Managing Treatment

Untangling Treatment for Trauma and ADHD

A leading ADHD expert tackles your toughest questions on how trauma contributes to ADHD, genetic testing for medication fit, treatment during pregnancy, and the future of ADHD.

Q: Does a history of trauma contribute to ADHD, and, if yes, how is this treated?

Small studies suggest that an individual with trauma may be predisposed to ADHD, just as anyone with a history of trauma is predisposed to depression, anxiety, and post-traumatic stress disorder (PTSD).

The task of a good diagnostician is to identify a patient’s current diagnoses and treat them, focusing particularly on the most pressing and problematic symptoms. If all of those appear to be symptoms of PTSD, we treat that with a different kind of therapy called trauma-focused cognitive behavioral therapy (TF-CBT). If we find that ADHD symptoms linger even after the trauma is addressed, then we add in ADHD treatment as well. The general rule is to treat the most pressing problem first, then determine whether there are other problems, such as ADHD, that also require treatment.

Q: What do you think about genetic or blood testing, and using those results to choose a prescribed medicine?

These blood tests look at the enzymes in the liver and some of the blood cells to learn how antidepressants, in particular, metabolize in an individual. Enzymes come in different variants, some of which may metabolize an antidepressant very quickly. Other variants of the same general enzymes metabolize medication very slowly.

[Read: What to Expect When You Start Depression Medication]

If someone metabolizes an antidepressant quickly, they’re going to need a higher dose. A slow metabolizer given a doctor’s standard dose will be more likely to have higher blood levels of the medication and more likely to experience side effects.

Q: Can taking certain medications during pregnancy cause ADHD in the child?

The medications people most commonly worry about during pregnancy are SSRIs taken for depression or anxiety. However, there is no evidence that taking SSRIs poses a risk. On the other hand, we do know that taking opioids or heavily abusing stimulants, such as methamphetamine or cocaine, can have a negative effect. Opioids, the top concern on my own list, have been linked to birth defects. Federal and state health agencies provide resources online about reducing the risk of birth defects through behavioral and environmental exposures.

[Read: Treating for Two – ADHD Meds in Pregnancy]

Q: What do researchers think will be different about ADHD treatment in, say, 10 years?

ADHD is a final common pathway of external symptoms. Like a bad cough, it can have many different causes. A cough might occur because of allergies, an infection such as pneumonia, or even cancer. We can find many causes using physical examinations, X-rays, blood tests, and so on.

We don’t yet have precise tools to do that for ADHD. But there is reasonable hope that advances in research will help us develop testing to identify an individual’s specific ADHD causes. And when we figure that out, we can begin to think about preventing and treating ADHD in a very person-specific way. But this is 10 to 20 years away.

PTSD Symptoms and ADHD: Next Steps