Childhood Trauma Misdiagnosed as ADHD

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Consider two classroom scenarios: In the first, a teacher struggles to calm and reengage her class after the repeated disruptions of a student who cannot remain seated. He behaves impulsively—flipping over his desk and knocking books and papers out of other students’ hands—despite consequences (being removed from the reward system, being sent to the principal’s office, calls home to Mom). He laughs loudly and sporadically, and can rarely sit still for long. Sometimes, he becomes aggressive. When the boy leaves for the day, both he and his teacher are exhausted. He rides the bus home until he is kicked off the bus for “bad behavior,” and enters a home with a work-at-home mom and younger sister. Mom struggles to help her son until his father gets home, at which point Dad takes over. Theirs is a home of both love and disciple, though both parents are equally confused about their son’s behavior. A doctor tells them their son has ADHD and recommends medication; the behavior therapies and stimulants he is prescribed seem to help. In the second scenario, several blocks over, another teacher struggles. This time, her struggle is with not just one child, but several. They behave similarly to the first boy: disruptive, antsy, loud, impulsive and sometimes aggressive. They refuse or are unable to listen to instructions, and cannot pay sustained attention even when they try. As a result of their behavior, they are not advancing academically, and are holding back others who desire to learn. In individual IEP meetings with the teacher and parents or guardians, it is said that some of these students may have problems with ADHD. Parents and guardians are asked to seek medical treatment, but when they do, they find the treatments aren’t working. It’s important to look deeper: when these kids get home, their lives look very different than the boy in scenario one. Their neighborhoods are dramatically poorer; they are more likely to encounter crime and violence; few have an adult waiting at home for them, and if an adult is home, he or she may not be fully engaged. Drugs, domestic violence and single-parent households are more common for this group. Children everywhere can experience trauma, but these kids experience it as a matter of course.

Adversity Can Look Like ADHD

Pediatrician Nicole Brown made an important discovery while completing her residency at Johns Hopkins University in Baltimore. She was trying to understand the behavior of her young patients when she hit upon an important fact: chronic adversity can look just like ADHD. The hyper-vigilance and dissociation of trauma victims “could be mistaken for inattention,” and “impulsivity might be brought on by a stress response in overdrive.” Dr. Brown explained that with those kids for whom behavioral and drug therapies failed, she began to hypothesize that “… perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.” ADHD is a brain disorder that causes sufferers to become hyperactive, impulsive and inattentive. But these same symptoms occur in young people who are subjected to ongoing and repeated trauma, like abuse, family violence or neighborhood violence. When the addition of stimulant drugs—medications used to treat ADHD—do not help patients experiencing these symptoms, or appear to make their symptoms worse, it may be important to look deeper into background and family and community dynamics.

Healing Childhood Trauma Related Behavior

According to the CDC, 6.4 million American youth are currently diagnosed with ADHD. And in recent years, the number of diagnoses has risen dramatically. Concerned parents and advocates worry these numbers may be inflated as a result of the push from pharmaceutical companies, inadequate psychiatric care and/or an education system that focuses on test scores over and above behavioral well-being. While it isn’t known what percent of the increase may be out of proportion, if at all, Dr. Brown’s discovery may help patients and practitioners—as well as families and teachers—begin to understand something vital about youth trauma and the need for integrated trauma therapy. Young people who experience or have experienced trauma may be unable to focus, may behave impulsively, and may display “acting out” behaviors that allow them to express difficult emotions they cannot address internally. They need the understanding of families and teachers, as well as therapeutic practitioners, in order to heal.

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