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Problems with concentration, angry outbursts, sleep disturbances, and socially withdrawn behaviors are all examples of symptoms of children who have experienced a significant event, or trauma.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 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.