not fighting it, just letting it wash over me and eventually pass. I’ve since grown out of the fear of vomiting, but for many, many years of my life it affected me in a huge way. Hope this gives some insight!

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Patty

I remember my sister ( a teacher) once told me that many children who come from abusive homes have ADD/ADHD. This article makes perfect sense. It’s actually trauma mimicking ADD/ADHD symptoms. I appreciate the work you do with trauma victims & those suffering from ADD/ADHD.

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Kelly

I was abused , beaten, molested by my brother and his friends and still am very traumatized by the beating and verbal abuse that my mother used for her amusement.

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Karen - Hey Sigmund

Kelly I’m so sorry that this has happened to you. These things you have described should never ever have happened. The people who have hurt you should have protected you, and it is completely understandable that you are still traumatized. You don’t have to do the healing on your own. I would strongly encourage you to speak to a counsellor (if you aren’t already) who can give you the support you need to heal from what has happened to you. We all need support from others sometimes. You deserve to find a way through this and to be happy. I wish you love and healing moving forward.

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Mama M.

My niece moved in with me a year ago, after neglect from both parents and being moved back and forth from parent to grandparents. She had to adjust to a new city, school, home and came with little of her own. She was defiant and aggressive initially with tons of hyperactivitt. I thought she was ADHD but quickly realized she suffers from trauma. A few months ago she started therapy and adjusted my parenting of her. Happy to say we have made great strides. We are all happier and she is doing better socially and academically at school. Slow but steady progress being made.

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Maggie

Wow! I like this article. Would it be similar to autism? My brother was diagnosed autism spectrum disorder. After reading your article maybe after all he is not but just suffering from trauma. When he was still few months old he had a major operation in his hernia. Would you think its really that that causing him? How can a baby who had a trauma from a medical procedure be revived? Thanks

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Mandy

Some children with autistic traits can get a mis diagnosis , as these traits may have been manifested from attachment issues , abuse, neglect , trauma , to name a few . How ever there are many children who are on the autistic spectrum with learning difficulties (some severe) which would go beyond the scope of being explained by trauma induced and this must be remembered .
A detailed history of the child would need to be explored to get to the true nature of the child’s difficulties and which avenues would help the most .

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Maria

This was such a great article. My now seven-year-old had been diagnosed with ADHD since the age of 4 and now I’m starting to think that that wasn’t the right route to go. Where would I be able to find this type of treatments he is currently on medication because of his diagnosis at the time. He has only been on medication for 3 months and I do anything to remove them from medications but I also want to help them thrive. Any advice or any suggestion would be very helpful. Thank you.

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Debbie

WOW, this is very interesting and really has my mind spinning if this is what my son is struggling with. He’s 20 now and is a bit easier to control himself physically and mentally but maybe I’ve been treating him for bi-polar when he has trauma.

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Nadine

This was highly interesting to me. My eldest daughter suffered 2 traumatic events back to back then refused school and started to exhibit OCD traits such as everything in even numbers, crossing over doorways twice, lights on and off twice. The school (taken over by an academy) – another trauma she experienced after the first 2 as stability and known staff were gone were very quick to say ADHD. I pointed out all the trauma she was experiencing and felt ADHD was incorrect (perfect school record and attendance until this point) through counselling and change of change we got there but it was traumatic for us all. 3 years on and just back from her first high school parents meeting she is doing amazing. My dilemma is now that my youngest nearly 9 has suddenly started to display the same behaviour but there hasn’t been ‘big’ traumas recently but much going back she witnessed by daughters behaviour which was distressing and violent and my ex husbands violence (she was about 2/3yrs) Has she stored up the memories or learnt the behaviour from the past and had it suddenly triggered by an event do you think ? She has found it tough her sister going to high school and missing her. Big sister also doesn’t want to play games etc much anymore ? A bit confused in how to deal with the younger one now as I can’t pinpoint the triggers ?

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Angela

This could well be the case with my 13 year old son, who we’ve been trying to get help for since he was 8 !! He was diagnosed with ADHD last year . Trying to get someone to help is another story though plus he won’t engage with anyone ?

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Anue Nue

Or could it be the childhood trauma of grief over the loss of relationship with a living relative/grandparent whom nobody in the child’s life speaks about, or to anymore?

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Meeka

Hi Sigmund,

This was a very interesting article to read. I am an elementary School Counselor and private practice therapist. I see many students who are diagnosed with ADHD, but it may in fact be a trauma they experienced early in life. This is something parents do not tend to disclose as I fear they are afraid of being judged and keep key information such as that to themselves. Noteable, I have noticed my ADHD students increase which is quite alarming. There is a mix between those being medicated and those who are not. I see behavior concerns in those who are not medicated, but fear that instability in the home may be to blame for school behavior and failure to complete homework.

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Daphne C.

I stumbled upon this gem of an article! It certainly makes one pause and think. I was a classroom teacher for many years and after reading your article the light bulb went on in my head. I’ve come across quite a few students who met the criteria for trauma and not ADHD. Thank you for such an enlightening article!

Reply
Emry

This makes a lot of sense for me. When I was five, I had just moved to Colorado, just gotten out of the homeless shelter and off the streets, and had almost been killed by my classmates when I was diagnosed with ADHD. I never thought that could have ever linked to my diagnosis in any way and will keep it in mind.

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Michelle C

What do i ask for when trying to finda therapist do these kinds of treatments? My son has had 3 open heart surgeries all under the age of 3 and I’ve always believed his behavior since is more PTSD than ADHD. after his 3rd surgery his personality TOTALLY changed and hasn’t been the same since! He’s being treated for adhd (he’s 12 now) but i really don’t think thats it. Any help would be appreciated

Reply
Karen Young

Michelle try the governing body for psychologists or therapists in your country, and see if they can point you in the direction of somebody who deals with children and trauma.

Reply

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Anxiety has a way of demanding ALL of the attention. It shifts the focus to what feels scary, or too big, or impossible, or what needs to be avoided, or what feels bad, or what our kiddos can’t do. As the grown ups who love them, we know they are capable of greatness, even if that greatness is made up of lots of tiny steps, (as great things tend to be).
Physical activity is the natural end to the fight or flight response (which is where the physical feelings of an anxiety attack come from). Walking will help to burn the adrenalin and neurochemicals that have surged the body to prepare it for flight or fight, and which are causing the physical symptoms (racy heart, feeling sick, sweaty, short breaths, dry mouth, trembly or tense in the limbs etc). As well as this, the rhythm of walking will help to calm their anxious amygdala. Brains love rhythm, and walking is a way to give them this. 
⠀⠀
Try to help your young one access their steady breaths while walking, but it is very likely that they will only be able to do this if they’ve practised outside of an anxiety attack. During anxiety, the brain is too busy to try anything unfamiliar. Practising will help to create neural pathways that will make breathing an easier, more accessible response during anxiety. If they aren't able to access strong steady breaths, you might need to do it for them. This will be just as powerful - in the same way they can catch your anxiety, they will also be able to catch your calm. When you are able to assume a strong, calm, steady presence, this will clear the way for your brave ones to do the same.
The more your young one is able to verbalise what their anxiety feels like, the more capacity they will have to identify it, acknowledge it and act more deliberately in response to it. With this level of self-awareness comes an increased ability to manage the feeling when it happens, and less likelihood that the anxiety will hijack their behaviour. 

Now - let’s give their awareness some muscle. If they are experts at what their anxiety feels like, they are also experts at what it takes to be brave. They’ve felt anxiety and they’ve moved through it, maybe not every time - none of us do it every time - maybe not even most times, but enough times to know what it takes and how it feels when they do. Maybe it was that time they walked into school when everything in them was wanting to walk away. Maybe that time they went in for goal, or down the water slide, or did the presentation in front of the class. Maybe that time they spoke their own order at the restaurant, or did the driving test, or told you there would be alcohol at the party. Those times matter, because they show them they can move through anxiety towards brave. They might also taken for granted by your young one, or written off as not counting as brave - but they do count. They count for everything. They are evidence that they can do hard things, even when those things feel bigger than them. 

So let’s expand those times with them and for them. Let’s expand the wisdom that comes with that, and bring their brave into the light as well. ‘What helped you do that?’ ‘What was it like when you did?’ ‘I know everything in you wanted to walk away, but you didn’t. Being brave isn’t about doing things easily. It’s about doing those hard things even when they feel bigger than us. I see you doing that all the time. It doesn’t matter that you don’t do them every time -none of us are brave every time- but you have so much courage in you my love, even when anxiety is making you feel otherwise.’

Let them also know that you feel like this too sometimes. It will help them see that anxiety happens to all of us, and that even though it tells a deficiency story, it is just a story and one they can change the ending of.
During adolescence, our teens are more likely to pay attention to the positives of a situation over the negatives. This can be a great thing. The courage that comes from this will help them try new things, explore their independence, and learn the things they need to learn to be happy, healthy adults. But it can also land them in bucketloads of trouble. 

Here’s the thing. Our teens don’t want to do the wrong thing and they don’t want to go behind our backs, but they also don’t want to be controlled by us, or have any sense that we might be stifling their way towards independence. The cold truth of it all is that if they want something badly enough, and if they feel as though we are intruding or that we are making arbitrary decisions just because we can, or that we don’t get how important something is to them, they have the will, the smarts and the means to do it with or without or approval. 

So what do we do? Of course we don’t want to say ‘yes’ to everything, so our job becomes one of influence over control. To keep them as safe as we can, rather than saying ‘no’ (which they might ignore anyway) we want to engage their prefrontal cortex (thinking brain) so they can be more considered in their decision making. 

Our teens are very capable of making good decisions, but because the rational, logical, thinking prefrontal cortex won’t be fully online until their 20s (closer to 30 in boys), we need to wake it up and bring it to the decision party whenever we can. 

Do this by first softening the landing:
‘I can see how important this is for you. You really want to be with your friends. I absolutely get that.’
Then, gently bring that thinking brain to the table:
‘It sounds as though there’s so much to love in this for you. I don’t want to get in your way but I need to know you’ve thought about the risks and planned for them. What are some things that could go wrong?’
Then, we really make the prefrontal cortex kick up a gear by engaging its problem solving capacities:
‘What’s the plan if that happens.’
Remember, during adolescence we switch from managers to consultants. Assume a leadership presence, but in a way that is warm, loving, and collaborative.♥️
Big feelings and big behaviour are a call for us to come closer. They won’t always feel like that, but they are. Not ‘closer’ in an intrusive ‘I need you to stop this’ way, but closer in a ‘I’ve got you, I can handle all of you’ kind of way - no judgement, no need for you to be different - I’m just going to make space for this feeling to find its way through. 

Our kids and teens are no different to us. When we have feelings that fill us to overloaded, the last thing we need is someone telling us that it’s not the way to behave, or to calm down, or that we’re unbearable when we’re like this. Nup. What we need, and what they need, is a safe place to find our out breath, to let the energy connected to that feeling move through us and out of us so we can rest. 
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But how? First, don’t take big feelings personally. They aren’t a reflection on you, your parenting, or your child. Big feelings have wisdom contained in them about what’s needed more, or less, or what feels intolerable right now. Sometimes it might be as basic as a sleep or food. Maybe more power, influence, independence, or connection with you. Maybe there’s too much stress and it’s hitting their ceiling and ricocheting off their edges. Like all wisdom, it doesn’t always find a gentle way through. That’s okay, that will come. Our kids can’t learn to manage big feelings, or respect the wisdom embodied in those big feelings if they don’t have experience with big feelings. 
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We also need to make sure we are responding to them in the moment, not a fear or an inherited ‘should’ of our own. These are the messages we swallowed whole at some point - ‘happy kids should never get sad or angry’, ‘kids should always behave,’ ‘I should be able to protect my kids from feeling bad,’ ‘big feelings are bad feelings’, ‘bad behaviour means bad kids, which means bad parents.’ All these shoulds are feisty show ponies that assume more ‘rightness’ than they deserve. They are usually historic, and when we really examine them, they’re also irrelevant.
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Finally, try not to let the symptoms of big feelings disrupt the connection. Then, when calm comes, we will have the influence we need for the conversations that matter.

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