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Problems with concentration, angry outbursts, sleep disturbances, and socially withdrawn behaviors are all examples of symptoms of children who have experienced a significant event, or trauma.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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How we are with them, when they are their everyday selves and when they aren’t so adorable, will build their view of three things: the world, its people, and themselves. This will then inform how they respond to the world and how they build their very important space in it. 

Will it be a loving, warm, open-hearted space with lots of doors for them to throw open to the people and experiences that are right for them? Or will it be a space with solid, too high walls that close out too many of the people and experiences that would nourish them.

They will learn from what we do with them and to them, for better or worse. We don’t teach them that the world is safe for them to reach into - we show them. We don’t teach them to be kind, respectful, and compassionate. We show them. We don’t teach them that they matter, and that other people matter, and that their voices and their opinions matter. We show them. We don’t teach them that they are little joy mongers who light up the world. We show them. 

But we have to be radically kind with ourselves too. None of this is about perfection. Parenting is hard, and days will be hard, and on too many of those days we’ll be hard too. That’s okay. We’ll say things we shouldn’t say and do things we shouldn’t do. We’re human too. Let’s not put pressure on our kiddos to be perfect by pretending that we are. As long as we repair the ruptures as soon as we can, and bathe them in love and the warmth of us as much as we can, they will be okay.

This also isn’t about not having boundaries. We need to be the guardians of their world and show them where the edges are. But in the guarding of those boundaries we can be strong and loving, strong and gentle. We can love them, and redirect their behaviour.

It’s when we own our stuff(ups) and when we let them see us fall and rise with strength, integrity, and compassion, and when we hold them gently through the mess of it all, that they learn about humility, and vulnerability, and the importance of holding bruised hearts with tender hands. It’s not about perfection, it’s about consistency, and honesty, and the way we respond to them the most.♥️

#parenting #mindfulparenting
Anxiety and courage always exist together. It can be no other way. Anxiety is a call to courage. It means you're about to do something brave, so when there is one the other will be there too. Their courage might feel so small and be whisper quiet, but it will always be there and always ready to show up when they need it to.
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But courage doesn’t always feel like courage, and it won't always show itself as a readiness. Instead, it might show as a rising - from fear, from uncertainty, from anger. None of these mean an absence of courage. They are the making of space, and the opportunity for courage to rise.
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When the noise from anxiety is loud and obtuse, we’ll have to gently add our voices to usher their courage into the light. We can do this speaking of it and to it, and by shifting the focus from their anxiety to their brave. The one we focus on is ultimately what will become powerful. It will be the one we energise. Anxiety will already have their focus, so we’ll need to make sure their courage has ours.
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But we have to speak to their fear as well, in a way that makes space for it to be held and soothed, with strength. Their fear has an important job to do - to recruit the support of someone who can help them feel safe. Only when their fear has been heard will it rest and make way for their brave.
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What does this look like? Tell them their stories of brave, but acknowledge the fear that made it tough. Stories help them process their emotional experiences in a safe way. It brings word to the feelings and helps those big feelings make sense and find containment. ‘You were really worried about that exam weren’t you. You couldn’t get to sleep the night before. It was tough going to school but you got up, you got dressed, you ... and you did it. Then you ...’
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In the moment, speak to their brave by first acknowledging their need to flee (or fight), then tell them what you know to be true - ‘This feels scary for you doesn’t it. I know you want to run. It makes so much sense that you would want to do that. I also know you can do hard things. My darling, I know it with everything in me.’
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#positiveparenting #parenting #childanxiety #anxietyinchildren #mindfulpare
Separation anxiety has an important job to do - it’s designed to keep children safe by driving them to stay close to their important adults. Gosh it can feel brutal sometimes though.

Whenever there is separation from an attachment person there will be anxiety unless there are two things: attachment with another trusted, loving adult; and a felt sense of you holding on, even when you aren't beside them. Putting these in place will help soften anxiety.

As long as children are are in the loving care of a trusted adult, there's no need to avoid separation. We'll need to remind ourselves of this so we can hold on to ourselves when our own anxiety is rising in response to theirs. 

If separation is the problem, connection has to be the solution. The connection can be with any loving adult, but it's more than an adult being present. It needs an adult who, through their strong, warm, loving presence, shows the child their abundant intention to care for that child, and their joy in doing so. This can be helped along by showing that you trust the adult to love that child big in our absence. 'I know [important adult] loves you and is going to take such good care of you.'

To help your young one feel held on to by you, even in absence, let them know you'll be thinking of them and can't wait to see them. Bolster this by giving them something of yours to hold while you're gone - a scarf, a note - anything that will be felt as 'you'.

They know you are the one who makes sure their world is safe, so they’ll be looking to you for signs of safety: 'Do you think we'll be okay if we aren't together?' First, validate: 'You really want to stay with me, don't you. I wish I could stay with you too! It's hard being away from your special people isn't it.' Then, be their brave. Let it be big enough to wrap around them so they can rest in the safety and strength of it: 'I know you can do this, love. We can do hard things can't we.'

Part of growing up brave is learning that the presence of anxiety doesn't always mean something is wrong. Sometimes it means they are on the edge of brave - and being away from you for a while counts as brave.
Even the most loving, emotionally available adult might feel frustration, anger, helplessness or distress in response to a child’s big feelings. This is how it’s meant to work. 

Their distress (fight/flight) will raise distress in us. The purpose is to move us to protect or support or them, but of course it doesn’t always work this way. When their big feelings recruit ours it can drive us more to fight (anger, blame), or to flee (avoid, ignore, separate them from us) which can steal our capacity to support them. It will happen to all of us from time to time. 

Kids and teens can’t learn to manage big feelings on their own until they’ve done it plenty of times with a calm, loving adult. This is where co-regulation comes in. It helps build the vital neural pathways between big feelings and calm. They can’t build those pathways on their own. 

It’s like driving a car. We can tell them how to drive as much as we like, but ‘talking about’ won’t mean they’re ready to hit the road by themselves. Instead we sit with them in the front seat for hours, driving ‘with’ until they can do it on their own. Feelings are the same. We feel ‘with’, over and over, until they can do it on their own. 

What can help is pausing for a moment to see the behaviour for what it is - a call for support. It’s NOT bad behaviour or bad parenting. It’s not that.

Our own feelings can give us a clue to what our children are feeling. It’s a normal, healthy, adaptive way for them to share an emotional load they weren’t meant to carry on their own. Self-regulation makes space for us to hold those feelings with them until those big feelings ease. 

Self-regulation can happen in micro moments. First, see the feelings or behaviour for what it is - a call for support. Then breathe. This will calm your nervous system, so you can calm theirs. In the same way we will catch their distress, they will also catch ours - but they can also catch our calm. Breathe, validate, and be ‘with’. And you don’t need to do more than that.
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.

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