ADHD Comorbidities & Related Conditions

How Trauma and Chronic Stress Affect Developing Brains

Trauma alters the developing brain, triggering behavioral and mental health issues. Under prolonged exposure to stress, resources are diverted from the “thinking” part of the brain to its survival centers. Here, learn how to best support stressed children and teens who have been exposed to traumatic events.

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Faulty working memory, deficient executive functioning, dysregulated emotions, risky behaviors, and school challenges are telltale signs of ADHD — and also common manifestations of trauma in children and teens. Science tells us that exposure to traumatic events and chronic stress undoubtedly affect children’s brains, but experience tells us that outward signs are seldom obvious or easily diagnosable.

Understanding trauma and how it impacts the developing brain is critical to recognizing red flags and supporting stressed children and teens in the heat of the moment — and as they heal.

What Counts as Trauma?

Trauma is a significant, emotional shock that follows a single stressful event or a series of them. There are several types of trauma, generally differentiated by the duration and repetition of the associated traumatic events.

That said, all traumatic events, environments, and experiences share one thing in common: they undermine a child’s sense of safety and stability. They may include the following:

  • School shootings
  • Bullying
  • Abuse: physical, emotional, sexual
  • Neglect
  • Violence at home (victim or witness)
  • Community violence
  • Systemic racism and discrimination
  • Poverty
  • Witnessing death; death of a close family member
  • Extreme weather events
  • Serious accidents and injury
  • Divorce; ongoing conflict between parental figures
  • Household dysfunction
  • Homelessness

[Read: An Overview of Childhood Trauma and ADHD]

Researchers talk about potentially traumatic events in terms of “adverse childhood experiences,” or ACEs. ACES may lead to the development of toxic stress, or excessive activation of the body’s stress response systems.1 Children who experience multiple ACEs have a higher likelihood of developing health issues and other adverse outcomes.2

Trauma is complex and multifaceted. Not everything that is stressful is necessarily traumatic. And what is traumatic for one child or teen may not be traumatic for another. A child with a genetic predisposition to depression, for example, may be affected differently by adverse experiences than would a child without the predisposition.3

Trauma and ADHD

Attention deficit hyperactivity disorder (ADHD) has an intimate and nuanced relationship to trauma. Children with ADHD, for example, are at a higher risk for experiencing ACEs than are children without ADHD.6 ADHD is also more prevalent in children from families living below the poverty line, and poverty, as we know, is linked to trauma.5

How Trauma Changes the Developing Brain

Think of the brain as a peach. The pit (i.e., the limbic system) corresponds to the survival functions of the brain – heart rate, blood pressure, respiration, etc. The fleshy part of the peach (i.e., the prefrontal cortex) is where higher-order functions – problem-solving, shifting, planning, etc. – live. The pit is essentially intact once we’re born, and the fleshy part develops over time.

[Get This Free Download: Secrets of the ADHD Brain]

In healthy brains, these parts seamlessly work together and receive sufficient “fuel” to function and develop. But under stress and exposure to trauma, the brain – under threat – effectively enters survival mode. It funnels more fuel and resources into the pit and diverts them away from the fleshy part of the brain. The prefrontal cortex in a developing brain, therefore, is especially sensitive to the effects of stress.6

Prolonged exposure to trauma and stress is also linked to the following:

  • Smaller volume in the hippocampus – a part of the brain implicated in learning and memory.7
  • High, surging adrenaline and cortisol levels (a result of toxic stress), which flood the fleshy part of the brain and disrupt its long-term development.8
  • Imbalance in the brain’s gray and white matter, resulting in faulty neural communication networks.9

The Effects of Trauma on Children

The pit of the brain is in charge under prolonged stress; the fleshy, “thinking” and regulating part of the brain is incapacitated. Children who experience trauma or chronic stress often exhibit the following behavioral signs and issues (not an exhaustive list):

  • Irritability
  • Impulsivity
  • Inattention
  • Trouble focusing
  • Difficulty recalling information
  • Difficulty following multi-step instructions
  • Poor relationships; social withdrawal
  • Academic underachievement

When children experience trauma early, the impact on brain development may only be evident years down the line, when academic and social demands increase, and brain functions aren’t “online” as expected to meet those demands.

Many of the signs of trauma listed above are also signs of ADHD. What’s more, children with ADHD may be even more sensitive to the effects of traumatic stress.4

Supporting Children After Stressful, Traumatic Events

Various approaches, from cognitive behavioral therapy (CBT) to mindfulness exercises, can help address trauma and shift the brain away from survival mode, even for children with ADHD.

Parents and other caring, trustworthy adults in a child’s life (from older siblings and sport coaches to teachers and other positive role models) also play a major role in shaping a child’s response to trauma and buffering its effects.10

  • Hold space for your child or teen. Don’t pry for information on the traumatic event(s). Instead, assure them that you’re available to talk whenever they are. Ask if they want to watch a movie or go out for ice cream – but don’t show up with an agenda.
  • Practice active listening. Let your child tell their story, uninterrupted, to help them sort through their feelings. Follow up with reflective statements (“What you’re saying is…” or “I think I’m hearing you say…”). Avoid sweeping in with unsolicited advice, which may shut down your child.
  • Simplify your language. Shorten your sentences, avoid lengthy parenthetical phrases, and simplify your vocabulary.
  • Keep your directions brief and short, and anticipate problems. Stressed, anxious children will have difficulty remembering information. Gently remind them about chores and other responsibilities. Offer your support: “I know you have a lot on your mind, but we need to be out of the house by 7 a.m. for school tomorrow. How can I help you so we’re out at that time?”
  • Externalize information. Create a picture list of your child’s morning and bedtime routines, for example, to save them from having to pull out the information from their stressed minds.
  • Model self-regulation. Your child will learn to self-regulate if you set the example. Time-outs (which I believe should never be used for punishment) are great for calming down and regaining control over the brain. Encourage your child to pause and reset as needed.
  • Foster resilience. Help your child…
    • …make connections (family, friends, community, youth groups, etc.)
    • …look for opportunities for self-discovery.
    • …nurture a positive self-view.
    • …accept that change and discomfort are a part of life.
    • …keep moving toward goals and maintain a hopeful outlook despite setbacks.
    • …develop a plan for self-care.

How Does Trauma Affect the Brain? Next Steps

The content for this article was derived, in part, from the ADDitude Mental Health Out Loud episode titled, “How Stress and Trauma Affect Brain Development” [Video Replay and Podcast #407] with Cheryl Chase, Ph.D., which was broadcast live on June 23, 2022.


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View Article Sources

1 Jacob, G., van den Heuvel, M., Jama, N., Moore, A. M., Ford-Jones, L., & Wong, P. D. (2019). Adverse childhood experiences: Basics for the paediatrician. Paediatrics & Child Health, 24(1), 30–37. https://doi.org/10.1093/pch/pxy043

2 Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet. Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4

3 Schmidt C. W. (2007). Environmental connections: a deeper look into mental illness. Environmental Health Perspectives, 115(8), A404–A410. https://doi.org/10.1289/ehp.115-a404

4 Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Academic Pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013

5 Zablotsky B, Alford JM. Racial and ethnic differences in the prevalence of attention- deficit/hyperactivity disorder and learning disabilities among U.S. children aged 3–17 years. NCHS Data Brief, no 358. Hyattsville, MD: National Center for Health Statistics. 2020.

6 Arnsten A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature reviews. Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648

7 Kim, E. J., Pellman, B., & Kim, J. J. (2015). Stress effects on the hippocampus: a critical review. Learning & memory (Cold Spring Harbor, N.Y.), 22(9), 411–416. https://doi.org/10.1101/lm.037291.114

8 Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663

9 Li, L., Wu, M., Liao, Y., Ouyang, L., Du, M., Lei, D., Chen, L., Yao, L., Huang, X., & Gong, Q. (2014). Grey matter reduction associated with posttraumatic stress disorder and traumatic stress. Neuroscience and Biobehavioral reviews, 43, 163–172. https://doi.org/10.1016/j.neubiorev.2014.04.003

10 David-Ferdon, C., Vivolo-Kantor, A. M., Dahlberg, L. L., Marshall, K. J., Rainford, N. & Hall, E. (2016). A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/yv-technicalpackage.pdf

1 Comments & Reviews

  1. I would also add that being neurodivergent in a neurotypical world can be traumatic for many. As Dr. Bruce Perry says in “What Happened to You?:” “Marginalized peoples — excluded, minimized, shamed — are traumatized peoples, because as we’ve discussed, humans are fundamentally relational creatures.” Neurodivergent people are, sadly, marginalized.

    Expanding what we call traumatic can help kids with ADHD and/or autism because it helps us understand them and their neurobiology. And then we can change the narrative on behavior from “why are you acting like that” to “what is causing you to have a hard time?” And that changes everything.

    Penny Williams
    thebehaviorrevolution.com and ParentingADHDandAutism.com

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