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Problems with concentration, angry outbursts, sleep disturbances, and socially withdrawn behaviors are all examples of symptoms of children who have experienced a significant event, or trauma.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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When things feel hard or the world feels big, children will be looking to their important adults for signs of safety. They will be asking, ‘Do you think I'm safe?' 'Do you think I can do this?' With everything in us, we have to send the message, ‘Yes! Yes love, this is hard and you are safe. You can do hard things.'

Even if we believe they are up to the challenge, it can be difficult to communicate this with absolute confidence. We love them, and when they're distressed, we're going to feel it. Inadvertently, we can align with their fear and send signals of danger, especially through nonverbals. 

What they need is for us to align with their 'brave' - that part of them that wants to do hard things and has the courage to do them. It might be small but it will be there. Like a muscle, courage strengthens with use - little by little, but the potential is always there.

First, let them feel you inside their world, not outside of it. This lets their anxious brain know that support is here - that you see what they see and you get it. This happens through validation. It doesn't mean you agree. It means that you see what they see, and feel what they feel. Meet the intensity of their emotion, so they can feel you with them. It can come off as insincere if your nonverbals are overly calm in the face of their distress. (Think a zen-like low, monotone voice and neutral face - both can be read as threat by an anxious brain). Try:

'This is big for you isn't it!' 
'It's awful having to do things you haven't done before. What you are feeling makes so much sense. I'd feel the same!

Once they really feel you there with them, then they can trust what comes next, which is your felt belief that they will be safe, and that they can do hard things. 

Even if things don't go to plan, you know they will cope. This can be hard, especially because it is so easy to 'catch' their anxiety. When it feels like anxiety is drawing you both in, take a moment, breathe, and ask, 'Do I believe in them, or their anxiety?' Let your answer guide you, because you know your young one was built for big, beautiful things. It's in them. Anxiety is part of their move towards brave, not the end of it.
Sometimes we all just need space to talk to someone who will listen without giving advice, or problem solving, or lecturing. Someone who will let us talk, and who can handle our experiences and words and feelings without having to smooth out the wrinkles or tidy the frayed edges. 

Our kids need this too, but as their important adults, it can be hard to hush without needing to fix things, or gather up their experience and bundle it into a learning that will grow them. We do this because we love them, but it can also mean that they choose not to let us in for the wrong reasons. 

We can’t help them if we don’t know what’s happening in their world, and entry will be on their terms - even more as they get older. As they grow, they won’t trust us with the big things if we don’t give them the opportunity to learn that we can handle the little things (which might feel seismic to them). They won’t let us in to their world unless we make it safe for them to.

When my own kids were small, we had a rule that when I picked them up from school they could tell me anything, and when we drove into the driveway, the conversation would be finished if they wanted it to be. They only put this rule into play a few times, but it was enough for them to learn that it was safe to talk about anything, and for me to hear what was happening in that part of their world that happened without me. My gosh though, there were times that the end of the conversation would be jarring and breathtaking and so unfinished for me, but every time they would come back when they were ready and we would finish the chat. As it turned out, I had to trust them as much as I wanted them to trust me. But that’s how parenting is really isn’t it.

Of course there will always be lessons in their experiences we will want to hear straight up, but we also need them to learn that we are safe to come to.  We need them to know that there isn’t anything about them or their life we can’t handle, and when the world feels hard or uncertain, it’s safe here. By building safety, we build our connection and influence. It’s just how it seems to work.♥️
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#parenting #parenthood #mindfulparenting
Words can be hard sometimes. The right words can be orbital and unconquerable and hard to grab hold of. Feelings though - they’ll always make themselves known, with or without the ‘why’. 

Kids and teens are no different to the rest of us. Their feelings can feel bigger than words - unfathomable and messy and too much to be lassoed into language. If we tap into our own experience, we can sometimes (not all the time) get an idea of what they might need. 

It’s completely understandable that new things or hard things (such as going back to school) might drive thoughts of falls and fails and missteps. When this happens, it’s not so much the hard thing or the new thing that drives avoidance, but thoughts of failing or not being good enough. The more meaningful the ‘thing’ is, the more this is likely to happen. If you can look behind the words, and through to the intention - to avoid failure more than the new or difficult experience, it can be easier to give them what they need. 

Often, ‘I can’t’ means, ‘What if I can’t?’ or, ‘Do you think I can?’, or, ‘Will you still think I’m brave, strong, and capable of I fail?’ They need to know that the outcome won’t make any difference at all to how much you adore them, and how capable and exceptional you think they are. By focusing on process, (the courage to give it a go), we clear the runway so they can feel safer to crawl, then walk, then run, then fly. 

It takes time to reach full flight in anything, but in the meantime the stumbling can make even the strongest of hearts feel vulnerable. The more we focus on process over outcome (their courage to try over the result), and who they are over what they do (their courage, tenacity, curiosity over the outcome), the safer they will feel to try new things or hard things. We know they can do hard things, and the beauty and expansion comes first in the willingness to try. 
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#parenting #mindfulparenting #positiveparenting #mindfulparent
Never in the history of forever has there been such a  lavish opportunity for a year to be better than the last. Not to be grabby, but you know what I’d love this year? Less opportunities that come in the name of ‘resilience’. I’m ready for joy, or adventure, or connection, or gratitude, or courage - anything else but resilience really. Opportunities for resilience have a place, but 2020 has been relentless with its servings, and it’s time for an out breath. Here’s hoping 2021 will be a year that wraps its loving arms around us. I’m ready for that. x
The holidays are a wonderland of everything that can lead to hyped up, exhausted, cranky, excited, happy kids (and adults). Sometimes they’ll cycle through all of these within ten minutes. Sugar will constantly pry their little mouths wide open and jump inside, routines will laugh at you from a distance, there will be gatherings and parties, and everything will feel a little bit different to usual. And a bit like magic. 

Know that whatever happens, it’s all part of what the holidays are meant to look like. They aren’t meant to be pristine and orderly and exactly as planned. They were never meant to be that. Christmas is about people, your favourite ones, not tasks. If focusing on the people means some of the tasks fall down, let that be okay, because that’s what Christmas is. It’s about you and your people. It’s not about proving your parenting stamina, or that you’ve raised perfectly well-behaved humans, or that your family can polish up like the catalog ones any day of the week, or that you can create restaurant quality meals and decorate the table like you were born doing it. Christmas is messy and ridiculous and exhausting and there will be plenty of frayed edges. And plenty of magic. The magic will happen the way it always happens. Not with the decorations or the trimmings or the food or the polish, but by being with the ones you love, and the ones who love you right back.

When it all starts to feel too important, too necessary and too ‘un-let-go-able’, be guided by the bigger truth, which is that more than anything, you will all remember how you all felt – as in how happy they felt, how loved they felt were, how noticed they felt. They won’t care about the instagram-worthy meals on the table, the cleanliness of the floors, how many relatives they visited, or how impressed other grown-ups were with their clean faces and darling smiles. It’s easy to forget sometimes, that what matters most at Christmas isn’t the tasks, but the people – the ones who would give up pretty much anything just to have the day with you.

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