Attention deficit hyperactivity disorder (ADHD) and trauma share a complex connection. There is overlap in symptoms – particularly in children – giving rise to the potential for misdiagnosis. There is also a contentious debate in the psychiatric community over the role of trauma as a predictor of ADHD. Although it is a neurodevelopmental condition that has long been thought to have a formal heritability of about 80%, recent studies estimate the proportion of heritability based on single nucleotide variants is much lower, at 22%. It is a matter of debate and continued research on which genetic mechanisms explain this significant difference and what role environment and life experiences – such as trauma – play in the onset or exacerbation of ADHD symptoms.
ADHD and Trauma Symptom Overlap
The symptom overlap between trauma and ADHD presents a complex diagnostic challenge, especially in children. Both conditions can manifest symptoms such as difficulty concentrating, impulsivity, hyperactivity, and emotional dysregulation. Children exposed to trauma, whether through abuse, neglect, or other adverse experiences, often exhibit these behavioural traits, mirroring ADHD symptoms.
Trauma can impair attention, leading to inattention and distractibility, which are core symptoms of ADHD. Similarly, hyperactivity and impulsivity can stem from a traumatised nervous system, making it difficult to distinguish between trauma-induced behaviours and ADHD-specific characteristics. As a result, misdiagnoses are not uncommon, further complicating appropriate treatment strategies.
Emotional dysregulation is another shared feature of ADHD and trauma, which compounds the diagnostic challenge. Both trauma and ADHD can manifest in emotional outbursts, mood swings, and difficulty managing feelings, both in children and adults.
ADHD and Adverse Childhood Experiences
Studies investigating Adverse Childhood Experiences (ACEs) emerged in the 1990s and have expanded in scope and popularity since. ACE research investigates the impact of early life stressors, like abuse or neglect, on long-term health outcomes. It explores connections between childhood trauma and physical, mental, and social well-being in adulthood.
ACE research has revealed that those with a high ACE score – meaning they have experienced multiple childhood stressors – are more likely to face chronic diseases, mental health disorders, substance abuse, and social challenges.
Research has revealed that exposure to ACEs, like family stressors such as divorce or incarceration, can trigger behaviours resembling ADHD in children. ACEs elevate stress levels, impairing brain development, behaviour, and overall well-being. Analysing a national sample of over 75,000 children, a recent study revealed that those with ADHD were more likely to have multiple ACE exposures. Children exposed to socioeconomic hardship, family mental illness, or neighbourhood violence were significantly more prone to ADHD and its severity.
There is some evidence that ADHD symptom expression differs between children who have experienced childhood trauma and those who have not. In particular, traumatised children have been found to be less hyperactive. Furthermore, stressful events, such as conflicts at work, divorce, and financial problems, are linked to levels of ADHD severity.
ADHD and Trauma: Is There a Link?
It is widely accepted that genetic predispositions and environmental factors contribute to the development and manifestation of ADHD. However, debates and differing viewpoints within the scientific community often revolve around the relative contributions of genetics versus environment in ADHD.
Some researchers emphasise the genetic component more strongly, acknowledging the hereditary aspect of the disorder. In contrast, others place greater emphasis on environmental factors, such as prenatal exposure to toxins or early life experiences, in shaping ADHD symptoms.
The scientific and sociocultural understanding and research of ADHD are evolving fields, and researchers continuously refine their perspectives based on new evidence and research findings.
Prominent psychologists Gabor Maté and Peter A. Levine emphasises the growing understanding in neuroscience and neurobiology regarding the effects of early-life stress on brain development and its potential links to conditions like ADHD. Chronic stress in early childhood can disrupt neural circuits and impair the development of key brain regions, including the prefrontal cortex and the limbic system, influencing attention, impulse control, and emotional regulation. These neurobiological alterations may contribute to the manifestation of symptoms associated with ADD. Maté’s approach, in particular, underscores the need to integrate psychological and biological perspectives to comprehensively address ADHD. His work reflects on the influence of a child’s environment in the development of ADHD symptoms, bringing particular attention to stress and instability in the family setting.
Peter Levine highlights the effects that early trauma can have on brain development and function, particularly in areas associated with attention, impulse control, and emotional regulation.
Brain Structure and Function: Chronic stress and trauma during critical periods of brain development can alter the structure and function of key brain regions. The prefrontal cortex, responsible for executive functions such as attention and impulse control, may be adversely affected.
Neurotransmitter Imbalance: Trauma can disrupt neurotransmitter systems, including dopamine and norepinephrine, which play crucial roles in attention and focus. Imbalances in these neurotransmitters are also observed in individuals with ADHD.
Hypervigilance and Sensory Processing: Trauma can lead to a state of hypervigilance and heightened arousal, impacting sensory processing. Individuals may struggle to filter and integrate sensory information, affecting attention and concentration.
Genes and Epigenetic Modifications: ADHD is a complex and polygenic disorder, meaning it involves multiple genes. There isn’t a single “ADHD gene”; rather, various genes are believed to contribute to the development of ADHD, each with a small effect. These genes are often involved in neurotransmitter pathways, brain development, and the regulation of attention and impulse control.
While genes play a significant role in the development of ADHD, researchers such as Levine and Mate suggest that environmental factors also contribute, and the interaction between genetics and the environment likely shapes the onset and severity of the disorder.
Moreover, trauma can induce epigenetic modifications—changes in gene expression without altering the DNA sequence. These modifications can influence neural pathways associated with ADHD symptoms.
What Does This Mean for Treatment?
Understanding the connection between trauma and ADHD is crucial for effective treatment because it allows for a comprehensive and personalised approach to address the root causes and improve outcomes for individuals with ADHD.
By recognizing and addressing the trauma that might underlie ADHD-like symptoms, treatment can be tailored to meet the specific needs of individuals. Trauma-informed approaches can help individuals process their traumatic experiences, regulate their emotions, and develop coping strategies. Additionally, interventions can focus on healing the brain’s stress response systems, which are often dysregulated in both trauma and ADHD.
Personal understanding of the connection between trauma and ADHD can also be of vital importance in combating the pervasive sense of failure and shame often experienced by individuals with ADHD. Recognizing that ADHD symptoms may result from trauma, stress, or adversity in early childhood rather than personal shortcomings helps reduce self-blame and shame.
Addressing trauma alongside ADHD allows for a more holistic and effective treatment plan that considers the individual’s unique experiences and challenges, ultimately improving their overall well-being and functioning in various aspects of life.
Endnotes
- Grimm O, Kranz TM, Reif A. Genetics of ADHD: What Should the Clinician Know? Curr Psychiatry Rep. 2020 Feb 27;22(4):18. doi: 10.1007/s11920-020-1141-x. PMID: 32108282; PMCID: PMC7046577.
- Brown, N.M. et al. (2017) ‘Associations between adverse childhood experiences and ADHD diagnosis and severity’, Academic Pediatrics, 17(4), pp. 349–355. doi:10.1016/j.acap.2016.08.013.
- Vrijsen JN, Tendolkar I, Onnink M, Hoogman M, Schene AH, Fernández G, van Oostrom I, Franke B. ADHD symptoms in healthy adults are associated with stressful life events and negative memory bias. Atten Defic Hyperact Disord. 2018 Jun;10(2):151-160. doi: 10.1007/s12402-017-0241-x. Epub 2017 Oct 28. PMID: 29081022; PMCID: PMC5973996.
- https://www.findcenter.com/video/22653/peter-a-levine-phd-speaks-to-adhd-in-relation-to-trauma
- Mate, G. (2023) Scattered minds: The origins and healing of attention deficit disorder. New York: Avery, an imprint of Penguin Random House.