You have difficulty concentrating. You’re easily distracted. You zone out of conversations. Your sleep is poor. You feel different from other people.
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You must have ADHD, right?
It is true that all of the above can be indicators of Attention Deficit Hyperactivity Disorder (also known as ADHD or ADD), a condition that comes in various forms. But did you know that they can also point to trauma, including conditions such as PTSD and C-PTSD?
For this reason, it can be worth exploring whether certain challenges you are having in your life — such as difficulty completing tasks, restlessness or even relationship issues — have their roots in ADHD, trauma or both. Because identifying the cause of a problem can be a huge help in managing it, as well as working out the kind of support you might need.
So let's explore the differences and similarities between ADHD and trauma, as well as the overlap between the two.
ADHD is a condition that can cause people to be restless, impulsive and have trouble concentrating. They may also have challenges with communication, time management, procrastination, sitting still, keeping their living space tidy or focusing on things that they find boring. This is because ADHD affects a person’s executive functioning, the mental processes that enable us to plan, focus our attention, multi-task and remember instructions.
That said, people with ADHD can also experience hyperfocus, which is the ability to concentrate your attention on a task or topic for long stretches of time, often at the expense of other things. So ADHD doesn’t always look like people’s stereotypical idea of it.
It is thought that between 3% to 4% of adults have ADHD in the UK. However, as most of them are actually undiagnosed, they might be facing continuous life challenges without even knowing why.
While ADHD has long been believed to be a neurodevelopmental disorder that is present from birth, new research is challenging this view. For instance, according to renowned mental health expert Dr. Gabor Maté, author of Scattered Minds: The Origins and Healing of Attention Deficit Disorder, ADHD is a reversible condition with its origins in infancy. Rather than viewing it as a medical disorder or illness, he believes that it is an impairment, rooted in multigenerational family stress and the disturbed social conditions of a stressed society.
In his words: ‘…In my view ADD is not an inherited condition, contrary to the commonly held opinion, but originates in early childhood stresses during the first years of crucial brain and personality development…especially in early childhood, our brains are very much affected by social and psychological relationships.’
In essence, he sees children with the condition as lightning rods who pick up on underlying dysfunctions in a family and then react to it: ‘ADD kids are, temperamentally, highly sensitive creatures — that’s what predisposed them to developing ADD in the first place — so they’re often the canaries in the coal mine. When something’s even slightly off in the surrounding environment — stresses in the marriage relationship, for instance — it will trip these kids’ emotional alarms much more readily than other kids’.
Backing up his claims is a 2017 study which indicated that early age trauma could be linked to ADHD. A further study in that same year also linked adverse childhood experiences (ACES) to the condition.
The idea that ADHD might actually be caused by trauma — and that likewise, the stress of dealing with ADHD (particularly when it is undiagnosed) can in turn cause trauma — is worth bearing in mind as we explore the interplay between the two conditions.
As there are three main subtypes of ADHD, not everyone will share every single symptom or issue. For instance, despite its name, not everyone with the condition is impulsive and hyperactive. For some people, their main challenges are distractibility and inattention.
With this in mind, here are some key signs:
— Difficulty sustaining attention
— Struggling to follow instructions
— Difficulty with organisation
— Fidgeting or squirming
— Difficulty waiting or taking turns
— Taking excessively
— Interrupting or intruding upon others
— Losing things necessary for tasks and activities
In essence, ADHD is a syndrome in which the brain is less able to regulate itself, meaning someone with ADHD is less able to regulate their emotions, moods, impulses and/or motivation.
And while it is always advisable to get a full medical assessment for ADHD, this can be a lengthy process. As a result, you might have self-diagnosed yourself based on your own research, or just suspect that ADHD is a good explanation for various issues you’ve been facing, perhaps for many years.
Yet bear in mind that it is also unadvisable to self-diagnose, as the process of assessing for ADHD is extensive and needs to be overseen by specialists.
Trauma is a response to a shocking or terrible event or experience, such as an accident or assault. It can also be a response to living through a long-term stressful situation, for instance, growing up in an unhappy or abusive home or being bullied.
This second type (known as complex trauma or C-PTSD) can fly under the radar, as people might not realise that they have been traumatised. This is because dysfunctions in their family could have become normalised to them at an early age, or they might be repressing difficult memories. In the words of Gabor Maté, ‘…human beings can tune out entire periods of their lives that were characterised by emotional pain.’
Also, as children are highly sensitive, they can become traumatised by circumstances that don’t (on the surface at least), seem all that dramatic or damaging. But what matters is that it wounds them and can have a lifelong impact.
Trauma can show up in many different ways. Overall, it causes people to have an overactive Fight or Flight response to real or perceived threats, including emotional threats in some cases. Key signs can include:
— Irritability and quickness to anger
— Increased arousal, edginess and agitation
— Mood swings and emotional dysregulation
— Feelings of fear, helplessness, uncertainty and vulnerability
— Feelings of guilt and shame
— Dissociation (feelings of unreality or of being ‘outside’ your body)
— Continually feeling on alert for threat or danger
— Unusually reckless, aggressive or self-destructive behaviour
— Avoidance of reminders of trauma or upsetting events
— Flashbacks of distressing events (visual, auditory or emotional)
— Physical symptoms like fatigue or migraines
— Perfectionism and procrastination
— Social anxiety or withdrawal
— Unstable relationships
— Addictive behaviours
— Zoning out or daydreaming
Where things get tricky is that ADHD and trauma can share some characteristics, including the following:
— Low self-esteem
— Difficulty concentrating and learning
— Difficulty listening to people
— Easily distracted
— Disorganisation
— Hyperactiveness
— Restlessness
— Agitation
— Difficulty sleeping
What makes it even more complicated is that living with ADHD — especially if it remains unidentified into adulthood — can also cause trauma to develop. Plus as we have already explored, some theorists believe that ADHD itself is rooted in trauma.
As a result, some people go through life trying to manage one or both of these conditions, often undiagnosed and blaming themselves for perceived ‘shortcomings’ that are not actually their fault.
From an early age, people with ADHD can experience a lot of distress related to their condition. This can include social judgement, rejection from peers and frustration from adults, as well as feelings of being different or an ‘outsider’. When you are still young and developing your sense of self, this can have devastating lifelong consequences.
For instance, children with the hyperactive forms of ADHD might be labelled as ‘out of control’, ‘defiant’ or even ‘bad’. Their parents could also be blamed for their child’s behaviour, causing tension and shame within the family. Everyone from teachers to neighbours to relatives might treat the child as a nuisance, leaving them out of social events or shared activities. Yet tragically, none of this is the child’s fault.
Also, as not everyone fits the stereotypical model of the hyperactive form of ADHD, it is possible for the condition to go undiagnosed. For instance, children with the inattentive (non-hyperactive) form might have come across as dreamy and, instead of getting the support they need, be berated for not concentrating or being ‘lazy’.
Overall, people with undiagnosed ADHD can spend their lives feeling that something is deeply ‘wrong’ with them. They might believe that they are ‘inadequate’ or ‘dysfunctional’, or have others label them as those things. Yet no matter how hard they try they can’t seem to change.
Eventually, years of rejection, judgement, frustration, anger, confusion and bullying — as well as academic under-performance — can totally erode a child’s self-esteem and lead to trauma responses that might overlap with their ADHD symptoms. And once they reach adulthood, they might find themselves facing challenges with everything from career progression to maintaining relationships to managing daily tasks, while sometimes still not being aware of the underlying issue.
Added to this, many people with ADHD describe having ‘rejection sensitivity’. This means experiencing severe emotional pain at real or perceived rejection. However, it is still not clear whether this is a neurological aspect of the condition or is related to the ongoing distress of being misunderstood. Yet either way, it seems to be a painful aspect of ADHD.
Yet it is also worth noting that individuals with complex trauma can also experience rejection sensitivity. This can be due to years of being misunderstood or judged for issues such as mood dysregulation, plus it can be rooted in earlier rejection or abandonment wounds from parents and/or other significant people.
With this in mind, how can you tell the difference between the two? How can you start to unpick and unpack the complex relationship between trauma and ADHD? How can you tell if you have one or the other, or both, or something else? Especially if you haven’t had any kind of formal diagnosis?
Added to this, conditions such as bipolar disorder, depression, anxiety and borderline personality disorder (BPD) can sometimes be ‘lookalike’ conditions to ADHD, meaning that self-diagnosis can be a minefield.
So if you are struggling in certain areas of your life, for instance self-esteem, feeling constantly on edge, emotional impulsivity or chronic procrastination, then ADHD might not be the only explanation. And if you haven’t received a diagnosis, then it’s worth keeping an open mind about whether this label best fits your experiences.
This is where therapy can be incredibly helpful in making sense of what you are going through.
If you want to know whether you have ADHD, then the only way to confirm this is by arranging a specialist assessment or asking your GP to refer you for one.
That said, getting an assessment can take a while and even if you do get diagnosed with ADHD, you might still find it useful to see a therapist. This is because a psychologist or psychotherapist can help you to work out if certain patterns of thinking and behaviour are linked to ADHD, or trauma, or both. This way, you can gain a lot more clarity about challenges in your life that you might have been struggling to overcome and which might be trauma-based and which might be ADHD.
For instance, do you find it hard to concentrate and focus because your system is on high alert and you are frequently out of your window of tolerance (where cognitive processes become compromised) due to unprocessed childhood traumas or is it an executive function issue? Or do both play a role?
Working through the traumatic memories with trauma-focused approaches such as EMDR and Body-Focused Psychotherapies can help you take out any impact they might be having and potentially help you feel more present and connected to the present moment. It can then be clearer what remains and what might be best explained by an ADHD diagnosis. Of course having undiagnosed ADHD and navigating school – particularly when others around don’t understand the challenges you’re facing – can also leave its mark and processing these experiences can also make life easier to manage going forward.
Another helpful approach might be Cognitive Behavioural Therapy (CBT), as it encompasses an awareness of issues like PTSD as well as being a form of ‘brain training’ and skills learning for ADHD. For instance, CBT can equip you with practical tools for improving typical ADHD issues like time management or keeping track of belongings. It can also help you explore behaviour such as procrastination by looking at what’s going through your mind when faced with completing a task. By becoming more aware of the inner critical voice that might arise from both trauma and/or ADHD, your therapist can work with you to replace it with a more helpful and supportive inner monologue. For instance, instead of all-or-nothing thinking like ‘I’m so pathetic, that’s why I didn’t get offered the job’, you can learn to examine other possibilities to why the position was given to someone else, other than it being a reflection on your worth as a person or an all-out rejection.
As many of the difficulties with ADHD are around self-regulation, approaches that help teach skills for coping with emotion, such as Dialectic Behavioural Therapy (DBT) and Acceptance and Commitment Therapy (ACT), can be helpful. Additionally, relational approaches that help people develop the capacity to cope with emotions in the context of an attachment relationship (with the therapist) can also be beneficial.
Of course, the relationship between ADHD and trauma is complicated, especially as it is still up for debate. But with the right support you can start to make sense of various challenges that you are facing, work out the best way forward for managing them and, most importantly, let go of the weight of self-blame.
Is it ADHD, trauma or both? Therapy can help you to make sense of it all. Book an in-person, video or live chat appointment with a world-class MTA therapist today.
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