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

why_is_ADHD_misdiagnosed

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 very real 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 many of these young peoples’ primary diagnosis really be one of PTSD, not ADHD?

Many experts think so. In fact, 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 own internal distressed thoughts, leading to my teachers actually 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 completely misinterpreted ; 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, in fact, have been diagnosed with PTSD were heightened further by the observation that standard ADHD treatment simply did not work for many children.

Perhaps, then, Brown hypothesised, these children were, in facf, ‘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).

In order 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.

A Closer Look At The Link Between Childhood Trauma And ADHD :

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 3 times more likely to have been diagnosed with ADHD and prescribed medication for it than those who had not experienced any.

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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 whilst 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 4 or more ACEs. Further analysis of the data revealed that the more ACEs the children had experienced, the more likely they were display behavioral 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 may be occurring because symptoms of severe stresss, such as hyperarousal and cognitive dysregulation were being mistaken for symptoms of ADHD.

Conclusions:

The above studies suggest that, in some cases, PTSD me be being mistakenly diagnosed as ADHD and that many children could be being mistakenly diagnosed with ADHD whereas, in fact, 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.

Implications for treatment:

If some children are being treated for ADHD when they should, in fact, 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 properly qualified professional who is familiar with the specific case under consideration.

Why might misdiagnosis of ADHD as PTSD be happening?

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, fully, 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 and 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, disorganization, restlessness and easy distractability.

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

WHAT IS THE ACTUAL DIFFERENCE BETWEEN ADHD AND COMPLEX PTSD?

Perhaps the best way to demonstrate how ADHD and complex PTSD differ from one anorher 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, based upon

SYMPTOMS SPECIFIC TO COMPLEX POSTTRAUMATIC STRESS DISORDER :

agitation

hypervigilance

feelings of shame and guilt

risk taking behaviors

proneness to aggressive behaviors

self – destructiveness

irritability

perpetual feelings of being on ‘red alert’ / under threat

hyperarousal

avoidance behaviors

outburts of rage / anger

dissociation

SYMPTOMS SPECIFIC TO ADHD :

problems following instructions

fidgeting and squirming

poor organizational 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 impression of not listening

hyperactivity

problems with concentration

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

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

For information about complex PTSD from one of the UK’s leading mental health charities (MIND), click HERE

RELATED ARTICLES :

Complex PTSD And Misdiagnosis.

Wrongly Diagnosed With BPD?

Reasons Why ADHD Might Be Being Overdiagnosed.

eBook :

Above eBook now available for immediate download on Amazon. Click here.

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