The link between ADHD and trauma

I used to think my professional interests - adult ADHD and trauma/PTSD - were an odd combination. Would I have to give up my work with ADHD adults in order to pursue my new(er) passion? Do these two issues have enough commonality to make sense for me to specialize in both?  Would people get it?

Over time I've noticed that many of my ADHD clients are also struggling to heal from neglect or abuse sustained during childhood. This is actually a big part of the reason I decided in 2013 to get my master's in counseling - so I could help them with both. Conversely, one of my internship supervisors shared her belief that all clients with trauma histories will also have ADHD symptoms.  This has been echoed by multiple professionals in the Equine Assisted Psychotherapy (EAP) field during my various trainings.

Why is this? 

ADHD is characterized by inattention and / or impulsivity and hyperactivity. It is diagnosed via a symptom checklist rather than blood work or scans. Medical professionals often don't ask about trauma histories when responding to a request to identify "why is my kid so out of control" or "why isn't he doing better in school". If ADHD is suspected, the checklists are administered and the diagnosis is made. If trauma is asked about, it isn't always disclosed, or is considered secondary.

Hypervigilance (constantly scanning for threats) and dissociation (checking out) can look a lot like inattention.

Impulsivity can be a response to unmanageable stress.

It's hard to sit still when you don't feel safe.

Neural pathways are created in the brain that entrench these behaviors over time until they become the norm. The trauma is pushed to the back of the mind and not talked about. After enough time passes, the two feel more and more separate. But they aren't.

I've concluded that my specialization doesn't have to be - indeed it can't be - one or the other.  If you're looking at ADHD, you could also be looking at trauma and vice versa. It can be extremely helpful to work with a professional who deeply understands both.

To be clear, I'm not saying that ADHD is always caused by trauma. The current working theory is that it's a genetic condition. Scientists generally agree that there could also be other causes, and trauma could be one of them. I'm just saying we need to correctly identify the underlying cause, so we can treat it appropriately and effectively. 

Check out this article for more details on how childhood trauma could be mistaken for ADHD.



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