How Childhood Trauma Could Be Mistaken for ADHD

By: Amy Torchia, Children’s Program Coordinator, Vermont Network Against Domestic and Sexual Violence

It feels like Advocates have been talking about this for years.  We know that a good number of the kids with whom we work – children and teens who have experienced domestic violence, child sexual abuse, and sexual assault – are diagnosed with ADHD.  We have had infinite conversations with caretakers about situations where their children have been prescribed stimulants for ADHD to help increase neurotransmitter levels (connected to pleasure, movement, and attention) with no apparent positive impact on their behavior or emotional well-being.

Children who have experienced trauma often behave in ways that resemble those associated with ADHD.  They may have difficulty controlling their behavior and may quickly shift from one mood to the next. They might periodically ‘relive’ a terrifying memory and lose focus or become hyper-vigilant anticipating a threat to their safety.

For this group of children, could it be that it isn’t ADHD that is driving their seemingly inattentive, hyperactive and impulsive behavior?  Could it instead be a normal response to the adversity and trauma that they may have experienced?  Or, could it be a combination of the two?  Pediatricians and researchers are now asking these questions – and are appealing to clinicians, teachers, and medical professionals to become “curious practitioners” and ask about what has happened in the lives of kids showing signs of ADHD – rather than only looking at their behavior.

A recent article in The Atlantic, How Childhood Trauma Could Be Mistaken for ADHD, suggests that there could be nearly 1 million US children misdiagnosed with ADHD because the professionals who have assessed their behavior have not known to take the time to ask about adverse life events.  It may be that children legitimately have ADHD, but, if they have also experienced trauma that goes unnoticed and untreated, responses directed only to the ADHD may never result in positive behavior changes.

Fortunately, 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.  In the meantime, it would be helpful for all of us – teachers, clinicians, medical professionals, advocates, and parents – to keep this new perspective in mind as we think about the best ways to support the children in our lives.