How Do You Get Diagnosed With Add – Packing? It is a composite. There are different approaches when looking at attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). Some doctors argue that we overdiagnose trauma as ADHD, while others argue that we overdiagnose PTSD and miss ADHD.
Complex problems, PTSD and ADHD often go together. ADHD makes a person more vulnerable to developing PTSD after a traumatic event and can worsen PTSD symptoms. And trauma can trigger ADHD in people with a genetic predisposition. Like I said, it’s complicated, so let’s dive in!
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ADHD is classified as a neurodevelopmental condition. This means it starts during development (usually in childhood) and has a strong genetic component. As a neurodevelopmental condition, ADHD is considered a congenital neurodegeneration (meaning a person is born with it).
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Areas of the brain that control emotions, attention and concentration are affected by ADHD. ADHD has the following characteristics:
While present from birth, ADHD may not manifest until demands exceed capacity (for example, when a person starts college and their workload becomes more intense or after the birth of a second child). Many children develop complex compensatory strategies to compensate for areas of conflict. In these cases, it can also be detected throughout the life of the person with ADHD.
ADHD is the most common developmental disorder in the US, with an estimated prevalence of 5–11% (Alley, 2014; Visser et al., 2014). According to the CDC, the current estimate is that about 11% of children in the US have ADHD.
The prevalence rate of ADHD in adults is low (4.4%) (CDC). This could mean that 1) there is an increase in ADHD or 2) we have become better at identifying ADHD and there are more adults with undiagnosed ADHD.
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Symptoms interfere with daily activities in at least two contexts (eg: home and school or work and home). Some common symptoms of ADHD include:
Now that we’ve covered ADHD, let’s look at post-traumatic stress disorder (PTSD). PTSD is caused by a traumatic event – affecting brain chemistry and brain wiring. However, most people who experience a traumatic event do not develop PTSD.
PTSD is also considered a form of neurodeversion. However, it is an acquired neurodegenerative disorder (meaning it is a condition and can be resolved with treatment). At this point, the person can return to their original neurotypical level.
Note: ADHD, on the other hand, is considered a congenital neurodisorder (meaning it is present from birth and is an important part of a person’s personality).
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A common misconception is that people always develop PTSD after a major trauma. However, while approximately 50–60% of people experience significant trauma in their lifetime, only 5–10% develop PTSD (Aupperle et al., 2011).
People with ADHD have higher rates of PTSD. There are many theories about how our neurobiology can make us more vulnerable—from having a less resilient nervous system to difficulty paying attention to more intense sensory experiences and the sensory encoding of trauma.
PTSD occurs when a traumatic event affects a person’s brain enough to cause changes in brain wiring and brain chemistry. After a trauma, a person may feel permanently vulnerable. The brain rewires to try to keep the person safe.
For example, when the brain’s “safe haven” – the amygdala – is overwired, it leads to increased alertness. The brain is constantly scanning its environment for threats. This awareness affects things like focus, concentration, and the ability to regulate difficult emotions.
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The stress response (nervous system) also becomes hyperactive (ie the fight or flight response). This causes abnormal amounts of adrenaline and cortisol to be produced, causing the nervous system to overextend. Like the amygdala, the fight or flight system kicks in to protect the body from future danger.
Intrusive symptoms are a prominent feature of PTSD. Intrusive symptoms may appear as disturbing memories, flashbacks, or nightmares. When a disturbing memory or flashback occurs, the person can become distracted and affect things like attention and concentration (Crenshaw & Mayfield, 2021).
One way to try to deal with the chaos that all of this creates is to engage in prevention strategies. Avoidance strategies are actions a person takes to avoid difficult feelings, thoughts, and places.
The problem with avoidance strategies is that they make our anxiety worse and deeper (as opposed to healing and improving). The more a person avoids memories, thoughts, associations, or feelings associated with the trauma, the more severe the symptoms of PTSD become.
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After a traumatic event, the body is in a state of alertness. The person often experiences exaggerated startle reactions, physical anxiety, irritability, and trouble sleeping. It negatively affects executive function and makes things like focus, concentration, and attention more difficult.
Before you leave the PTSD conversation, a quick word about complex trauma and development – despite numerous experts calling for complex trauma and development to be included in the DSM, it is still not accepted and is not an official diagnosis.
The main difference is that PTSD is usually associated with a single event or series of events, while compound trauma is associated with repeated events over a long period of time, usually during childhood.
Continuous exposure to traumatic childhood experiences affects a child’s brain when the brain is most vulnerable. A child’s brain is usually neuroplastic, meaning it adapts and moves easily to its environment. This is how a child’s brain hardens when the environment is not safe.
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Therefore, children with complex trauma continue to have symptoms into adulthood, and symptoms are unlikely to fully resolve (although they will improve with treatment). Symptoms are vulnerable to recurrence, especially during times of stress.
Many victims of complex childhood trauma struggle with symptoms well into adulthood. These symptoms can be similar to ADHD (Crenshaw and Mayfield, 2021). Alternatively, if a person has both, compound trauma can rule out their ADHD.
There are many reasons why ADHD and PTSD can be difficult to separate, perhaps the most important reason being that they go hand in hand! The fact that PTSD and ADHD often coexist is one reason why it is difficult to distinguish between them (Biederman et al., 2012).
It appears that PTSD and ADHD have a two-way relationship (the two-way concept is two-way and affects each other). For example, ADHD is a risk factor for the development of PTSD (Hurwitz et al., 2000), and complex childhood trauma can trigger ADHD in those with a genetic predisposition (Crenshaw & Mayfield, 2021).
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There are many reasons why ADHD and PTSD go together. ADHD is considered to be a risk factor for the development of PTSD (Adler et al., 2004; Kessler et al. 2006). Here are some other factors that contribute to their appearance:
2. ADHD patients have a more sensitive nervous system, which means they are more negatively affected by traumatic events and are more likely to develop PTSD after a traumatic event.
3. Early trauma can act as a trigger for those genetically predisposed to ADHD (Crenshaw & Mayfield, 2021).
Although the true prevalence of PTSD and ADHD is sometimes difficult to determine, the following is a summary of several research studies:
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When they come together, the signs intensify each other and the person faces daily struggles and hardships.
ADHD is associated with more traumatic events. And, on the other hand, the presence of ADHD is associated with more severe PTSD symptoms (compared to individuals with PTSD who do not have ADHD) (Crenshaw & Mayfield, 2021).
It is important that treatment addresses both PTSD and ADHD and the complex stress of living with both. Given the added level of complexity, diagnosis and treatment of both are important.
One factor that makes it difficult to distinguish ADHD from PTSD is the high rate of comorbidity. Another factor that makes it difficult to distinguish between these conditions is the degree of recurrence of symptoms.
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They have many overlapping features. In some cases, the level of overlap between symptoms can lead to misdiagnosis (Szymanski, 2011).
These two conditions have more similarities than differences. In other words, their similarities outweigh their differences, thus significantly increasing the risk of misdiagnosis and non-diagnosis (Szymanski, 2011).
Similarities between the two include difficulty focusing and concentrating, hyperactivity, difficulty regulating emotions, and more. Both conditions affect executive function, attention and concentration, and sensory processing.
Although they have different origins, they are difficult to tell apart and are often mistaken for one another because they look so similar. Experience both:
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Executive function is affected in both ADHD and PTSD contexts. Although the cause of the executive function is different, outwardly they may be the same, making it difficult to distinguish between the two.
Executive function problems are a key feature of ADHD and are related to neurodevelopmental differences. Areas of the brain commonly affected by ADHD include: working memory, the ability to control attention and focus, emotional regulation, inhibition, and the ability to break large tasks into smaller tasks.
With PTSD, distraction and vigilance from attacks overloads the brain. Cognitive load is affected
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