Rebecca Ruiz

How childhood trauma could be mistaken for ADHD

 

Acry

[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.

Brown’s findings, which she presented in May at an annual meeting of the Pediatric Academic Societies, revealed that children diagnosed with ADHD also experienced markedly higher levels of poverty, divorce, violence, and family substance abuse. Those who endured four or more adverse childhood events were three times more likely to use ADHD medication.

Interpreting these results is tricky. All of the children may have been correctly diagnosed with ADHD, though that is unlikely. Some researchers argue that the difficulty of parenting a child with behavioral issues might lead to economic hardship, divorce, and even physical abuse. This is particularly true for parents who themselves have ADHD, similar impulsive behavior or their own history of childhood maltreatment. There is also no convincing evidence that trauma or chronic stress lead to the development of ADHD.

For Brown, who is now a pediatrician at Montefiore Medical Center in the Bronx, the data are cautionary. It’s not evident how trauma influences ADHD diagnosis and management, but it’s clear that some misbehaving children might be experiencing harm that no stimulant can fix. These children may also legitimately have ADHD, but unless prior or ongoing emotional damage is treated, it may be difficult to see dramatic improvement in the child’s behavior.

“We need to think more carefully about screening for trauma and designing a more trauma-informed treatment plan,” Brown says.

Dr. Kate Szymanski came to the same conclusion a few years ago. An associate professor at Adelphi University’s Derner Institute and an expert in trauma, Szymanski analyzed data from a children’s psychiatric hospital in New York. A majority of the 63 patients in her sample had been physically abused and lived in foster homes. On average, they reported three traumas in their short lives. Yet, only eight percent of the children had received a diagnosis of post-traumatic stress disorder while a third were diagnosed with ADHD.

“I was struck by the confusion or over-eagerness–or both–to take one diagnosis over another,” Szymanski says. “To get a picture of trauma from a child is much harder than looking at behavior like impulsivity, hyperactivity. And if they cluster in a certain way, then it’s easy to go to a conclusion that it’s ADHD.”

A previous edition of the Diagnostic and Statistical Manual of Mental Disorders urged clinicians to distinguish between ADHD symptoms and difficulty with goal-directed behavior in children from “inadequate, disorganized or chaotic environments,” but that caveat does not appear in the latest version. Unearthing details about a child’s home life can also be challenging, Szymanski says.

A child may withhold abuse or neglect to protect his family or, having normalized that experience, never mention it all. Clinicians may also underestimate the prevalence of adversity. The Adverse Childhood Experiences Study, a years-long survey of more than 17,000 adults, found that two-thirds of participants reported at least one of 10 types of abuse, neglect, or household dysfunction. Twelve percent reported four or more. That list isn’t exhaustive, either. The study didn’t include homelessness and foster care placement, for example, and the DSM doesn’t easily classify those events as “traumatic.”

It’s not clear how many children are misdiagnosed with ADHD annually, but a study published in 2010 estimated the number could be nearly 1 million. That research compared the diagnosis rate amongst 12,000 of the youngest and oldest children in a kindergarten sample and found that the less mature students were 60 percent more likely to receive an ADHD diagnosis.

Though ADHD is thought to be a genetic condition, or perhaps associated with lead or prenatal alcohol and cigarette exposure, there is no brain scan or DNA test that can give a definitive diagnosis. Instead, clinicians are supposed to follow exhaustive guidelines set forth by professional organizations, using personal and reported observations of a child’s behavior to make a diagnosis. Yet, under financial pressure to keep appointments brief and billable, pediatricians and therapists aren’t always thorough.

“In our 15-minute visits—maybe 30 minutes at the most—we don’t really have the time to go deeper,” Brown says.

If she suspects ADHD or a psychological condition, Brown will refer her patient to a mental health professional for a comprehensive evaluation. “You may have had this social history that you took in the beginning, but unless the parent opens up and shares more about what’s going on in the home, we often don’t have the opportunity or think to connect the two.”

Caelan Kuban, a psychologist and director of the Michigan-based National Institute for Trauma and Loss in Children, knows the perils of this gap well. Four years ago she began offering a course designed to teach educators, social service workers and other professionals how to distinguish the signs of trauma from those of ADHD.

“It’s very overwhelming, very frustrating,” she says. “When I train, the first thing I tell people is you may walk away being more confused than you are right now.”

In the daylong seminar, Kuban describes how traumatized children often find it difficult to control their behavior and rapidly shift from one mood to the next. They might drift into a dissociative state while reliving a horrifying memory or lose focus while anticipating the next violation of their safety. To a well-meaning teacher or clinician, this distracted and sometimes disruptive behavior can look a lot like ADHD.

Kuban urges students in her course to abandon the persona of the “all-knowing clinician” and instead adopt the perspective of the “really curious practitioner.”

Rather than ask what is wrong with a child, Kuban suggests inquiring about what happened in his or her life, probing for life-altering events.

Jean West, a social worker employed by the school district in Joseph, Missouri, took Kuban’s course a few years ago. She noticed that pregnant teen mothers and homeless students participating in district programs were frequently diagnosed with ADHD. This isn’t entirely unexpected: Studies have shown that ADHD can be more prevalent among low-income youth, and that children and adolescents with the disorder are more prone to high-risk behavior. Yet, West felt the students’ experiences might also explain conduct easily mistaken for ADHD.

Kuban’s course convinced West to first consider the role of trauma in a student’s life. “What has been the impact? What kind of family and societal support have they had?” West asks. “If we can work on that level and truly know their story, there’s so much power in that.”

As a school official, West sometimes refers troubled students to a pediatrician or psychiatrist for diagnosis, and meets with parents to describe how and why adversity might shape their child’s behavior. In her private practice, West regularly assesses patients for post-traumatic stress disorder instead of, or in addition to, ADHD.

Though stimulant medications help ADHD patients by increasing levels of neurotransmitters in the brain associated with pleasure, movement, and attention, some clinicians worry about how they affect a child with PTSD, or a similar anxiety disorder, who already feels hyper-vigilant or agitated. The available behavioral therapies for ADHD focus on time management and organizational skills, and aren’t designed to treat emotional and psychological turmoil.

Instead, West teaches a traumatized child how to cope with and defuse fear and anxiety. She also recommends training and therapy for parents who may be contributing to or compounding their child’s unhealthy behavior. Such programs can help parents reduce their use of harsh or abusive discipline while improving trust and communication, and have been shown to decrease disruptive child behavior.

Szymanski uses a similar approach with patients and their parents. “I think any traumatized child needs individual therapy but also family therapy,” she says. “Trauma is a family experience; it never occurs in a vacuum.”

Yet finding a provider who is familiar with such therapy can be difficult for pediatricians and psychiatrists, Szymanski says. Though some hospitals have centers for childhood trauma, there isn’t a well-defined referral network. Even then, insurance companies, including the federal Medicaid program, may not always pay for the group sessions commonly used in parent training programs.

Faced with such complicated choices, Szymanski says it’s no surprise when clinicians overlook the role of trauma in a child’s behavior and focus on ADHD instead.

While there are few recommendations now for clinicians, that will likely change in the coming years. The American Academy of Pediatrics is currently developing new guidance on ADHD that will include a section on assessing trauma in patients, though it won’t be completed until 2016.

Dr. Heather Forkey, a pediatrician at University of Massachusetts Memorial Medical Center, who specializes in treating foster children, is assisting the AAP. Her goal is to remind doctors that inattentive and hyperactive behavior can be traced back to any number of conditions—just like chest pains don’t have the same origin in every patient. Ideally, the AAP will offer pediatricians recommendations for screening tools that efficiently gauge adversity in a child’s life. That practice, she says, should come before any diagnosis of ADHD.

When speaking to traumatized children inappropriately diagnosed with ADHD, she offers them a reassuring explanation of their behavior. The body’s stress system, she says, developed long ago in response to life-or-death threats like a predatory tiger. The part of the brain that controls impulses, for example, shuts off so that survival instincts can prevail.

“What does that look like when you put that kid in a classroom?” Forkey asks. “When people don’t understand there’s been a tiger in your life, it looks a lot like ADHD to them.”

This story was produced for ACEs Too High and originally appeared on The Atlantic.

111 comments

  1. My work to date is following the function of the reptilian brain the first brain to develop some weeks after conception. My observation of how it acts as a defender of the development of the infant which is a foreign object in the journey towards birth, any assistance given during the delivery is interpreted by this brain as a treat having our natural alarm system remains on this in turn elevates the senses smell taste touch hearing. This child living in a state of alert will be very challenging for the parents. I call this infantile posttraumatic. My question is why we have not made the conection between the number of C sections, forcepts and aggressive procedures during the delivery. To date I have been able to help more than 1000 children who have been the victims of such . By helping them to understand what happened in the first place and have them lern to be able to manage to reset their natural alarm system and live an Anxiety free life.

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  2. Can this also be related to the trauma of a childhood loss of a parent? My son is currently being assessed for adhd but is not disruptive just can’t concentrate and is fidgeting all of the time.

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  3. Interesting …2 boys diagnosed with ADHD, while we have a safe, stable, living family envt, both had silent reflux as babies, and I always wonder if the pain and ‘trauma’ of that as a very young baby rewired their brains. Food fur thought perhaps.

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  4. ADHD, whilst its origins have a link to genetics, possibly to metals and other toxins, it also arises in relatively functional homes where parental emotions are both over determined and unpredictable. This may not really amount to trauma, but in an emotional overwhelming which certainly mimics trauma in the sense of not being present enough to plan and execute tasks in the normal way.In more able children , despite the current trend and particularly in the Uk where med insurance is less of a factor, this often remains undiagnosed since the behaviours and failures are infuriating as a opposed to disruptive.

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  6. Hei Dr. Nicole Brown, innlegget ditt gir virkelig bevissthet om psykisk helsesykdom ADHD/ADD og dens virkelige virkninger for å skade ethvert menneskes psykiske helse. Dessuten, hvis du vil vite mer om ADHD og ADD, kan du besøke nettstedet vårt. “https://www.psykiater.no/adhd-add/”
    Tusen takk kjære.

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  8. I remember sitting in my grade school counselors office, crying because people thought I was crazy or brain damaged (it was the 70’s) and later ADD. I wouldn’t say anything, only cry quietly. I think I’d nod or shake my head at yes or no questions. But I couldn’t speak. I think I whispered “my mom yells at me” once… I either said it or really wanted too but couldn’t. My family looked good on the outside, but on the inside was a verbally and emotionally abusive narcissistic mother and an emotionally absent father. I had trouble in school, and was bullied & teased by peers. Progress reports said I was “Daydreaming all the time”, problems reading out loud (due to anxiety probably), problems with self esteem & peers, problems with math (probably due to I suck at math.🙄).
    I’m 49 years old now, and just now getting to the heart of my problems, C-PTSD. Some abuse comes without bruises, from nice middle class families. Daydreaming children might actually be disassociating.

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    • You’re absolutely correct that there is abuse in “nice” middle-class families, but it is not always devoid of bruises. Someone I know who grew up in my middle-class town was beaten every single day by her mother. Like me with the neglect and emotional abuse I endured, no one helped her because “pillars of the community” (read white, affluent people) don’t hurt their children. They don’t have time to, what with all the reading to them of exquisite children’s books, and all the doting and constant heart-to-heart conversations they have with them, etc. Look no further for the reason social workers, doctors and nurses, and teachers use a demographic test to decide which children could possibly be abused or neglected by their parents. Sorry your parents were the wrong color and class, Janelle.

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  10. Thank you for publishing this. I am a bit of a dinosaur of a psychiatrist. DSM II was active when I was a medical student. I work on an appointment inpatient adolescent unit. It is very difficult to get this message across once years of psychostimulant use have gone by in a child with a mood disorder or trauma history. Someone published a summary bulletin in the 1980’s of “ADD Copy-cat Disorders” that I continue to photocopy for parents today. PTSD, Abuse, and Neglect are at the top of the list.

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  11. I found this article highly interesting and it did stop me in my tracks. I myself was diagnosed with ADHD aged 24 when my first child was diagnosed. My son was later diagnosed with ASD as well aged 14.

    It was a long journey as one with experience could imagine. I’m ex-military meaning that too has shaped who I am. I’ve worked in health and community for 25 years, with the last 3 working with traumatised youth in residential care under child safety.

    I grew up in an environment of abuse, with my parents being high profile socialites. But behind closed doors, well, that’s another story.

    I’ve since learned management strategies to function well in today’s everyday although at times I struggle. I’m on the floor aged 46 in my job because I reach these kids and get good results.

    I’m very interested to learn more again, as I thought I knew so much but now I’m curious and wanting to discuss this so much further directly with Dr.Brown.

    I think she is onto something critically important for our children and maybe adults.

    My details follow:

    Kirsten Cunnungham
    Senate Candidate
    Domestic Violence Victim/Campaigner

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  13. My sisters grand daughter is being abused by her dad and his girl friend, no help from social workers, the dad took little girl into a dr. Where the dr. Said she has a.d.h.d. which is wrong, she is 5 yrs old, and my sister tought her all of the alphabets, and how to count to 20, then the girls dad, decided to take her away from my sister for 9 months, which was cruel, and she 4 got everything, due to abuse.

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  14. Thank you for this I wish that information like this would’ve plastered on giant bilboards … or required as a drivers license renewal. I don’t know what the answer is but I pray we find one sooner than later. 🙏🏼✝️💖

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  15. […] as a ‘flow state’, losing themselves in their performance.  Chiraag Mittal found that while research typically finds that people with high ACE loads lack impulse inhibition, which can have negative consequences, the mirror image of this quality is the ability to shift […]

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  16. While many educators will be satisfied to identify a disruptive or inattentive child who will then be mellowed out with drugs, I would like to see them provide a safe and welcoming haven for each child during the school day. Expecting a child to learn what they can and relieving their stress for a portion of their day are not mutually exclusive. In fact, a child given this reprieve will do better in school. Having taught many children who experienced a number of traumas which were out of their control and out of mine, I knew it was as important to give them an environment where some of the impact could be felt less for the nearly 200 days of the year they were in my class. I hope the embers from a little fire that warmed their hearts with “you matter, you are important, you are cared for” helped buoy them as long as possible during the year I had them and into their futures. Yes, school is about learning, but it is also about learning to care and about learning to support one another through challenging times. These are the partners and parents of the future and these softer skills will be valuable. While children living in poverty are likely more affected by trauma, I also taught children from affluent families who experienced trauma. I add this last observation to dispel any notion that certain demographic environments escape trauma or the misdiagnosis of ADHD. I actually found that the better educated and more affluent parents often wanted their children medicated as a solution. When career climbing and material wealth become the primary focus for some parents the emotional neglect and the lack of time spent with their children have a traumatic impact.

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  17. Thank you so much for this information! I am a former trauma survivor and former educator in our local school. When I saw the insanity continue, I went even more public with my story and have become an advocate and activist for our kids and youth that need a voice. Legislation and several other systems are beginning to recognize and take action on this fact about misdiagnosis and trauma. Feel free to read and/or follow my blogs about my personal journey of being loaded up on psych meds, misdiagnosed, unable to function in society and used illegal substances because I didn’t know how to cope. redeemedloved1.wordpress.com

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  18. I saw this personally with my two adopted sons. We knew their background and the trauma they had been exposed to. When the teachers and their supposed experts from school told us they needed to be on medication for their behavior, I knew it was not accurate, but what did “I” know? I was just an adoptive mother with no previous experience raising other children. When we gave the Ritalin to them, it totally took their personality away. When I saw how their classrooms were organized and run, and read the boring materials (that were very PC) I knew there had to be a better way for these 2 to flourish. We ended up homeschooling through 8th grade. One of them would have done better by not being in the public high school. Even inexperienced parents such as I know more about their child than an “experts” 10 minute test.

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  19. I’ve spoken to my doctor about this. Not all trama is from abuse but is believed to lead to hyper-vigilance, impulse control issues and other ADHD like behaviour. Trama can be loss of a loved one at a young age, extended illness of the child or someone in the home. He said making sure your child is with a teacher who cares enough to learn about the difference is essential. Being misunderstood can make these issues worse. These children do not respond to ADHD medications.

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  20. Fantastic, this is what I’ve wondered from spending time with 35yo daughter (currently living with me) of the late friends of mine, her parents (mother who suicided aged 24 yrs 11 months leaving behind her daughter aged 2 yrs 2 months, & father who died 7.5yrs ago of glioblastome multiforme brain tumours who reared her). She was diagnosed around age 15 with ADHD, however, given the diversity of symptoms it displays and the noted inconsistencies in behaviours marching to ADHD of this young woman I have thought that how she was parented must’ve had an impact too, not to mention her mother dying let alone possibility of childhood foetal alcohol syndrome (unsure if her mother drank, smoked tobacco or marijuana during her pregnancy of this child).
    I will continue to love her providing a loving and stable home life as best I can, God-willing prayerfully. Thank you for the article.

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  21. I believe my 5 1/2 year old child falls into this category. Where can I turn yo for more info, help and tools to help him?

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  23. For some reason my comment didnt work 😥

    But the essence of it was a have a 4yr old son who has suffered medical trauma a few times through out his short life and we are just starting the diagnosis of him.

    I would love more information on treatment for trauma or how to help as our doctors and medical options at the moment are very limited…

    Thank you in advance

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  24. There are some awesome comments here. Rarely do people get that schools are doing very poorly by kids, and NEVER do I see anyone say, “Hey, even the country club set is eligible for being shitty parents.” Unfortunately, here, as everywhere else, that thought is a lone voice in the wilderness. So, while I applaud the idea of evaluating kids for trauma before drugging them for ADHD, I know it will be a long time before more than a very few of us are ready to admit that it’s not just poor people who traumatize their kids.

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  25. My son was diagnosed with ADHD after I read an article in Mensa magazine & his private school contacted the Ed.Physcologist who diagnosed it .We would not allow him to be medicated so he was only allocated more time for exams & at uni was given a laptop.
    We have no broken homes on either sides of our families or any drug/substance abuse .We are a very happy ordinary family with only 1 of our 3 sons affected.We disagree that it is abusive /dysfunctional homes that cause it.
    Thankfully with lots of care & hard work he passed.his degree & has a successful media career as a TV producer .ADHD is a debilitating disease that affects all of society.

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    • I think you miss read. What I got from this is there are children being diagnosed with ADHD and it is a misdiagnosis. They have similar symptoms, but while families like yours are fine and a child has ADHD, these children of abuse or trama are diagnosed with ADHD when it is not what they have.

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    • I think you completely mis-read the article. This is about how ADHD is sometimes mis-diagnosed and that it is really PTSD that the child has because of something traumatizing that happens to them. No where in this article were they saying that children with ADHD were coming from abusive/dysfunctional homes.

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    • Trauma is not always related to “child abuse” trauma can be related to growing up in a violent neighborhood, death of a parent or grandparent, people having a un health hate towards you or your loved ones due to the color of your skin. Many situations and experiences can stimulate the trauma response in a child.

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    • I’m in Mensa myself and was diagnosed with ADD at age 2 and again at age 16. It wasn’t long after I was born that my mother, she had schizophrenia, began to believe there was something wrong with me. She took me to a psychiatrist who put me on stimulants. My mother said she took me off them because I was riding my tricycle really fast and wouldn’t stop. A little girl on speed ridding her trike. It’s a sweet image, isn’t it? It also suggests I did not have ADD because stimulants slow kids who have ADD down. My parents, and my father is a psychiatrist, were abusive. It’s like this, when I was 16 and diagnosed with adjustment disorder (along with the ADD) which would’ve meant a professional thought I experienced mal-adjustment in the “protective” environment my parents provided, immediately spurred my father to start repeatedly telling me how well-adjusted I was. He had a hat in the ring didn’t he? Even now, and I’m 47 and know what’s what, my dad says he wasn’t abusive and neither was my schizted out mom. What you say sounds like what my parents say. They say they provided a good home and were not abusive. It may be that you are not an abuser but you definitely have a hat in the ring, a vested interest in believing ADHD isn’t the product of abuse. What you do with your hat is write me and my very real and damaging experiences off, and not just my experiences, many survivor’s experiences. What’s true, or possibly true, in your family doesn’t apply to everyone.

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  27. My foster daughter had been diagnosed with ADHD at the age of 5 yrs old. She was born into a disfunctional family who neglected her basic needs with drugs, alcohol and prostitution being a big part of her mother’s life. Having read the symptoms and behaviour of Ace’s theory, it has definately made me re think her diagnosis.

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  33. A narcissistic mother and an introverted father don’t help, either, even if they were members of the Country Club and never fought in front in the children. The children had no anchor.

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  36. Reading through this article the one thing I noticed is that the was no reference to trauma relates to sexual abuse. I was one of those children diagnosed with inattentive Add when it is actually complex trauma, maybe a combination.

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  44. What about children exposed to alcohol even one binge drink early in pregnancy causes neurological changes. With the binge drinking pattern so common to America many, many babies are conceived and or exposed early in utero causing permanent brain damage.

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  45. “The Boy Who Was Raised as a Dog” Illustrates this very topic very well. This is sadly not new information, but hope more professionals pay attention. Great article.

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  48. One thing I’ve been noticing as a counselor, is that a surprising number of adults who had suffered from untreated traumas as children and were instead given Ritalin or Adderall for years, grew up to become seriously addicted to amphetamines and/or meth. This is very troubling to me.

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  52. So much harder to respond to repeated trauma than to a clinical diagnosis, especially when tracking expenditures on healthcare. As the VA continues to address PTSD in veterans, we see sending them back into combat is not the wisest action.

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  53. Reblogged this on Na'ama Yehuda and commented:
    This is an immensely important article. Not because traumatized children cannot have ADHD–they can, and many do–but because children with ADHD must also be screened for trauma. They are already at a higher risk for maltreatment and overwhelm, and trauma may also lower their ability to manage stimuli and process information, exacerbating inattention.
    Trauma and attention for learning are at cross purposes–this alone is a good enough reason to assess what part trauma may play in a child’s clinical presentation.
    And of course–if there is trauma that is ongoing, we are all of us entrusted with doing all we can to identify it and stop it, so that children can be safe.
    Until we ensure they are safe and FEELING safe, we cannot truly expect them to lower their hypervigilance or attend to what the teacher is saying in class. We cannot expect their brains to respond well to medications that are meant to treat inattention when their survival may feel as it hinges on remaining in hyper-vigilance mode and constantly scanning for danger.
    I highly recommend reading this article.

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  54. This article is eye opening & enlightening. I am a childhood abuse survivor. The one thing lacking in this article is that the abuse isn’t always recognized in all socio-economic groups. It may be more prevalent in lower income families, but it can also occur across all economic groups.

    My adopted parents were clearly middle-class. I was their only child, adopted soon after birth. My father came from a well-to-do family, my mother grew up dirt poor. I was systematically abused by both, including death threats. Not a single doctor or psychologist, teacher, or other authority figure recognized that I was being abused. Worse, some of my teachers were also abusive, & I was bullied by my peers.

    At age 50, I was diagnosed with ADHD. Funny how mental health professionals still miss the signs, even though I am able to articulate many past traumatic events. How is this even possible? I had a medical doctor tell me last year, she believes I have PTSD.

    I hope that abused children have at least one caring adult who will take the time to acknowledge the abuse, & get that child the proper assistance needed. Kids needs to be heard, & more importantly, given the help they require to thrive. Otherwise they end up in other abusive relationships over & over, repeating the patterns they learned as a child. Any child who is taught that they are bad, or wrong, or worthless is a target for abuse, not just in the formative years, but throughout his or her lifetime. I know, I experienced this first hand. I have yet to find a psychologist who gets it. All the the healing & moving beyond the traumas I experienced has been working on myself alone without the assistance of a mental health professional. Why is it so difficult for them to recognize? Something needs to change!

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  56. Reblogged this on ***Whats In Her Head*** and commented:
    Hmmmm…I think they are on to something…every person I have come in contact that not only has mental illness & teams has happend in their life…but also having ADHD had trama in their life including myself…Great read tho!!!

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  61. I wonder if the number of ADHD diagnoses has risen because it is one of the routes to special education? As a teacher, I have tried to obtain special ed services for many students and been denied. It is almost impossible to obtain permission to test students for specific learning disabilities, and even harder to get them tested for emotional disturbance. If a student is diagnosed with ADHD they can obtain special ed services with an Other Health Impairment eligibility. I can see how it would be easier to get the student on an IEP with an ADHD diagnosis, whether the family chooses to medicate or not, at least the child will be getting services based on his or her needs. By the way, I also really resent the broad generalizations that all these villainous teachers are just wanting everyone to be medicated so we don’t have to work hard. Anyone who thinks that hasn’t spent much time in a public school classroom.

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  62. I am not disputing the findings but what about an even more basic root cause…nutrition? Typically low income diets are full of cheap food alternatives that are full of chemical preservatives, artificial food coloring, GMOs, hormones, etc…the list is endless.

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    • I agree with this whole heartedly I can give my son Sarah Lee ham and Turkey because they have no dyes in them and he does so much better at school… but it’s hard to be able to afford a meat that’s 6.98 a pound vs a meat that is 1.99 a pound that has the red dyes in it… and the different literally showed at school on days he had dye free neat vs days he mad regular dye meat and definitely on days for school lunches ugh what a difference

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  63. Oh for the love of pete, how about we stop asking why children aren’t learning and start asking how they learning and then compare that to the teaching methods. Ever notice how not one single school based evaluation mentions that perhaps the teaching practices don’t match the child? Ever wonder why we have good studies showing that as much as 20% of the population has Dyslexia, and yet your typical elementary may have less that 1% identified as Dyslexic? I can’t begin to enumerate the number of teachers I’ve spoken to that say they’ve never had a Dyslexic student. Anyone ever wonder why we have studies showing the youngest children in the class are the most likely to be diagnosed with ADHD? What about those children who don’t have traumatic childhoods, that have symptoms according to the teacher? How about those who are rated as normal by the parents and daycare, but the school teacher puts them as severely ADHD? How many visual spacial and kinesthetic learners are misdiagnosed as ADHD? Heck, the kinesthetic learner can qualify even if they have the focus of a bomb defuser. What we need to do is stop making excuses for not teaching to these children’s strengths. We need to stop making excuses for not identifying Dyslexia and other learning disorders. We need to stop making excuses to put kinesthetic learners on Ritalin and Adderall. We need to have teachers who can and will teach to visual-spacial learners. Yes, children use all of these, but some are much more so than others. Let’s quit medicating students because of our own inflexibilities and desire to make students sit down and shut up, so that we can stand up, verbally vomit a bunch of info, and then deciding that little Johnny is lazy and has ADHD because he didn’t learn a bit of that verbal vomiting. Stop teaching them that this is the way it is, and start teaching them why it is this way. Children are designed to use all of their senses to learn, and we do out best to drill that out of them as quickly and thoroughly as possible. Lets stop medicating the ones that don’t go along with that scheme. If anyone would bother to stop for a minute and ask how this child learns, they would usually find that the so called ADHD child is a spacial learner, and very likely requires a high kinesthetic component. We would also find a very high percentage of them have Dyslexia or some other learning difference. But instead of finding a way to teach them that works, we drug them up and put weighted vests on them and velcro on their desks, and keep them in from recess for getting out of their seat. My goodness people, not everyone processes incoming information the same way or at the same speed. We need to find ways to teach them not find ways to drug them up. Teach to their strengths, use their multitasking brains so they can web everything together. Instead of shutting down their brains, how about we start using ours!

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    • Preach it!!!
      I have a mentally challenged daughter that was provided with all the resources and opportunities to learn using the different styles that worked for her. The ultimate goal being for her to reach the highest potential despite her low IQ.
      I have 3 “normal” children given the opportunity to conform to what worked for the system. They were not challenged to use their senses, their bodies, their fine motor skills, sense of movement, on and on to learn like their sister did.
      Why?

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  64. For 16 years, I’ve been an advocate in the area of Adult ADHD. You know, the parents of these kids with ADHD.

    I started by organizing public lectures about ADHD in my community (Silicon Valley). And what I noticed is that the people who didn’t seem to be getting any traction with their children (who had ADHD) were the people whose own ADHD was obvious to everyone but themselves.

    This is one reason I have focused on Adult ADHD: because this highly neurogenetic syndrome affects all aspects of adult life, especially parenting and many other domestic issues affecting any children living in the home. There are higher rates of conflict, more substance abuse, higher rates of IPV, more traffic accidents, lower employment, more bankruptcies, more divorces, etc. Everyone in the family can be at the mercy of unrecognized, untreated ADHD — the adult who has ADHD, the spouse, and most certainly the children. They have not only the genetic vulnerability but also the impact of living with chaos and confusion, and sometimes high conflict.

    In short, it is little short of child abuse to treat children for ADHD without screening the parents. When I mentioned this in an online group years ago, one physician left in a huff.

    It is not easy to reach these parents. They often think they are “compensating” well. Their “denial” can be immense.

    A pilot study recently looked at treating first the mothers of children with ADHD (that is, those mothers who were diagnosed with ADHD).

    For many years, we’ve gotten this backwards: treating the children first. While in the case of foster homes and the like, treating pediatric ADHD might be the biggest chance for positive change that child will experience, I always recommend that the entire family be evaluated before a child is treated.

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  65. My stepdaughter was thought to have ADD/ADHD by school authorities, but no one ever thought to look into the situation at home. Unfortunately, she was living with a single mother with Borderline Personality Disorder who was adept at covering up what was truly going on outside of the school environment. When my stepdaughter lived with her father and myself for almost 2 years, teachers at the small rural school she attended (we lived in a different state) did not see any sign of ADD/ADHD, just saw a child who was 3 years behind in reading and who had delayed motor skills. By the time she left us, she was reading on grade level – but once back home she resumed her previous behaviours in school. Unfortunately, schools are not adept at recognizing symptoms of trauma and PTSD – and even if they do, there is little they can do unless a child shows signs of physical abuse.

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  67. This intrigues me. My 6 y.o son was diagnosed with ADD several months ago after spending a few days on a psych ward. He HAS been through multiple traumas, including watching his father abuse me, being abused himself, divorce, an abrupt move, and possibly even the hospitalization. He’s been on several medications since then, and the combination that he’s on now seems to be helping. I do wonder, though, if his “symptoms” could be his way of coping with the trauma he’s been through.

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  68. In other words, even though this article is very carefully worded to suggest otherwise, ADHD is made up. We know so little about it, yet we prescribe our kids Amphetamine based drugs for it, sounds great for the developing already traumatized mind. Not. All your kids need is your time. I know behavioral issues are a monster of their own but the problem is not the child, the child is having a problem, and until some over worked parents pull their heads out of the sand and actually parent, be a source of not just financial support but emotional and everything else, nothing will change. No medication out there has been proven to work for anything more than short term, then after that the body and brain gets to cope with withdrawals and a new type of chemical to change the way shit gets from point A to point B in our brains.

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    • Thanks for your comment, Ashley. Parents need support, too. They’re often passing on what they’ve grown up with, and, because many have to work long and hard just to put a roof over the heads of their kids and food on the table, they’re stressed out.

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    • Thanks Ashley,

      It is true that your environment can contribute to the development of ADHD, however it is not the only factor at play. In addition parents with undiagnosed ADHD probably are those who work more in lower paying roles and spend less time with their families because of the inner turmoil they experience and stress at work? ADHD makes patients susceptible to developing secondary conditions such as depression, bipolar, and post traumatic stress disorder to name a few. Can you imagine having to hold down a job that you struggle with and keep the house, yard, car and your kids in order with all of this going on?

      I wasn’t diagnosed until my adult life because no one knew that girls could have ADHD and my parents didn’t believe it was real (they taught me the same thing). I have struggled my whole life because of this and wasted 7 years of my life trying to sort myself out through therapy for the idiopathic depression and anxiety I suffer from. Now I know it’s ADHD and I can start to forgive myself for all the things I’ve failed at and for the things I continue to find extremely difficult.

      Dexamphetamines have helped me get my life back, CBT helped with my thinking due to trauma and things learned from my parents but anti-depressants never helped me get better.

      The frustrating part of ADHD for me is people don’t believe it is real and assume your lazy or making shit up because you can perform well sometimes but not all the time. People don’t know enough about ADHD because they don’t want to know. They want to make excuses like “everyone feels like that sometimes” to which I think “maybe you could try feeling like that all the time?”.

      Once a childhood has been lost it’s too late. If drugs don’t help then don’t use them? ADHD treatment is all about trial and error not “take this pill”. If your doctor sounds like that run in the opposite direction!

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  69. I must say as a parent of adopted children who were traumatized in their bio/foster lives…no matter the cause, whether it be circumstantial, heredity, genetics, whatever, I know this for certain. My children were suffering, being passed over and written off in school, teased by classmates. They are both in therapy and have been since 2011, and we have successfully peeled back the onion skin of Reactive Attachment Disorder as well as some other behavioral issues pre-medication. After many of these issues were figured out, we had come to the end of our behavioral fixes and still had the ADHD symptoms that were almost impossible to deal with and maintain sanity in the house. They are both on meds now and are excelling in school, able to focus on their extra curricular activies (which the love), they are not written off as unhelpable or just misbehaving… No matter the cause, the meds have improved my children’s quality of lie as well as my own. They are thriving. I am satisfied. We spent two full years devoted to finding a way of helping them live a more normal, happy life. This continues as any normal family. But now, it is different. It is happy…mainly for my children.

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  70. I wonder if traumatic experiences are the only environmental factor being explored. Particularly, comparing biological families to adoption cases where the children were adopted as infants. This is not to suggest that ADHD parents cannot be wonderful parents. I want to ask if, left undiagnosed and untreated, could an ADHD parent create environmental conditions in which the child unintentionally mimics the symptoms? If so, is it possible that it’s not as hereditary as we are led to believe since it cannot be isolated with DNA analysis?

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  76. The fatal error being made here is to imagine that ADHD is a genetically based disease. As per all other “conditions” listed in the DSM, ADHD is a clinically defined syndrome.

    I personally was diagnosed ADHD 6 years ago at age 46- the first in my family, and both of my children also fit the diagnosis. Many of my friends also have ADHD children- without having had ADHD themselves.

    I am now 52, and have worked in medicine since age 25. The incidence of the condition is clearly on the increase in a manner not consistent with genetic causation. The difference in incidence between Europe and the US, and the differences in incidence within the US are also inconsistent with a genetic causation.

    I work mostly with ADHD patients and would make the following suggestions:
    A chronic attention problem will generate recurrent traumatic experiences. That is easy to understand but can be expanded upon:

    Attention problems delay new learning severely- causing difficulties with falling behind in school and at work, and hindering the neuroplastic development of the brain. Effectively this can create a self perpetuating situation where the inattention feeds back and traps the individual in dysfunction.

    Any child who has inattention and emotional instability is difficult to handle- especially if the parents have their own vulnerabilities. This will lead to a situation of a difficult emotional climate in any family where the ADHD dynamic is operating- and may well generate more traumas.

    In fact I have not dealt with any ADHD individual not impacted upon by emotional trauma.

    In short- there may well be a dynamic positive feedback loop between attention problems and trauma.
    In this context the dichotomy between “ADHD” and complex trauma really is a false one.

    Deciding the exact cause can be very difficult- but unravelling the problem is much less so:
    Proper management of the syndrome we choose to call ADHD needs to be thorough, and involve attention to psychosocial issues whether or not stimulants are used.

    As for the decision to use stimulants– it is really not all that hard:
    Stimulants improve attention and allow new learning. Very often the absence of new learning can maintain ADHD. The correct approach in my books should be to offer comprehensive treatment involving psychosocial interventions as a matter of course in every case of ADHD and consider the option of a therapeutic trial of stimulants in every case of ADHD- even if trauma is part of the syndrome. However- the trial needs to be closely monitored with a view to assessing its effectiveness.

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    • I would also highlight that in his book Scattered, Dr Gabor Mate highlights trauma as a cause of ADHD, and that equally it is acknowledged by experts in childhood trauma that it can adversely affect childhood development.

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    • Has there been any investigation into the possibility of heavy metal toxicity?
      Also poor diet, omega 3 deficiency?
      Stress, of course, has its’ own legacy of impaired digestion and repair.
      Am not ignoring the significant contribution that emotional trauma plays, but am curious about other possible contributing factors.

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  79. I am so glad these issues are being studied! My niece, who is now 20, was diagnosed with ADHD in early elementary school. I wondered even then (before I had gotten my own college degrees) whether that diagnosis was accurate. Sure, she was hyperactive, chatted incessantly, had poor concentration etc., but she also was raised in a home with an alcoholic father, financially lacking parents, parents who loved her but related dysfunctionally to each other (yelling at each other, separations, cursing by both parents etc) Because my sister protected her to the extent that she could (and a few years later, her little brother) and did her best to leave the house if their father was drunk, didn’t leave them with him if he’d been drinking etc., DHS wouldn’t do anything. When my nephew started school, he too was diagnosed ADHD. They have both been on medication for it and their pediatrician concurred with the school’s impressions! I have long felt that if the environment had been healthier–or at least looked at more thoroughly, these kids MIGHT not have been given the ADHD diagnosis. And if they had, after investigating, the outcome would have been better because they’d have the full picture.

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  84. I was 5 when my father disappeared into a mental institution diagnosed with schizophrenia (wrongly, he was bipolar) and my grandparents on his side of the family, stand up Catholics that they were, threw us out onto the street. They were well-to-do and gave us no help: my mother’s fight for survival was epic. The blow destroyed me. For years nobody could get through to me, I was classic Tommy; a walking vegetable. Luckily there were no drugs to write me off with back in the 70s. People think kids are so resilient just because they can function on a basic level of breathing and eating and sleeping and growing. Ha! ‘Fine’ is relative, but it is true that where there is life there is hope.

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  85. Really interesting article. As someone who works with a mental health organization, especially men with trauma, I find that most of our poor clients struggle with the effects of early childhood trauma, as well as current trauma. We have as an organization developed the TREM model for helping women with trauma and have added, M-TREM, for men, G-TREM, for girls and now B-TREM, for boys. They are practically based, psychoeducational groups designed to help those who suffer from trauma learn about its roots and its effects, and to developing new coping skills to help them lead happier, more productive lives. I will forward this article on to all I know who work in the field.

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  86. Excellent article! Thanks to a school psychologist who dared to disagree with our adopted son’s neurologist, we dug deeper. Had we accepted the initial ADHD diagnosis, our son would have been on medication that would exacerbate his challenges. Instead we now have a child whose self-esteem is building and whose negative behaviors are diminishing, thanks to the right medicines and therapy.

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