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Problems with concentration, angry outbursts, sleep disturbances, and socially withdrawn behaviors are all examples of symptoms of children who have experienced a significant event, or trauma.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

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

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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.

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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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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!

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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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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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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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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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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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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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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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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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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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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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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.

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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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Anxiety is a sign that the brain has registered threat and is mobilising the body to get to safety. One of the ways it does this is by organising the body for movement - to fight the danger or flee the danger. 

If there is no need or no opportunity for movement, that fight or flight fuel will still be looking for expression. This can come out as wriggly, fidgety, hyperactive behaviour. This is why any of us might pace or struggle to sit still when we’re anxious. 

If kids or teens are bouncing around, wriggling in their chairs, or having trouble sitting still, it could be anxiety. Remember with anxiety, it’s not about what is actually safe but about what the brain perceives. New or challenging work, doing something unfamiliar, too much going on, a tired or hungry body, anything that comes with any chance of judgement, failure, humiliation can all throw the brain into fight or flight.

When this happens, the body might feel busy, activated, restless. This in itself can drive even more anxiety in kids or teens. Any of us can struggle when we don’t feel comfortable in our own bodies. 

Anxiety is energy with nowhere to go. To move through anxiety, give the energy somewhere to go - a fast walk, a run, a whole-body shake, hula hooping, kicking a ball - any movement that spends the energy will help bring the brain and body back to calm.♥️
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#parenting #anxietyinkids #childanxiety #parenting #parent
This is not bad behaviour. It’s big behaviour a from a brain that has registered threat and is working hard to feel safe again. 

‘Threat’ isn’t about what is actually safe or not, but about what the brain perceives. The brain can perceive threat when there is any chance missing out on or messing up something important, anything that feels unfamiliar, hard, or challenging, feeling misunderstood, thinking you might be angry or disappointed with them, being separated from you, being hungry or tired, anything that pushes against their sensory needs - so many things. 

During anxiety, the amygdala in the brain is switched to high volume, so other big feelings will be too. This might look like tears, sadness, or anger. 

Big feelings have a good reason for being there. The amygdala has the very important job of keeping us safe, and it does this beautifully, but not always with grace. One of the ways the amygdala keeps us safe is by calling on big feelings to recruit social support. When big feelings happen, people notice. They might not always notice the way we want to be noticed, but we are noticed. This increases our chances of safety. 

Of course, kids and teens still need our guidance and leadership and the conversations that grow them, but not during the emotional storm. They just won’t hear you anyway because their brain is too busy trying to get back to safety. In that moment, they don’t want to be fixed or ‘grown’. They want to feel seen, safe and heard. 

During the storm, preserve your connection with them as much as you can. You might not always be able to do this, and that’s okay. None of this is about perfection. If you have a rupture, repair it as soon as you can. Then, when their brains and bodies come back to calm, this is the time for the conversations that will grow them. 

Rather than, ‘What consequences do they need to do better?’, shift to, ‘What support do they need to do better?’ The greatest support will come from you in a way they can receive: ‘What happened?’ ‘What can you do differently next time?’ ‘You’re the most wonderful kid and I know you didn’t want this to happen. How can you put things right? Do you need my help with that?’♥️
Big behaviour is a sign of a nervous system in distress. Before anything, that vulnerable nervous system needs to be brought back home to felt safety. 

This will happen most powerfully with relationship and connection. Breathe and be with. Let them know you get it. This can happen with words or nonverbals. It’s about feeling what they feel, but staying regulated.

If they want space, give them space but stay in emotional proximity, ‘Ok I’m just going to stay over here. I’m right here if you need.’

If they’re using spicy words to make sure there is no confusion about how they feel about you right now, flag the behaviour, then make your intent clear, ‘I know how upset you are and I want to understand more about what’s happening for you. I’m not going to do this while you’re speaking to me like this. You can still be mad, but you need to be respectful. I’m here for you.’

Think of how you would respond if a friend was telling you about something that upset her. You wouldn’t tell her to calm down, or try to fix her (she’s not broken), or talk to her about her behaviour. You would just be there. You would ‘drop an anchor’ and steady those rough seas around her until she feels okay enough again. Along the way you would be doing things that let her know your intent to support her. You’d do this with you facial expressions, your voice, your body, your posture. You’d feel her feels, and she’d feel you ‘getting her’. It’s about letting her know that you understand what she’s feeling, even if you don’t understand why (or agree with why). 

It’s the same for our children. As their important big people, they also need leadership. The time for this is after the storm has passed, when their brains and bodies feel safe and calm. Because of your relationship, connection and their felt sense of safety, you will have access to their ‘thinking brain’. This is the time for those meaningful conversations: 
- ‘What happened?’
- ‘What did I do that helped/ didn’t help?’
- ‘What can you do differently next time?’
- ‘You’re a great kid and I know you didn’t want this to happen, but here we are. What can you do to put things right? Do you need my help with that?’♥️
As children grow, and especially by adolescence, we have the illusion of control but whether or not we have any real influence will be up to them. The temptation to control our children will always come from a place of love. Fear will likely have a heavy hand in there too. When they fall, we’ll feel it. Sometimes it will feel like an ache in our core. Sometimes it will feel like failure or guilt, or anger. We might wish we could have stopped them, pushed a little harder, warned a little bigger, stood a little closer. We’re parents and we’re human and it’s what this parenting thing does. It makes fear and anxiety billow around us like lost smoke, too easily.

Remember, they want you to be proud of them, and they want to do the right thing. When they feel your curiosity over judgement, and the safety of you over shame, it will be easier for them to open up to you. Nobody will guide them better than you because nobody will care more about where they land. They know this, but the magic happens when they also know that you are safe and that you will hold them, their needs, their opinions and feelings with strong, gentle, loving hands, no matter what.♥️
Anger is the ‘fight’ part of the fight or flight response. It has important work to do. Anger never exists on its own. It exists to hold other more vulnerable emotions in a way that feels safer. It’s sometimes feels easier, safer, more acceptable, stronger to feel the ‘big’ that comes with anger, than the vulnerability that comes with anxiety, sadness, loneliness. This isn’t deliberate. It’s just another way our bodies and brains try to keep us safe. 

The problem isn’t the anger. The problem is the behaviour that can come with the anger. Let there be no limits on thoughts and feelings, only behaviour. When children are angry, as long as they are safe and others are safe, we don’t need to fix their anger. They aren’t broken. Instead, drop the anchor: as much as you can - and this won’t always be easy - be a calm, steadying, loving presence to help bring their nervous systems back home to calm. 

Then, when they are truly calm, and with love and leadership, have the conversations that will grow them - 
- What happened? 
- What can you do differently next time?
- You’re a really great kid. I know you didn’t want this to happen but here we are. How can you make things right. Would you like some ideas? Do you need some help with that?
- What did I do that helped? What did I do that didn’t help? Is there something that might feel more helpful next time?

When their behaviour falls short of ‘adorable’, rather than asking ‘What consequences they need to do better?’ let the question be, ‘What support do they need to do better.’ Often, the biggest support will be a conversation with you, and that will be enough.♥️
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#parenting #positiveparenting #mindfulparenting #anxietyinkids

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