ADHD en emotioneel traumamaart 19, 2020
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Can emotional trauma mimic ADHD? What is the association of ADHD with emotional trauma? It turns out that the relation between ADHD and emotional trauma is multifaceted. It’s not a bad time to reflect on this. During periods of collective anxiety like what we are now experiencing with the COVID-19 outbreak, some people will re-experience traumatic fears or anxieties. These may be parents or adults with ADHD. Some children will feel heightened fears and anxieties either from seeing news stories or from picking up on parental anxieties.
How is trauma different than stress?
Everyone experiences stress. “Good stress” is a challenge that we feel able to face or overcome. This kind of stress builds confidence, and emotional strength. Healthy development requires these types of challenges.
Normal “bad stress” is an upsetting or difficult situation that we feel we failed to cope with effectively. But it is over and it doesn’t stay with us. We seem able to “bounce back” to our baseline of feelings and to resume our usual way of being. This also happens to everyone.
However, a third situation is different. A frightening event triggers a fight-or-flight response. The biology of this response includes a shot of cortisol and adrenaline that we feel physically. This emergency response system in the body adds physical strength, suppresses pain, and quickens reaction time. It is vital for survival in a sudden physical life-or-death situation like a physical attack. Sometimes we still bounce back. But for some people, sometimes, the fight or flight response stays on.
That may be because of personal sensitivity. Or it may be due to the situation, for example, no physical or verbal response is viable. Or, a child may have had ongoing adverse events that take a toll on the development of self-regulation over time. These ongoing events continually place a child in a state of emotional arousal and fight-or-flight feelings. Some examples of sustained adverse events might include:
- Living with an emotionally abusive individual
- Addiction in the household
- Physical conflict in the household
- Sustained physical hardship (such inadequate housing)
- Witnessing or experiencing serious violence in the neighborhood
- Upsetting separation from or loss of a parent due to overseas deployment to a war zone, incarceration, or death.
- Suffering recurrent racism and discrimination as a minority individual
- The emotional aftermath of a volatile parental divorce
This continuous activation of an alarmed state is harmful for health and development. It can overwhelm a child’s developing emotional capacities so that they can’t achieve the level of self-regulation they otherwise might.
The result: as the child or adult grows, they tend to over-interpret problems or challenges as much more serious than they are. They may overreact to a mild insult or off-hand remark; easily startle; or experience poor sleep, chronic anxiety, and ultimately poorer health. If we are in this situation, we experience poor attention, impulsivity, up-and-down emotions, and feel overwhelmed by additional stress. Coping with life’s daily hassles can seem too hard.
If a mother experienced severe emotional stress while she was pregnant, or if the child experienced abuse or other trauma early in life, this inner emergency alarm may be turned on throughout development. In that case, the child also may look like they have ADHD. The child may be inattentive, irritable, over-reactive to challenge, even reactively-aggressive. But they don’t really have ADHD. They have a chronic trauma reaction.
The triple whammy of ADHD and emotional trauma
The first way that emotional trauma and ADHD relate, then, is that emotional trauma, either during childhood or even before birth, can sometimes lead to a “mimic” of ADHD that isn’t really ADHD. In this case the correct treatment may not be an ADHD treatment, but a treatment for emotional trauma (such as trauma-based cognitive behavioral therapy).
The second way they relate is that some people have both. People with ADHD tend to have more bad things happen. This is for several reasons: High impulsivity; altered or weaker judgement of social situation; seeking for elusive peer approval; attraction to risky situations for the thrill or the excitement. Research shows that having ADHD is associated with a higher rate of traumatic events happening.
The third reason for overlap is perhaps the most slippery. Given the same dangerous situation, individuals with ADHD are more likely than other people to experience it as traumatic. This relates to the heightened sensitivity to experience that people with ADHD seem to have, which I alluded to earlier. In addition, some individuals with ADHD don’t have strong coping mechanisms, such as the ability to suppress upsetting thoughts and put them out of mind.
Adding this all up, the bad news is that kids and adults with ADHD are 3 times as likely as other kids and adults to get post traumatic stress disorder. The good news: even at that, only a minority will ever have this experience.
Take home message
If your child seems to have suddenly developed symptoms of ADHD, consider whether something emotionally very upsetting or traumatic may have happened or may still be going on. Did they experience online bullying, or some physical threats? Some investigation here may be suitable and can be carried out by a skilled clinician if the child or teen isn’t comfortable sharing with a parent.
If they are not responding well to treatment or help for ADHD, or if you know there is a difficult history, or a difficult ongoing circumstance like some of those listed earlier, consider whether your child may need additional coping support (counseling or additional coping help). This may be either instead of, or in addition to, being seen through the lens of ADHD.
If there is a traumatic history, societal anxieties like the present pandemic can be activating and lead to worsening of behavior or coping. This may indicate a need for some additional short term support or counseling. During this pandemic, many mental health providers are authorized to provide support remotely. Be kind to yourself, be kind to your children, and stay well.
Nigg, J. T. (2018). Getting ahead of ADHD: What next-generation science says about treatments that work—and how you can make them work for your child. Guilford Press.
Spencer et al (2016) Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Clin Psychiatry. 2016 Jan;77(1):72-83. doi: 10.4088/JCP.14r09479.
This pooled analysis of all relevant studies showed that children with ADHD were 3x as likely as otherwise healthy children to develop post traumatic stress disorder.
Kennedy et al (2016) Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study.J Child Psychol Psychiatry. 2016 Oct;57(10):1113-25. doi: 10.1111/jcpp.12576.
This study examined a severely socially and emotionally deprived population of children who had lived their early life in orphanages in Romania with inadequate attention or care. This population showed an increase in ADHD, indicating that severe early life adversity increases the risk of ADHD. The adversity in this population was more extreme than typically seen in developed nations, so its generalization to milder adversities cannot be assumed.