ADHD Archives • Childhood Trauma Recovery

Reasons Why ADHD Might Be Being Overdiagnosed

October 8, 2019 3:50 pm , Leave a Comment , David Hosier BSc Hons; MSc; PGDE(FAHE)

How Many Young People Are Diagnosed With ADHD?

Statistics reveal around 1 in 7 young people in the United States currently receives a diagnosis of ADHD (the majority of whom are male)) and it is has been argued by many that a large proportion of these diagnoses are incorrect ; in fact, it is quite possible that the number of incorrect diagnoses outweigh the correct ones.

Overdiagnosis ?

The extremely strong suspicion that ADHD is being overdiagnosed in young people in the United Stated is underlined by the fact that The American Psychiatric Association estimates the true number of ADHD sufferers to be around 5% (i.e. a mere third of those who are being diagnosed with the condition – see above) and this figure is generally endorsed as a realistic estimate ny most experts in the field.

Explosion of Diagnoses :

Also, it should be taken into consideration that there has been an absolute explosion in relation to the diagnosis of ADHD in the recent past ; for example, in 1990 only about 1% of young people, at most, had been diagnosed with ADHD.

In the UK, prescriptions of retalin have doubled for children and adolescents between 2003 and 2008 (and, in relation to adults, they have quadrupled).

So, if we accept the ADHD is indeed being overdiagnosed in young people, what are the possible reasons for this unfortunate occurrence?

Possible Explanations For Over-Diagnosis Of ADHD:

PROFITS :

One reason that is frequently put forward is that the organizations profiting from selling the drugs that are used to treat ADHD are funding studies, running aggressive campaigns (including campaigns endorsed by celebrities) and hiring physicians who will increase their sales and, of course, their profits.

RATIONALIZATION TO GAIN CONTROL :

It is also argued in some quarters that diagnosing a young person with ADHD so that he or she can then be medicated with drugs that have a ‘subduing’ effect may be, at least in part, motivated by a wish of some (e.g. over-stressed teachers) to control disruptive students rather than by a sole inclination to act in the young person’s best interests. Indeed, such motivation may, in some cases, be operating on an unconscious level with the concept of the young person having a genuine clinical need for the medication serving as a convenient rationalization.

‘PATHOLOGIZING BOYHOOD’ :

Indeed, some researchers have even suggested that the diagnosis of ADHD,and the subsequent administration of medication purpotedly to treat it, represents a cultural intolerance of boys deriving from a perception that their high levels of energy and aggressive tendencies make them hard to keep under discipline. In fact, as long ago as the 1970s, the drug retalin was being described by some as the ‘bahvior drug’ and, more recently, terms like ‘pathologizing boyhood’ and ‘medicating boyhood’ have been suggested in relation to the perceived inappropriate use of the drug (Kindton and Thompson, 1999 :Raising Cain: Protecting the Emotional Life of Boys ).

‘MILD’ AND ‘MODERATE’ CASES :

A very large proportion of children (estimated at around 85 per cent) are diagnosed with ‘mild’ or ‘moderate’ symptoms of ADHD. It is argued that in such cases where symptoms are not severe and dramatically pronounced, the diagnosis is subject to being overly influenced by subjective opinion.

FAKING / PERFORMANCE ENHANCEMENT :

Some individuals may fake ADHD symptoms so that they can gain a prescription for ADHD medication in the hope that it will improve their powers of concentration and attention in a way that helps them to achieve better academic grades. In other words, they treat such medication as ‘performance-enhacing drugs.’

INDIVIDUALS YOUNG FOR THEIR GRADE :

One study conducted in the 1990s (Watson) found that young students who were young for their grade in school were 20 times more likely to receive a diagnosis of ADHD than those who were not in this category (although there was some initial dispute, subsequently resolved, over her findings).

Another study, conducted by Ford-Jones, PhD, found that children born in December (the youngest in their grade) were more likely to receive a diagnosis of ADHD than those born in December (the oldest in their grade).

DEPRESSION MISDIAGNOSED AS ADHD?

It is possible that depression is sometimes misdiagnosed as ADHD because of the symptoms the two conditions share in common such as disrupted sleep, irritable mood and problems relating to focus, concentration and attention.

ANXIETY MISDIAGNOSED AS ADHD?

Similarly, it is possible that anxiety is sometimes misdiagnosed as ADHD because of the symptoms the two conditions share in common such as irritable mood, problems relating to focus, concentration and attention, restlessness and difficulties relating to interpersonal relationships due to social anxiety.

PTSD MISDIAGNOSED AS ADHD? :

See my previously published article : Childhood Trauma : Is PTSD Being Misdiagnosed as ADHD?

WHAT ABOUT THE CORRECT DIAGNOSES?

It is important to stress, that despite controversy regarding the appropriateness, or otherwise, of many diagnoses of ADHD, it is widely accepted amongst the medical community that a significant quantity of ADHD diagnoses are clinically justifiable and that sometimes the prescribed medication that follows such a diagnoses is beneficial to the individual to whom it is administered.

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) GUIDELINES FOR TREATMENT OF ADHD :

The UK guidelines (PDF, 217Kb)

N.B. ALWAYS SEEK APPROPRIATE, EXPERT, PROFESSIONAL ADVICE BEFORE STARTING OR STOPPING MEDICATIONS.

RESOURCES :

Improve Impulse Control

MANAGE ADHD

David Hosier BSc Hons; MSc; PGDE(FAHE).

ADHD And Its Link To Childhood Trauma And A Negative Thinking Bias

October 7, 2019 11:46 am , Leave a Comment , David Hosier BSc Hons; MSc; PGDE(FAHE)

There is increasing evidence derived from research studies that ADHD is linked to psychosocial stress, particularly childhood trauma which has been established as a major factor putting the child at increased risk of developing ADHD (e.g. Stevens et al., 2007).

Indeed, there is a growing school of thought expressing the view that many individuals are receiving a diagnosis of ADHD which is erroneous (i.e. a misdiagnosis) and, instead, should have received a diagnosis relating to the effects of traumatic stress (such as complex posttraumatic stress disorder – see my article entitled : ‘Childhood Trauma And ADHD : Is PTSD BEING MISDIAGNOSED AS ADHD?

Negative Thinking Styles May Develop As A Result Of Childhood Trauma :

One major effect of childhood trauma can be to cause us to develop a negative thinking style, particularly if we were rejected, constantly criticized, made to feel unsafe, were denied affection or were neglected and / or otherwise abused.

Recent research suggests that the negative thinking resulting from the experience of childhood trauma can contribute to the development of ADHD. (SEE BELOW).

NEGATIVE MEMORY BIAS :

Several studies have focused on a particular type of negative thinking that researchers refer to as : NEGATIVE MEMORY BIAS (this refers to the tendeny to recall and recollect negative memories, rather than positive ones, particular when it comes to memories relevant to oneself, a phenomenon already known to put individuals at risk of developing emotional problems).

STUDIES INVESTIGATING THE LINK BETWEEN NEGATIVE MEMORY BIAS AND ADHD :

A study conducted by Krauel (2009) found that teenagers diagnosed with ADHD displayed less positive memory bias than non-ADHD individuals.

Another study, carried out by d’Acremont and Van der Linden (2007) found that individuals with ADHD symptoms were better able to recall faces with a negative expression (anger) than they were able to remember faces with a positive (happy) expression.

A further study (Vrijsen et al., 2017) suggests that the link between childhood trauma and ADHD symptoms may be, in part, mediated (i.e. brought about) by the negative memory bias caused by the childhood trauma. So, according to this study, the effect of childhood trauma on the development of ADHD symptoms is an indirect one (though more research is needed to investigate this preliminary finding further).

Implications For Treatment :

If, indeed, such negative memory bias contibutes to the development of ADHD, and further research backs up the hypothesis, then this will serve to elucidate understanding about the relationship between psychosocial stressors (particularly childhood trauma), negative memory bias and ADHD, thereby possibly ifluencing the direction of research into therapy for ADHD in the future.

RESOURCES :

Improve Impulse Control

Manage ADHD

Be Less Negative Pack

David Hosier BSc Hons; MSc; PGDE(FAHE).

Posted in: ADHD, WHOLE SITE (ALL 850+ ARTICLES) , Tagged: adhd. negative thinking, childhood trauma

Understanding Developmental Trauma In Children And Young People.

October 27, 2018 9:13 am , Leave a Comment , David Hosier BSc Hons; MSc; PGDE(FAHE)

Researchers van der Kolk et al. have proposed that children who are significantly psychologically and emotionally disturbed as a result of their traumatic upbringings be diagnosed with Developmental Trauma Disorder (although the proposed diagnosis is not yet included in the DSM or, to give it its full title, The Diagnostic and Statistical Manual of Mental Disorders).

The researchers who propose the diagnosis argue that the various diagnoses disturbed children currently receive, such as Oppositional Defiant Disorder, Reactive Attachment Disorder and anxiety, are too narrow, restricted and limiting and, furthermore, do not recognize or acknowledge the ‘big picture’ (i.e. the full extent and range of the damage that has been done to child’s functioning).

They also argue that limited and narrow diagnoses like Oppositional Defiant Disorder lead to clinicians focusing too much on correcting the behaviour at the expense of identifying and understanding the underlying cause of it (i.e. the trauma that the child has suffered).

Van der Kolk, in his book The Body Keeps Score (see below) describes Developmental Trauma Disorder as having three prime features; these are as follows:

1) A pervasive pattern of dysregulation:

According to van der Kolk, this may entail dramatic mood swings, outbursts of extreme temper, panic, detachment, flatness, dissociation and the inability to self-sooth

(In relation to this, you may wish to read my article: FIVE TYPES OF DYSREGULATION LINKED TO CHILDHOOD TRAUMA.

2) Impaired ability to pay attention and concentrate (due to agitation and hyperarousal)

3) Impaired ability to get along with others and, as van der Kolk puts it, ‘a failure to get along with [ oneself ].’

Associated Physical Symptoms:

Van der Kolk also draws our attention to the fact that, because the child suffering from Developmental Trauma Disorder is constantly in a state of high stress (and, subsequently, is likely to have an abnormally high level of stress hormones – such as cortisol – coursing through his/her veins) s/he will also be susceptible to various physical symptoms; these include:

– headaches

– sleep disruption

– stomach upsets

– oversensitivity to sounds and tactile experiences

– problems with fine motion movements

EXTREME NEED TO AVIOD STRESS :

The young person with Developmental Trauma Disorder, in an attempt to alleviate the severe stress s/he perpetually feels, may, also, according to van der Kolk:

– self-harm (e.g. cutting self with a razor)

– masturbate excessively

– rock to and fro whilst sitting down

Neediness and Self-Hatred:

If the child has been rejected and/or largely ignored by his/her parents/caregivers this may lead him/her to become extremely ‘needy’ and ‘clingy.‘

Also, s/he is likely to have internalized his/her parents’/caregivers’ negative view of him/her and therefore develop feelings of self-hatred, of being intrinsically unlovable, and of being worthless and of no value to others.

How Childhood Trauma Can Disrupt Developmental Progress

What Is Meant By Childhood Development?

We can define childhood development as a complex process of developing competencies and attaining achievements from early childhood through to adolescence / early adulthood. These fall into the following main categories :

– physical

– emotional

– social

– intellectual / cognitive

– moral

Young Child :

During early childhood developmental tasks include :

building a sense of trust
learning to separate from parents (e.g. when starting school)
learning to adapt to the peer group
learning to adapt to authority figures
development of feeling of safety away from the home
development of friendships
development of thinking / cognitive / intellectual abilities
development of self-esteem

Adolescence :

During adolescence boys and girls experience 6 main developmental tasks. These are :

maintaining progress towards independence
solidifying a capacity for meaningful relationships
clarification of a sense of sexual identity
development of interests and competencies
internalization of moral values
development of autonomy

Timing :

How the child is affected will depend upon the timing of the trauma (and its adverse consequences) and at which stage of the developmental process the child is at at this time. Depending upon this timing the child may develop problems relating to attachment (such as reactive attachment disorder, disorganized attachment disorder or insecure attachment), separation anxiety, psychosexual issues and social issues such as problems with peer relationships. However, any of the developmental tasks referred to above may be adversely affected.

If traumatic experiences coincide with critical developmental transitions, such transitions may be jeopardized; how these ill-effects manifest themselves is subject to great variability – see below :

development may be interrupted
development may be delayed
development may be arrested (e.g. a traumatized teenager’s emotional development might get stuck at, say, thirteen)
the child may regress to an earlier stage of development (e.g. a toilet trained toddler might start having accidents)
a developmental stage may be accelerated / the child may undergo precocious development

Mastery :

Mastering these stages / developmental tasks are necessary for an emotionally and psychologically healthy adult life, and, because they require much psychic energy are largely dependent upon a safe, stable, supportive and nurturing environment.

RELATED ARTICLE :

Childhood Trauma And ADHD : Is PTSD Being Misdiagnosed As ADHD?

eBooks :

Above eBook now available for instant download from Amazon. Click here for further details or to view other titles.

To purchase Bessel van der Kolk’s book/eBook, click on image below:

<br />

David Hosier BSc Hons; MSc; PGDE(FAHE).

Posted in: ADHD, COMPLEX PTSD, WHOLE SITE (ALL 850+ ARTICLES) , Tagged: children in young people, developmental trauma, trauma in adolescents, trauma in children, understanding trauma

Why Labelling The Child As ‘Mentally Ill’ Can Be Unhelpful

September 10, 2018 7:46 am , Leave a Comment , David Hosier BSc Hons; MSc; PGDE(FAHE)

In his critically acclaimed book : ‘CRACKED : WHY PSYCHIATRY IS DOING MORE HARM THAN GOOD‘, the author, James Davies, argues that psychiatry is a pseudo-science which :

over-medicalizes human behavior, labelling individuals as mentally ‘ill’ when it is not appropriate to do so

is far too driven by the avarice and insatiable greed of profit-chasing pharmaceutical companies, leading to the over-prescription of drugs which are frequently not only ineffective, but actively harmful.

In order to illustrate this argument, one of the examples that Davies presents us with is that of a child displaying behaviors that would traditionally be associated with attention deficit hyperactivity disorder (ADHD), leading to two, alternative treatment scenarios (Davies recommends the second scenario) :

FIRST CASE SCENARIO : TRADITIONAL APPROACH / IN LINE WITH THE MEDICAL MODEL :

In the first case scenario, the child would be treated according to the traditional, medical model : i.e. assessed by a psychiatrist, and, if he met the diagnostic criteria, as designated by DSM V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), diagnosed with ADHD, ‘labelled’ as having ADHD, and put on psychoactive medication.

SECOND CASE SCENARIO : A MORE HUMANE APPROACH :

However, Davies proposes that a better, initial approach would be as follows :

The psychiatrist does NOT diagnose the child with ADHD, but, instead, interviews his mother to ascertain the family’s history.

From this interview, the following transpires :

The mother and the son had been living with a household in which there was domestic violence for several years before the physically abusive man responsible for this violence finally left the home.
As a result, the child incurred psychological damage which led to his behavior becoming ‘chaotic’ / angry / hypervigilant

However, in this scenario, rather than diagnosing the child with ADHD and putting him on medication, the psychiatrist focuses on helping him and his mother gain insight into the underlying reasons for the child’s behavioral difficulties.

Davies then expands upon this second case scenario :

Whilst the psychiatrist, in one session, is trying to help the mother and son gain insight into the reasons for the boy’s problems, the mother begins to feel guilty about having exposed her son to a violent environment, and starts to cry.

In response to his mother’s tears, the boy is quick to rebuke the psychiatrist, perceiving him (i.e. the psychiatrist) to be ‘yet another man hurting his mother.’

This event then opens up the opportunity for the psychiatrist to discuss with the boy and the mother that such hypervigilance reflected by the boy’s quickness to rebuke the psychiatrist was quite understandable given how he (i.e. the boy) would have had to have learned to become hypervigilant whilst living with the physically abusive man as a matter of self-preservation so that now such behavior had become automatic in situations in which he perceives himself or his mother to be under threat (whether the ‘threat’ is real or imagined).

In other words, his hypervigilance has become an unconsciously motivated survival response in situations which remind him, even on an unconscious level, of the danger once posed to him and his mother by the physically abusive man who used to live with them.

Armed with this information, the psychiatrist, during further sessions, is then able to develop a meaningful relationship with the boy and his mother and help them to understand the reasons behind his (i.e. the boy’s) behavior (chaotic, angry, hypervigilant etc) and talk through his issues. In this way, the boy is able to gain insight into his own psychological issues which, in turn, leads to an improvement both in his behavior and in how he feels about himself. And this is achieved without the need of a diagnosis or medication.

N.B. The above does not imply, nor is intended to imply, that medication for psychological conditions is always inappropriate. Davies himself accepts that medication in psychiatry still has its place in certain situations.

You may also wish to my related article :

THE HARMFUL EFFECTS OF LABELLING THE CHILD AS ‘BAD’

David Hosier BSc Hons; MSc; PGDE(FAHE).

Posted in: ADHD, WHOLE SITE (ALL 850+ ARTICLES) , Tagged: ADHD, labelling mentally ill, mental illness

Impulse Control : Study Showing Its Vital Importance

August 28, 2017 2:17 pm , David Hosier MSc

We have already seen that those who suffer such severe, protracted childhood trauma that they go on to develop borderline personality disorder (BPD) have very significant problems regarding self-regulation (i.e, controlling intense emotions) and with IMPULSE CONTROL (along with a wide range of other symptoms).

This impaired ability to control impulses, in turn, can have a seriously adverse effect on myriad aspects of the individual’s life, potentially leading to, for example, relationships problems, substance abuse, gambling, compulsive sex, poor financial control due to compulsive shopping, lowered work /academic accomplishments, violent outbursts and many other difficulties.

In this article, I will briefly outline a study that helps to show the relationship between poor impulse control in childhood and later life success :

THE STUDY ON IMPULSE CONTROL AS A CHILD AND FUTURE LIFE OUTCOMES :

The study was conducted by Walter Mischel and E.B Ebbeson. A group of children were given two options :

OPTION ONE : They could have one marshmallow immediately.

OR :

OPTION TWO : They could have two marshmallows if they were prepared to wait fifteen minutes for them.

The children were then left alone with the marshmallows.

RESULTS :

Some children gave in to temptation immediately and some managed to defer gratification for a short amount of time (but not the full fifteen minutes).

HOWEVER : About one third of the children were able to defer gratification for the FULL FIFTEEN MINUTES (in the main they distracted themselves from the temptation to eat the marshmallow by playing or singing to themselves, according to the researchers).

TWELVE YEARS LATER, a follow-up study was carried out on these same individuals. The results of this follow-up study were :

The individuals’ PERFORMANCE ON THE IMPULSE CONTROL TEST (as described above) was more highly correlated with future life success than any other measure, including socioeconomic status and I.Q.

In other words, on average, the children who managed to wait the full fifteen minutes before eating went on to have significantly more successful lives (as defined and measured by the twelve year follow-up study) than those children who were unable to do so. The fact that the level of an individual’s impulse control appears, according to this particular study, to be a better predictor of that same individual’s future life success than either their socioeconomic status or I.Q. implies that how well we are able to control our impulses is of vital importance.

N.B. UPDATE

However, researchers from New York and California Universities have unsuccessfully attempted to replicate the results of the above study to help confirm its reliability. More specifically, their study suggested that differences in levels of impulsivity found in 4 – year – olds had largely disappeared by the time that these same children reached the age of fifteen.once the confounding variable of these children’s parents had been controlled for.

In contrast to Mischell’s and Ebbeson’s study, this second study found that by the time children were fifteen years old, the children of wealthier parents, in general, had better impulse control than fifteen year olds from less wealthy families, irrespective of the level of impulse control the children had (from either wealthy or less wealthy families) at the age of four.

IMPROVE IMPULSE CONTROL | SELF HYPNOSIS DOWNLOADS

David Hosier BSc Hons; MSc; PGDE(FAHE)

Posted in: ADHD, WHOLE SITE (ALL 850+ ARTICLES) , Tagged: ADHD impulse control, delayed gratification, importance of impulse control, impulse control, marshmallow test

Childhood Trauma And The Development Of Impulse Control Disorders.

June 9, 2016 1:04 pm , David Hosier MSc

If, as adults, we find we have poor impulse control, this may be, in large part, due to the legacy of a disturbed and traumatic childhood. For example, those who have suffered severe and chronic childhood trauma are more likely to suffer from conditions such as borderline personality disorder (BPD) and anti-social personality disorder (APD) than the average person and both these conditions include impulsiveness as one of the symptoms.

If a person is impulsive it means s/he often acts prematurely with insufficient planning and lack of thoughtful deliberation; importantly, too, impulsiveness (when it is pathological) involves repeated efforts to make short-term gains but at the expense of long-term gains.

Tell-tale signs that a person may be impulsive:

– frequently making inappropriate comments (speaking without forethought)

– constantly interrupting others during conversations

– often displaying impatience (e.g when having to wait in queues)

Impulse control disorders may involve:

– ‘binge’ shopping for unnecessary items (although many ‘binge’ shoppers indulge in the activity in an attempt to escape from negative emotions such as depression)

– excessive use of alcohol/narcotics (which may themselves increase impulsiveness, thus creating a vicious cycle)

– binge eating (again, though, many indulge in binge eating to overcome – temporarily, of course – negative emotions)

– dangerous risk taking (such as dangerous overtaking of other vehicles when driving)

– promiscuous, unsafe sex

– kleptomania

– arson

– intermittent explosive disorder (I.E.D)

– pathological gambling

The Five Main Stages Involved In Impulse Control Disorders:

Research has identified five main stages a person who has pathological problems controlling his/her impulses goes through; these are:

STAGE 1: The experience of a powerful urge

STAGE 2: A failure to resist/inhibit this urge

STAGE 3: A state of high excitement/arousal (with physical and psychological manifestations)

STAGE 4: Giving in to the urge (this usually results in a sense of deep relief from tension)

STAGE 5: Feelings of guilt for having carried out the impulsive act (this feeling of guilt may be very intense and involve profound feelings of self-disgust, self-loathing and self-hatred).

Brain Regions Thought To Be Involved In Impulse Control Disorders:

Although further research is required in order to determine with greater accuracy how certain brain regions are involved in impulse-control disorders, it is currently hypothesized that damage to both the amygdala and orbitofrontal cortex may be relevant (it is also believed that these parts of the brain may be damaged by the experience of significant childhood trauma). Furthermore, it is theorized that the brain’s exexcutive function may also impaired.

Neurochemical Involvement:

Theories also exist that suggest people who suffer from impulse-control disorders are likely to have lower than normal levels of the neurotransmitters dopamine and serotonin in their brains.

The Possible Role Of Genes:

It is also thought that the dopamine receptor and serotonin receptor genes may be involved in impulse-control disorders which would, of course, follow from the above.

Risk Taking And Decision Making :

Below I outline a study that suggests that childhood trauma can impair our ability to make decisions and accurately assess risk, both of which deficits are linked to impulsiveness.

The Study – Part One :

Part One of a study conducted by Professor Seth Pollak (University of Wisconsin-Madison) involving over 50 young people (from a range of backgrounds and all approximately 20 years of age), required the participants to engage in various tasks (for example, simulated gambling) in order to ascertain their behavioral responses reward / punishment and risk-taking.

Results Part One Of The Study :

It was found that those who had experienced trauma / severe stress as children had impaired ability to make good decisions and to accurately assess risk compared to those young people who had not experienced trauma / severe stress while growing up ; especially noteworthy was the finding that, whilst participating in such tasks, those individuals who had experienced trauma / severe stress as children showed a marked inability to learn from their mistakes as well as poor levels of concentration.

Brain Scans :

Whilst the participants were in the ‘decision making’ phase of the task, scans of their brains were taken ; these scans revealed that the individuals who had experienced trauma / severe stress during childhood displayed BELOW NORMAL ACTIVITY in the area of the brain associated with decision making.

Part Two Of The Study :

The second part of the study was intended to discover how the same group of over 50 young people behaved in real life in relation to decision making.

This was carried out by giving the participants a questionnaire to fill out which comprised various questions about how much risk they took (e.g. do you wear a seat-belt?).

Results Of Part Two Of The Study :

The results of this part of the study were very similar to those found from the first part of the study, i.e. the participants who had suffered trauma / severe stress during childhood made worse decisions / indulged in riskier behaviors in real life compared to the participants who had not experienced trauma / severe stress during childhood.

Conclusion :

It was inferred from these results that severe stress during childhood adversely affects the way in which the brain functions when making decisions leading to poor judgment and a higher than normal propensity to indulge in risk-taking behavior in those affected.

It was also found that these deficits in decision-making ability were unrelated to I.Q. or intelligence. Because of this, Pollak alikened such deficits to a specific ‘learning disability’ which impairs individuals’ ability to effectively process information relating to potential loss or risk.

Implications For Youth Justice System :

Pollak also points out that up to 90 per cent of young people who become embroiled with the criminal justice system have experienced childhood trauma, and, if they do indeed have a kind of specific ‘learning disability’ (as described above and as the findings of this study suggest) then, in many cases, punishment is neither appropriate nor a solution.

Instead, Pollak suggests that, when dealing with young offenders, it will often be far better for these individuals to participate in training programs that improve the brain’s decision making capabilities.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Posted in: ADHD, WHOLE SITE (ALL 850+ ARTICLES) , Tagged: childhood trauma, decision making, impulse-control disorders, risk taking

Childhood Trauma And ADHD : Is PTSD Being Misdiagnosed As ADHD?

April 13, 2015 11:05 am , Leave a Comment , David Hosier MSc

IMPORTANT NOTE: This article considers the possible link between childhood trauma and ADHD. However, to clear up any possible misinterpretation of this article, it is important to state at the outset that ADHD is undoubtedly a genuine disorder and it is not by any means implied below that all cases involve underlying trauma.

In the USA, about one in every nine children are diagnosed with ADHD; this equates to a total of 6.4 million American youths.

But should a significant proportion of these young people’s primary diagnosis be one of PTSD, not ADHD?

Many experts think so. Post Traumatic Stress Disorder (PTSD) may be being misdiagnosed as Attention Deficit and Hyperactivity Disorder (ADHD) in up to a million children per year in the USA.

The psychologist, Brown, an expert in the field, has drawn attention to the fact that many children who have been diagnosed with ADHD have symptoms which one would expect to find in people suffering from PTSD such as difficulty controlling behaviour/impulsivity, severe mood fluctuations, hypervigilance and dissociation ( or ‘zoning out’).

The confusion may arise when such symptoms are mistaken for those of ADHD. For example:

– difficulty controlling behaviour/mood fluctuations may be seen as wilful disruptiveness.
– hypervigilance may be seen as distractability.
– dissociation may be seen as deliberate inattention/lack of focus (indeed, I suffered from this when I was eight. I didn’t respond to my name in class, so lost and caught up was I in my internal distressing thoughts, leading to my teachers suspecting that I was going deaf. I was taken for an ear test, but there was nothing whatsoever wrong with my hearing – let this serve as a salutary lesson to teachers as to how a child’s distress may manifest itself in unexpected ways and be misinterpreted entirely; indeed, another good example is the possibility that a child’s anger is serving to soothe his / her emotional pain – click here to read my article on this).

Brown’s suspicions that, often, children diagnosed with ADHD should have been diagnosed with PTSD were heightened further by the observation that standard ADHD treatment did not work for many children.

Perhaps, then, Brown hypothesised, these children were, in fact, ‘acting out’ (what psychologists refer to as ‘externalizing’) their distress caused by living in a dysfunctional family (the children in the study came from low-income families and were known to live in environments in which high levels of stress and violence were prevalent).

To examine the issue further, Brown set up a study looking at the overlap between the symptoms of ADHD and the effects of traumatic stress on children caused by maltreatment and abuse.

The study was based on a survey of 65,000 children in the USA, and the results showed that those who had been diagnosed with ADHD also had a significantly higher than average chance of coming from a background of divorce, poverty, violence and/or families who misused drugs and alcohol.

Indeed, those who had experienced the great stress of 4 or more ADVERSE CHILDHOOD EXPERIENCES (ACEs) – click here for more information about ACEs – were three times more likely to have been diagnosed with ADHD and prescribed medication for it than those who had not experienced any.

The psychologist, Szymanski, derived similar results from a study of 63 children who had been treated by a psychiatric hospital. On average, the children had suffered 3 ACEs, yet only 8 per cent had been diagnosed with PTSD, while 33 per cent had been diagnosed with ADHD.

Another study (Burke et al., 2011) of relevance involved the analysis of 701 children’s medical records. The children involved came from violent and economically deprived neighbourhoods in the Sans Francisco area.

It was found that two-thirds of the young people had experienced at least one ACE, and 12 per cent had experienced four or more ACEs. Further analysis of the data revealed that the more ACEs the children had experienced, the more likely they were to display behavioural problems.

Significantly, the researchers involved in the study expressed the concern that many such children may be receiving diagnoses of ADHD when a diagnosis of PTSD, or other stress-induced condition, would be more appropriate. It was suggested that this error might be occurring because symptoms of severe stress, such as hyperarousal and cognitive dysregulation were being mistaken for signs of ADHD.

Furthermore, Techer et al.conducted research that found that approximately 1 in 3 children who have experienced severe abuse meet the diagnostic criteria for ADHD and that children who are particularly at risk of going on to develop ADHD-like behaviour experienced such abuse very early in life.

Techer also draws our attention to the fact that ADHD is reliably found to be associated with abnormal neuroanatomy (brain structure) – specifically, a smaller than normal cerebellar vermis. Based on this and other evidence showing a link between physical brain abnormalities (e.g. in the mid portions of the corpus callosum) and the emergence of symptoms similar to those found in ADHD such as impulsivity Techer suggests that abuse in early life may result in physical alterations of the brain’s structure which, in turn, create ADHD-like symptoms.

The above studies suggest that, in some cases, PTSD me be mistakenly diagnosed as ADHD and that many children could be being wrongly diagnosed with ADHD whereas their primary diagnosis ought to be one of PTSD. Some estimates suggest that up to one million children per year could be being misdiagnosed in this way.

If some children are being treated for ADHD when they should be being treated for PTSD, their treatment may be inappropriate.

Indeed, one treatment for ADHD is the prescription of stimulants. However, this could worsen symptoms of agitation (agitation is a symptom of PTSD).

Furthermore, treatment for ADHD does not deal sufficiently with the emotional and psychological distress that the child with PTSD suffers.

Very obviously, the above does not in any way imply that all cases ADHD should, in fact, have been diagnosed as PTSD and, equally obviously, a child may simultaneously fulfil the diagnostic criteria to be considered to be suffering from both conditions (i.e. justifying a co-morbid diagnosis; indeed, research suggests the two conditions share familial risk factors) which is why I include the following warning: N.B. Any changes in medication should only be made on the advice of a suitably qualified professional who is familiar with the specific case under consideration.

One reason that has been suggested is that the companies producing the drugs for ADHD use advertising campaigns which, in effect, encourage the diagnosis of ADHD and its treatment, thus increasing their profits.

A second suggestion as to why ADHD may be being misdiagnosed as PTSD is that the assessment of children by clinicians is not extensive or thorough enough due to time and financial restrictions. A fifteen-minute or half-hour appointment is not enough to evaluate, sufficiently, a child’s mental state and factors related to his / her home life which may be damaging it.

It is also worth reiterating how there exists an overlap between the symptoms of ADHD and the symptoms of PTSD (e.g. Daud, 2009); these include, sleep difficulties, giving the impression of not listening in class, restlessness, disorganisation, restlessness and easy distractibility.

For useful advice about whether a child has ADHD or the effects of traumatic stress, you may wish to read this (CLICK HERE) helpful article from WebMD.

WHAT IS THE DIFFERENCE BETWEEN ADHD AND PTSD?

Perhaps the best way to demonstrate how ADHD and complex PTSD differ from one another is to list symptoms SPECIFIC to each condition followed by a list of the symptoms that both ADHD and complex PTSD have in common. I do so below:

SYMPTOMS SPECIFIC TO COMPLEX POSTTRAUMATIC STRESS DISORDER :

agitation
hypervigilance
feelings of shame and guilt
risk-taking behaviours
proneness to aggressive behaviours
self – destructiveness
irritability
perpetual feelings of being on ‘red alert’ / under threat
hyperarousal
avoidance behaviours
outbursts of rage/anger
dissociation

SYMPTOMS SPECIFIC TO ADHD :

problems following instructions
fidgeting and squirming
poor organisational skills
excessive talking
interrupting or intruding on others
losing items that are necessary for tasks and activities
difficulty concentrating
problems with waiting and turn-taking

SYMPTOMS THAT ADHD AND COMPLEX PTSD HAVE IN COMMON :

restlessness
sleep problems
distractibility
giving the impression of not listening
hyperactivity
problems with concentration

The above lists are based upon research conducted by The National Child Traumatic Stress Network (NCTSN).

To reiterate what I said in the opening paragraph of this article, however, ADHD is a very real and genuine condition and, whilst it is acknowledged that it cannot be diagnosed by any biological tests at present (though this may change), advocates of the reality and potential seriousness of the condition point out that it has been linked to abnormalities in the growth and development of the brain and that it runs in families. It is also associated with increased morbidity and mortality.

Although many individuals with ADHD eventually appear to ‘outgrow’ it, about 1 in every 25 adults has a diagnosis of ADHD and it is likely that many others also have the condition but, as yet, remain undiagnosed.