Does Trauma Cause ADHD? And Vice Versa?
Could experiencing traumatic stress cause ADHD in me or my child? What is the ADHD-PTSD link? What does effective treatment look like? Is it ever too late to be treated? Answers to these and more in this expert Q&A.
The connection between trauma and ADHD is fascinating, if not fully understood. As research continues to fill in the blanks, Nicole Brown, M.D., MPH, MHS, recently answered questions from ADDitude readers about whether trauma begets attention deficit hyperactivity disorder (ADHD or ADD), what treatment options help children with ADHD who have experienced trauma, and what constitutes “trauma” in a diagnostic sense.
Q: Can trauma cause ADHD?
Research doesn’t support the idea that trauma causes ADHD. Research does tell us that ADHD is a condition that’s largely genetic and inherited, and that it causes specific areas of the brain to be underdeveloped or otherwise impacted. Because trauma affects those same areas of the brain, it exacerbates ADHD symptoms. The science, however, is still out on what actually causes ADHD.
Q: If a parent suspects that their child has ADHD and has undergone trauma, what is the process for diagnosis and care?
Often the first point of contact, a pediatrician will use screening tools (like the Vanderbilt assessment) and other diagnostic materials that ask about the core symptoms of ADHD. An astute clinician, however, will do more than just administer a screener to determine whether a child has ADHD — or something else that mimics or looks like ADHD. Medical conditions like hyperthyroid disease, for example, may look like ADHD. The astute doctor would order some blood tests to rule out this and other medical conditions. They would also take a really good family history, and ask questions about whether ADHD and other mental health conditions run in the family.
If all of those things together still point to a diagnosis of ADHD, but the child has also experienced trauma, that pediatrician or primary care provider should refer them to a behavioral health clinician who can provide the critical therapy and insight that’s needed. They can further probe to see if the child is actually experiencing symptoms of traumatic stress and even PTSD, and suggest additional medication and therapies to treat those symptoms.
When it comes to ADHD and co-occurring trauma, clinical judgment is really important when thinking about starting any medication. Oftentimes, ADHD in children is managed with medication, but not necessarily by adjunctive behavioral therapy, which is so critical to their care. We know that having both medication and behavioral therapy is the gold standard; that is what makes the difference. In sum, pediatricians really should be working hand-in-hand with behavioral health providers to deliver a holistic, multi-modal treatment plan for the patient with ADHD and trauma.
Q: What “counts” as trauma?
Researchers use the term ACEs, which stands for “adverse childhood experiences,” to describe potentially traumatic events that occur before age 18. ACEs traditionally include incidents like physical and emotional abuse, neglect, and household dysfunction. Our conception of ACEs, however, is continuously broadening, and there’s an explosion of science around it.
Death of a caregiver has traditionally been thought of as an ACEs type, for example. But the experience of almost losing someone close to you can be just as traumatic. Some children are also more at risk for certain unique traumatic stressors, as is the case with children of color experiencing stressors like systemic racism and concentrated poverty. Another important element to consider is that trauma is experienced, lived, and internalized very differently among people.
It is possible for “smaller” events to add up to trauma. Many studies on ACEs are limited in that they only look at the incidents in a “snapshot” form, not a cumulative form. The timing and accumulation of adverse events aren’t considered, nor is how they may impact the health trajectory of an individual. But we absolutely know that the more ACEs experienced, the more negative outcomes that are predicted.
Q: Is there an especially sensitive age where children are more subject to or more adversely affected by ACEs?
When ACEs happen in early childhood, in the absence of protective buffers, there’s a high, high risk of severe chronic health issues in adulthood and even risk of early death.
At the same time, early childhood is the most optimal time to intervene because the brain is so plastic – it can still be molded, shaped, and changed. We can change the trajectory of those brain changes that become permanent in the absence of the buffers by recognizing ACEs early on, getting families the support that they need to prevent more ACEs from occurring, and mitigating the traumatic stresses that they may be currently experiencing.
Q: With trauma and adverse experiences in childhood, can there be delayed responses that manifest only in adulthood?
Absolutely. In fact, it seems like most of the literature on ACEs has actually been done in adult populations, and pediatric literature is catching up. What we’re gleaning from the science is that ACEs cause changes in the brain and changes in different organ systems that begin in childhood and that translate to heightened risk for mood disorders and other chronic health conditions in later adulthood.
Q: Can the neural connections that are inhibited or damaged from trauma be rebuilt or strengthened?
Yes, particularly in childhood. Therapy is really important as a way of providing protective buffers and leveraging the child’s strengths, which can create internal environments that are conducive to repair those neural connections.
Q: Is it ever “too late” for an individual to get effective help if interventions and treatment don’t take place in childhood?
It is absolutely not too late. If these issues aren’t dealt with in early childhood, it doesn’t mean that the effects will be permanent. No matter if the patient is a teen or a young adult, it’s really, really important for them to get help if they’re struggling with traumatic stress and/or exhibiting symptoms of ADHD. Treatment has been shown to be effective in all age groups, including in adults, and so help at any time is important and effective.
The content for this article was derived from the ADDitude Expert Webinar “How Stress and Trauma Affect ADHD in Children of All Colors — and How to Heal the Wounds” by Nicole Brown, M.D., MPH, MHS, which was broadcast live on October 15, 2020.
Trauma and ADHD: Next Steps
- Overview: ADHD and Trauma – Untangling Causes, Symptoms & Treatments
- Treatment: Somatic Therapy – Understanding the ADHD Brain, Body & Trauma
- Download: Is It More Than Just ADHD?
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Updated on November 23, 2020