People with ADHD often face unique challenges. One of these challenges is that, for a variety of reasons, ADHD often co-occurs with trauma and traumatic stress. Traumatic experiences can take many forms, from a one-time event, such as an accident or an assault, or a traumatic situation that is sustained over time, such as living in an abusive household. While anyone can experience traumatic events and suffer from related mental health conditions (such as PTSD, acute stress disorder, or other anxiety and mood disorders), ADHDers experience higher frequency of traumatic experiences and related mental health concerns than their neurotypical peers. In this blog post, we’ll discuss the association between ADHD and trauma.
What is trauma?
Trauma can be generally defined as a psychological and emotional response to experiencing an event that is highly distressing or disturbing. These events can include experiencing an accident, having an illness, losing a loved one, experiencing a natural disaster, or encountering violence such as sexual assault or torture. Some trauma is considered “complex” when the distressing event happens repeatedly or is ongoing for a lengthy period of time. These kinds of traumatic circumstances can involve unsafe, chaotic, or extremely stressful living situations (such as addiction, physical conflict/abuse, or emotional abuse in the household), upsetting or forced separation or loss, and recurrent discrimination, to name a few examples. With some people and in some situations, the circumstance is experienced with great difficulty but is integrated into their life with support and time. Other times, the circumstances cause sustained disruption and difficulty and the individual feels the effects on their functioning again and again.
How can trauma look like ADHD?
Symptoms of trauma can include difficulty concentrating, poor memory, emotional dysregulation, disrupted sleep, impulsivity, restlessness, and difficulty connecting with others -- all of which can be associated with ADHD as well. However the cause and experience is different. For example, poor memory associated with trauma may be connected to the avoidance of painful and distressing memories, whereas the poor working memory that ADHDers experience is more connected to their neurocognitive functioning. However, due to the prevalence of trauma among individuals with ADHD, there is often overlap with their symptoms. Additionally, it is important to note that trauma does not cause ADHD. However, trauma can exacerbate the symptoms of ADHD.
When an individual experiences traumatic events or daily traumatic stress, their body and mind can become consistently on guard as a way to attempt to protect themself from future pain. They may develop a kind of hypervigilance, watching for potential danger and learning how to get ahead of any risks that may come their way. They may experience a high level of tension in their body, as if preparing to run or respond to an attack at any moment. When these postures become automatic, the individual’s nervous system is basically in a state of constant dysregulation: encountering and evaluating each event or stimuli as if it may be dangerous.
(The National Child Traumatic Stress Network, 2016)
Individuals with ADHD tend to experience more traumatic events than neurotypical people
Research has shown that there is a greater likelihood of individuals with ADHD experiencing trauma when compared to their neurotypical peers. In a concrete way, this may be seen in how highly ADHDers score on the Adverse Childhood Experiences Questionnaire (ACE). One study found that children with ADHD experienced significantly higher rates of socio-economic hardships, familial mental illness, divorce, and incarceration in the family (Brown et al., 2017). Additionally, children with higher scores on the ACE were significantly more likely to have moderate to severe ADHD.
Growing up with ADHD, whether it is diagnosed or not, is typically a traumatic experience in and of itself. Children with ADHD may grow up not knowing why they feel different. They may question why certain things seem to be far more difficult, taxing, or even impossible for them compared to others. Their caregivers and teachers may have difficulty understanding their differences and challenges as well, leading to increased criticism, frustration, or punishment directed toward the child. ADHDers can easily internalize a deep sense of shame, self-loathing, or feeling of defectiveness when they and those around them do not understand why they operate the way they do. They may learn to always be on high alert, frantically learning systems and tricks to get ahead and prevent criticism before it happens, and often utilizing anxiety or adrenaline to keep themself on task and focused.
Additionally, individuals with ADHD have been shown to process and experience emotion with higher intensity than neurotypical peers. While this ability to feel emotions so deeply can allow for great empathy, creativity, and joy, it can also make painful experiences feel all-consuming and overwhelming when a flood of emotion takes over. Not only can this make the aftermath of trauma more difficult to tolerate, this may also lead to ADHDers being more frequently criticized as being dramatic or overly-sensitive when they express their feelings. This can further lead to shame, invalidation, and isolation.
Addressing Trauma and ADHD Symptoms in Therapy
When an individual has both ADHD and a history of trauma, it can be difficult to tease apart what exactly is impacting their nervous system and executive functioning. So, what do you bring up in therapy? Trauma or the ADHD symptoms? The answer is…both! The experiences you have had have shaped you, whether related to your ADHD directly or not and whether difficult events feel significant or mundane. Clients and clinicians should both consider potential experiences of trauma in treatment. If you are currently or considering working with a therapist, consider bringing up concerns regarding the co-occurrence of ADHD and past trauma in your life.
As you work to heal your trauma, you may expect that your symptoms will decrease or fade. However, change and healing aren’t linear. Something to keep in mind is that healing trauma involves self-acceptance and learning to know and love yourself. This often leads to masking less, which means that your ADHD traits will seem far more present and apparent than they might have been before. Your trauma symptoms may alleviate, but your ADHD symptoms might feel stronger than ever. As you build out a helping network with a therapist, friends, and family, consider what you may need as support through the adjustment process of familiarizing yourself with your ADHD. Therapy may need to involve coming to terms with the ADHD traits that have been with you all your life and are only now being interacted with authentically since you have begun addressing the trauma.
If you are experiencing difficulties and wonder if they are related to past trauma and ADHD, know that you are not alone. There is help available and talking to a therapist about your experiences can be an important part of understanding yourself in the context of your full history and finding healing and acceptance. If you are not yet connected to a clinician, reach out today for a consultation.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Academic pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013
Siegfried, C. B., Blackshear, K., National Child Traumatic Stress Network, with assistance from the National Resource Center on ADHD: A Program of Children and Adults with AttentionDeficit/Hyperactivity Disorder (CHADD). (2016). Is it ADHD or child traumatic stress? A guide for Clinicians. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.