How childhood trauma could be mistaken for ADHD

 

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[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”

Considered a heritable brain disorder, one in nine U.S. children—or 6.4 million youth—currently have a diagnosis of ADHD. In recent years, parents and experts have questioned whether the growing prevalence of ADHD has to do with hasty medical evaluations, a flood of advertising for ADHD drugs, and increased pressure on teachers to cultivate high-performing students. Now Brown and other researchers are drawing attention to a compelling possibility: Inattentive, hyperactive, and impulsive behavior may in fact mirror the effects of adversity, and many pediatricians, psychiatrists, and psychologists don’t know how—or don’t have the time—to tell the difference.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children.

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Am I really the worst? A day in the life of parenting special needs children

AfamilyThe other day after a particularly lively visit to PetSmart with my husband and our two special needs children, a woman who had been in the store at the same time drove up and said: “You are the worst parents I have ever seen.” She drove off before I could respond, not that I had a witty comeback. To clarify, no animals were hurt (or even handled), nothing was damaged and we did not leave any messes for store employees to clean up. We were probably the loudest family in the store, but that is normal in our world.

I am confident I cannot possibly be the worst parent out there.

My children, who both struggle with multiple disabilities, had a fun outing to the pet store with two parents who love them dearly. Despite their challenges, they are on the honor roll at school, play sports and engage in other extracurricular activities and have received awards for their accomplishments. Of course, it is easy to listen and accept negative comments of someone who sees my life for less than 15 minutes and makes a faulty assessment. I am like every other parent: I worry. I have doubts and fears. I doubt myself. I question if I am doing enough.

Most parents worry about their children, but parents of special needs children need to know the world is a better place because they are in it. We are parents who have been to more medical appointments with our young children than most adults have been to in their whole lives.  Our children often have had multiple diagnoses yet don’t really “fit” any of them. We sometimes feel isolated because our children don’t seem to fit into any group, even the “special needs” ones. We’ve scoured books, magazines and web sites in the hopes of finding something new that might be effective for our children’s needs. We feel exhausted, overwhelmed and incompetent on a daily basis but still get up every morning and try to provide the best for our children. We fight schools, doctors, friends and even family members every day just to get them to understand the basic needs of our children. And after all of that, we have to put a positive spin on some very ugly comments our children hear on a regular basis.

To paraphrase the late Erma Bombeck, God is looking down from heaven and pairing children with appropriate parents. When He chooses parents for a handicapped child, He decides they must be happy so the child can know laughter; they cannot have too much patience or they will drown in a sea of self-pity and despair; they must have a sense of self and independence so they will be able help the child who is in her or his own world function. They must to be a little bit selfish to separate themselves from the child occasionally to survive. They will see clearly ignorance, cruelty and prejudice and be able to rise above it.

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