Is Childhood Trauma Being Misdiagnosed as ADHD?

For months now, one of your teachers has been coming to you about a struggling student. The student is easily distracted, disorganized, often hyperactive, and restless. Your training tells you to recommend an evaluation for attention deficit/hyperactivity disorder (ADHD). Your gut tells you this may be something more.

The problem is, you’re not sure what.

What’s the link between childhood trauma and ADHD?

In 2014, The Atlantic highlighted research being done by Dr. Nicole Brown, a resident at Johns Hopkins Hospital in Baltimore. She noticed that many of the children diagnosed with ADHD at John’s Hopkins seemed to come from low-income backgrounds. This led to the possibility that trauma could be playing a role in some of those diagnoses, especially when medication and behavioral therapy didn’t manage symptoms for some of those kids.

“I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.” Brown told The Atlantic at the time.

Two years later, that hypothesis resulted in research published in Academic Pediatrics that confirmed Brown’s initial concerns. Utilizing data collected for the 2011–2012 National Survey of Children’s Health of the nearly 80,000 children between the ages of 4 and 17, Brown and her team discovered a significant association between a child’s Adverse Childhood Event (ACE) score and ADHD.

The research concluded with a call to improve ADHD assessments and routine evaluation for ACEs.

What counts as childhood trauma?

In an effort to raise awareness about ACEs and the impact they can have on a child’s mental and physical health, The American Academy of Pediatrics (AAP) has compiled a list of potential traumatic experiences in childhood. It includes:

• Child abuse (emotional, physical, sexual)
• Child neglect (emotional, physical)
• Parent or household mental illness
• Parent or household substance use/alcoholism
• Witnessing domestic violence
• Having a parent or family member incarcerated
• Parent separation or divorce
• Death of a parent or sibling

The more ACEs a child experiences, the greater risk they have for teen pregnancy, alcoholism, smoking, illicit drug use, depression, heart disease, and liver disease, among other things.

What are the differences between trauma and ADHD?

While childhood trauma and ADHD do have some symptoms that overlap, there are also some distinguishing features that can help educators and practitioners tell them apart.

“Children of trauma get startled and scare easily,” psychologist Dr. Karin Cleary recently told School Leaders Now. “They perceive many things as potentially unsafe and threatening, and may react in a way that seems out of character for them or in a way that seems argumentative or aggressive.”

Cleary is currently working on a presentation for a local high school on this very subject. She specializes in trauma and PTSD, and often does psychological testing, which includes assessing for ADHD.

She said other signs of childhood trauma include:

• Intrusive thoughts causing distraction
• Trouble sleeping at night, which may lead to trouble staying awake or maintaining attention in class
• Seeming emotionally flat, less likely to appear either angry or happy
• A desire to control every situation, which could look like overachieving
• Trouble remembering things they have previously learned or understood

Source: nctsn.org

What can educators do?

Do you suspect your student may be suffering from the results of trauma? You should immediately refer that student to the school counselor. From there, Cleary says, “The best way to distinguish between trauma/PTSD and ADHD is to have a mental health professional, preferably one with a specialty in trauma, do an assessment.”

While misdiagnoses do appear to occur, letting the counselor and evaluators know about your concerns can help them consider the possibility of trauma as opposed to ADHD more closely.

But Cleary says the most important thing educators can do is be aware of just how prevalent childhood trauma is. “The likelihood of experiencing a traumatic event, defined as experiencing or witnessing a life-threatening event, serious injury, or sexual abuse and violence, is about 90 percent.”

It’s a concerning number, but Cleary explained, “Teachers can work to create ‘trauma-informed classrooms,’ and there is a lot of literature on this to help teachers understand how trauma can impact classroom behavior and learning.”

Ultimately, it turns out, you do have the power to make a difference when it comes to identifying childhood trauma and ADHD.