Q: Did My Son’s Childhood Trauma Cause His ADHD Behavior Problems?
Studies suggest that children raised in institutions commonly experience delayed brain development, which may impact attention, memory, and executive functions. This presents adoptive parents with an additional set of considerations and nuances as they work to address symptoms of ADHD in a positive, loving way.
Reviewed on January 17, 2019
Q: “I’m still confused where my son’s orphanage delay ends and his attention deficit disorder (ADHD or ADD) begins. When we first brought him home, he was a very oral toddler who didn’t know when he was full, tired, or in pain. At 12, he’s now a very active and athletic pre-teen with executive functioning trouble who sometimes lacks common sense and seems easily manipulated by his peers. He plays well with younger kids and adults, but he has a hard time understanding kids his age. He moves at a fast pace through his school work, is constantly on the go, and gets up constantly during mealtime at home (though not at restaurants). Medication has helped a bit. However, his test scores and school work are below average. Has anyone looked into how early childhood institutionalization affects kids with ADHD? Are there other conditions I should get him tested for/discuss with a pediatrician? What is the best form of treatment? Thank you!”
Your son sounds like he’s an energetic, complex boy with a very dedicated mom. Adopting and raising a child with a complicated history makes it difficult to distinguish between ADHD and childhood trauma. Research suggests that children raised in institutions without the benefits of dedicated caregivers’ love and attention may experience long-term mental and emotional problems due to impaired brain development. Growing up in an orphanage, fetal alcohol syndrome, premature birth, and other risk factors may contribute to an elevated risk for inattention, memory, impulsivity, and an ADHD diagnosis among some adopted children.
How Early Childhood Trauma Can Affect Behavior
Children who received inconsistent care in their early years may present lots of contradictions in how they act and think. It may be harder for them to form lasting friendships, to know how to soothe themselves when upset, and to process their feelings appropriately. They tend to mature more slowly, hanging out with younger kids and preferring comfortable social situations.
Imagine your son as a baby who spent a lot of time alone in his crib, being fed, changed and held briefly on a rigid schedule — not when he needed it. Giving him extra time to mature makes sense. He needs to absorb things at his own pace. This process, due to some of the idiosyncrasies in his brain, can be uneven.
Focus on Strengthening Skills
Having worked with families like yours in my practice, I’ve seen the most progress when parents focus on strengthening executive functioning skills rather than trying to parse ADHD from “something else.” Sometimes, behavior is just behavior.
It sounds like he receives good treatment, exercises often and gets plenty of love and care. These things can make him feel safe in the world and connected to people — two of the most important things he didn’t receive in the Russian orphanage. Because of whatever childhood trauma he experienced there, as well as his ADHD and the impact of puberty on his brain and body, your son needs extra help. He isn’t learning and building his ability to manage himself, control his reactions and deal with stress in an age-appropriate way. If he’s not seeing a counselor already, I would recommend finding someone who understands issues related to ADHD and attachment.
What You Can Do Now
I encourage you to collaborate with him to work on setting goals for improving his executive functioning skills. Try these initial steps:
- Pick a calm time to sit down with him. Ask what’s going well and what he’d like to see improve. Write down his ideas.
- Share your reflections on his thoughts and decide together which area is the top priority. It’s important for him to provide input. You’ll experience better results when he’s invested in the issue. Giving him some appropriate control helps compensate for his pockets of delayed development. He didn’t have anyone follow his lead in playing peek-a-boo or building blocks or picking him up when he stumbled as a toddler. Now, when you listen and let him take initiative on something, he can build his confidence. It may seem small and insignificant, but it really matters.
- Come up with a plan to change one behavior. Perhaps you agree to improve mealtime behavior. What’s different between being in a restaurant and at home that causes him to stay at the table? What, if anything, could make the home experience more similar to the one in the restaurant? How can getting up from the table be naturally integrated into the meal? Maybe he’s in charge of filling everyone’s water glasses or clearing the dishes. Pick a few acceptable options, make a list, and put it up in the kitchen.
- Provide rewards. Together, pick an incentive that matters to him, decide what has to happen to earn it, and then follow through. If he doesn’t fulfill the agreement, then there’s no reward. Be firm. Don’t negotiate..
- Institute daily tasks. Before each family meal, ask him to review the list. This will cue his memory.
- Notice and praise his efforts. This provides him with the experience of being seen and accepted for his progress. This can be another healing opportunity.
Whatever happens, try to remember that your son is doing the best he can with the resources he has. In time, he’ll likely mature and develop the skills he needs to be a successful adult. Until then, try to manage your own frustrations and get the support you need. Staying patient and compassionate will carry you through many challenges.
The opinions and suggestions presented above are intended for your general knowledge only and are not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your own or your child’s condition.