Autism spectrum disorder (ASD)If a child in elementary or middle school is acting impulsively, not paying attention and doing poorly in class… the reason seems to be a given these days: ADHD! The child may then be promptly diagnosed and prescribed Ritalin, Adderall or some other stimulant medication.

While ADHD is a very real executive functioning brain issue that affects 7.2% of adolescents globally (according to CHADD)—there is major problem with this situation. All too often, nobody takes into account the other likely diagnosis: Trauma. Children are over-diagnosed with ADHD without ever fully evaluating for a trauma connection—and I want this approach to end.

Similarities Between ADHD and Trauma Symptoms

ADHD symptoms include:

  • Impulsivity
  • Lack of focus or concentration
  • Hyperactivity
  • Racing thoughts
  • Emotional overwhelm
  • Reactivity

All of these are also symptoms of chronic hyperarousal after trauma—because when you’re living in fear, when your brain is wired to be prepared for danger—it’s hard to pay attention, stay focused, make well-thought-out decisions, etc. (We touched on this in our recent post about worrying and emotional wellbeing.)

What’s Causing These Symptoms?

Of course parents want their children to be happy and healthy. If there is something wrong, they want to fix it. I’m suggesting that the route to helping a child is first to understand what is causing their symptoms—not just treating them with medication. And children with trauma or ADHD are more likely to have addiction issues—making the medication-approach potentially dangerous.

Trauma and ADHD: The Call for Routine Differential Diagnosis

After an ADHD diagnosis from a pediatrician, parents may not be aware of a critical next step.  Most parents think the next step is treatment. But it’s vitally important to explicitly screen for trauma.  A much-needed protocol when evaluating for ADHD is to assess for trauma, to confirm that ADHD treatment is warranted. 

A mental health assessment with a qualified professional should become standard procedure when evaluating a patient for ADHD. PTSD and related health disorders present symptoms that resemble ADHD symptoms very closely. So, children, adolescents and even adults need to be assessed for trauma so there’s a differential diagnosis. We need to look at the bigger picture. Is there a history of physical, sexual, emotional and/or attachment trauma? A frightened or frightening parent?

A differential diagnosis is the responsible — and necessary — course for the diagnosing medical professional, to ensure a child isn’t spending any period on unnecessary medication or with an incorrect diagnosis.

I’m So Passionate About This Issue Because…

A lot of clients who come to me for therapy have a trauma history. Many of them were diagnosed with ADHD as children and were prescribed medicine, or think they have ADHD because their symptoms provided reasons for that diagnosis. Now, even though they are not taking medication for their ADHD, their symptoms of hyperarousal are improving drastically with therapy (using a Window of Tolerance gauge, like the one below)…leading me to believe they never had ADHD at all, just symptoms that looked like it.

 

ADHD is a Real Medical Issue. But Don’t Ignore the Bigger Picture.

Many individuals do actually have ADHD. But many who are diagnosed with ADHD don’t have it—they have trauma histories. As a therapist who specializes in treating trauma and addiction, I’m conservative about medication until there is a clear-cut diagnosis. So if you, your child, or a child or adult you know, has been diagnosed with ADHD, please get a differential diagnosis in order to ensure that ADHD medication is, in fact, the right route forward.

Since my practice only sees adolescents and adults, if you are looking for this differential diagnosis for a child, I’m happy to refer to a child therapist who can provide an assessment.

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