ADDitude for Professionals

Traumatic Stress Alongside ADHD: 5 Reasons Clinicians Need to Consider Trauma

Traumatic stress and ADHD are connected — each worsening the symptoms of the other. That’s one reason why it is vitally important for ADHD assessments to include screening questions about trauma, and for treatment plans to factor in the effects of both.

Traumatic Stress and ADHD: Key Takeaways

  • ADHD and trauma often co-occur in ways we are still trying to understand.
  • PTSD and ADHD symptoms can overlap and exacerbate one another.
  • People with ADHD are more likely to have high scores on the Adverse Childhood Experiences Questionnaire (ACEs), meaning that there is greater likelihood of
    trauma.
  • Clients and clinicians should give trauma history and ADHD equal weight and consideration in treatment.
  • ADHD clinicians should perform comprehensive trauma screenings, then make treatment recommendations accordingly.
  • Neither ADHD nor traumatic stress is your fault. They are not character
    flaws.


Traumatic stress and ADHD share significant associations, according to a growing body of research on trauma and childhood maltreatment. Studies show that people with ADHD score higher than their neurotypical peers on the Adverse Childhood Experiences (ACEs) questionnaire1, which measures the impact of negative, stressful, or traumatic events on well-being. This means that they are likely to report troubling events like domestic violence, caregiver substance abuse, physical or sexual abuse, neglect, mental illness, poverty, and community violence. Experiences of racism, discrimination, and oppression can also lead to trauma.

So what is the connection between trauma and ADHD? How to we tease apart the diagnoses? What do their similarities mean for symptoms, diagnosis, and treatment? Here’s what you need to know about traumatic stress and ADHD.

1. Untreated ADHD Can Lead to Trauma


In considering the relationship between ADHD and trauma, we must first acknowledge that some of us start with greater access to resources than do others. Not having access to services for ADHD symptoms, being invalidated or dismissed by professionals, or going without an accurate diagnosis and treatment can lead to years of unnecessary distress, impairment, and neglect.

2. Traumatic Stress Can Worsen ADHD Symptoms

While research tells us that exposure to traumatic events can exacerbate ADHD symptoms, it doesn’t mean that trauma causes ADHD. Epigenetics — how genes might be turned on or off based on our environment — is key to understanding the role that trauma might have in leading to ADHD symptoms. Scientists are studying exposure to toxins, as well as nutrition, lifestyle, and stress levels, to learn what might make ADHD genes turn on or become activated.

[Read: A Complete Overview of Childhood Trauma and ADHD]

We need a better understanding of what ADHD really is and why it presents in unique and individual ways and at various ages. Trauma responses, in utero and/or at a young age, could trigger the development of ADHD symptoms. Research has shown that exposure to trauma changes the brain. This is essential to consider when evaluating or seeking out a diagnosis for ADHD.

3. Rejection Sensitive Dysphoria and Trauma Require Further Study

People with ADHD can become strongly emotionally triggered by perceived rejection or anticipation of judgment, often because of hurtful past experiences related to their differences. This is called Rejection Sensitive Dysphoria. RSD is not a clinical diagnosis, but it is important to contextualize this sensitivity as one being triggered by events that recreate past wounding experiences while living with ADHD. More research needs to be done to determine how RSD emerges in people with ADHD and how it could be a manifestation of a trauma response.

4. Trauma Can Be Misdiagnosed as ADHD

Both ADHD and trauma affect the functioning of the pre-frontal cortex — which controls executive functioning skills and reasoning — and the amygdala, which processes emotions. This can lead to hyperarousal or restlessness; difficulty with emotional regulation and making decisions; sleep problems; impulsivity; addictive behaviors; and difficulty relating to others.

[Understand: The Science of Fear]

How do clinicians tell the difference? We do the best we can by taking an in-depth trauma history and exploring the lived experience of each client, in addition to conducting traditional ADHD assessment procedures.

5. Trauma Screenings Should Be Part of Every ADHD Assessment

All ADHD assessments should include questions about trauma. Clinicians should perform comprehensive screenings that use both direct questions and more open explorations of a patient’s lived experiences over time (especially since trauma can sometimes take time to manifest).

Not everyone who experiences trauma will meet the full criteria for post-traumatic stress disorder (PTSD). Some people who do not meet the full criteria will still struggle with complicated impacts of traumatic stress, while others might not have symptoms at all.

When trauma occurs later in life, the diagnostic picture is a bit clearer, because a doctor can ask whether ADHD symptoms were present before the trauma occurred. The picture is more nuanced if the trauma occurred in childhood or is ongoing (developmental or attachment trauma). In these cases, clinicians must consider the client’s unique personality and lived experiences, and conduct treatment carefully.

ADHD and symptoms related to trauma, such as PTSD, can co-occur and exacerbate each other, so the presence of both leads to more problems than occur with ADHD or PTSD alone.

In all, to develop an effective treatment plan, it is vital that a person with ADHD find a clinician who inquires about trauma during the course of an ADHD evaluation. As for treatment, patients should look for providers who have been trained in Eye Movement Desensitization and Reprocessing or cognitive processing therapy. Both of these therapies reduce trauma symptoms, and they have been validated by extensive research.

ADHD and Trauma: Next Steps


SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

View Article Sources

1 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

Leave a Reply