The ADHD and Trauma Connection

While completing my morning doom scrolling, I stumbled across an account on Instagram (@psychologycortex) that posted about the similarities between growing up in a household where a child would experience trauma, and symptoms of ADHD. As an educator and as a mother, this immediately struck me as truth as I reflected back on the students I worked with in Houston, many of which I had confirmed traumatic pasts, as well as current 504 plans for ADHD. Currently, psychiatrists utilize the term ADHD as a catch all for attention deficit diagnoses, even when hyperactivity is not present, it is simply referred to as primarily inattentive presentation. ADHD diagnoses are on the rise, increasing approximately 4% over the last twenty years. Currently, about 10% of the population is clinically diagnosed with ADHD. Imagine, for educators, this means that in our classes of thirty students, on average, at least three children will hold an ADHD diagnosis. What experts are now finding, however, is that the similarities between symptoms of growing up with adverse experiences and the neurological disorder of ADHD are so small that it has become increasingly difficult to accurately diagnose. The symptoms of both include difficulty in focusing, obstacles in verbal communication, impulsivity and forgetfulness, low tolerance for frustration, and disrupted sleep. Additional symptoms of ADHD are identical to trauma exposure such as shame, dissociation and sensitivity. In order to truly understand the root cause of the symptoms, create an accurate diagnosis and treatment plan, and see tangible improvement in quality of life, we have to investigate the childhood environment and explore how experiences have significantly altered brain chemistry.

Children who suffer traumatic experiences or abuse develop a chronically overactive limbic system, a hyperaware amygdala, and a disengaged pre-frontal cortex. Essentially, the systems of the brain that are responsible for planning, follow through and focus are suppressed, while the amygdala and hippocampus have become increasingly overreactive to perceived threats. As with most children or students who experience or witness abuse, neglect or violence, their body goes into a survival mode, pruning all excess neural pathways to ensure safety. In children with true ADHD, stimulants and other prescriptions medications can be immensely helpful in managing symptoms, while children who appear to have ADHD but actually are suffering from altered brain chemistry due to trauma may receive these same drugs and experience increased anxiety and hypervigilance. For a child with ADHD, stimulants may aid in sleep routines, while a child who suffers from adverse experiences will become even more dysregulated in sleeping patterns.

One of the most impactful symptoms of abuse and maltreatment in children is dissociation, where the brain attempts to numb the memories and sensations that correspond to the trauma. Dissociation, when used as a coping method, becomes the default nervous system response for a brain that is dysregulated or overwhelmed, and medication or interventions for ADHD will do nothing to ease the burden of these implicit memories. A child who has dissociated from their past experiences and memories will require professional guidance in navigating the rewiring of their neural pathways to feel safe and at ease. Additionally, the chronic shame attached to adverse experiences in childhood can result in an altered self image for the child, where they develop core beliefs about their self worth and value. These beliefs can manifest in children as a lack of motivation or avoidance of difficult tasks, when in reality their body and mind are functioning within that survival mode which leaves little energy for additional tasks. Diagnosing a child with a traumatic past as ADHD and focusing only on controllable interventions such as daily medication and study skills can further impede a child's self confidence as they are repeatedly assured that the medication is all that they need to succeed, while their body is still stuck in cycles of hypervigilance and anxious concern for their safety.

So how can we intervene for the children in our lives and in our classrooms and ensure that our expectations align with the true cause of disinterest, lack of focus and intrinsic motivation? We must build relationships with our students and children and ask questions targeted to unearth the actual risk factors and causes behind the symptoms of ADHD. If you notice a student or child who has dissociated from their work and appears to be numb, consider asking them what is on their mind, or what they are feeling in that moment, as opposed to giving an immediate on-task reminder. Often, survivors of abuse or maltreatment experience implicit memories in the forms of sensations that cannot be seen or understood by those outside of their own body. These sensations act as triggers that cause the brain and body to react as if they were in the same dangerous position previously known to them during the past trauma. Whether their reaction is freezing, fighting, or running, their body is reacting intensely on implicit memory. If you experience a student who becomes combative, walks out of the room, or freezes when re-directed, there is a good chance that they are reacting in survival mode and need empathy and care in response.

When I was younger, I often cried in class, not because I was sad or trying to avoid my work, but because smells and sounds had the ability to send my memory racing back to moments where I felt like I was under the greatest threat. I specifically remember one teacher, annoyed with what she referred to as "my dramatic sensitivity" calling my parents to complain that I was once again upset because I didn't finish an assignment. In that moment, I didn't need additional time, medication, or re-direction, I needed an adult empathetic enough to ask why I was crying, move me away from the triggering smell or sound, and show me that I was safe. There was nothing lazy about me, I simply needed relief from a nervous system that was dysregulated, surviving through the fog of implicit memories triggered at an inconvenient moment. How many of our students and our children would benefit from a caring response when symptoms of disassociation, lack of focus, or anxiety arise? For some children, the overwhelming chaos and noise of a typical classroom is enough to thrust them into survival mode, and they may simply react by putting their head down to self-soothe. When re-directed to their work, they may appear combative as those survival instincts set in, responding to the intense amygdala hijack they are currently experiencing. While it may be tempting to escalate in tone or intensity, at this moment, what a child with past adverse experiences needs is the opposite response- calm, soothing tones and reminders of safety. I've heard many side conversations from teachers and those who work with kids, speculating that kids with ADHD just need more structure and punishment, but what if a student who presents as a typical ADHD diagnoses is reacting out of fear, and has already experienced more punishment than any child deserves?

Grace. Patience. Empathy. If we lead our classrooms with these traits in mind, we are less likely to misunderstand those around us who are suffering and truly make a positive impact on them not only academically, but emotionally, physically and socially.