Understanding How Trauma and ADHD Can Feel the Same

In clinical practices, one of the most common diagnostic errors occurs when a patient presents issues of restlessness, emotional dysregulation and a lack of focus. ADHD and trauma can even be defined as reflections in a mirror, because to the untrained eye, they might seem nearly indistinguishable. 

Understanding The Two Conditions 

1. What is ADHD? 

ADHD stands for attention-deficit/hyperactivity disorder. It is a neurocharacterised developmental disorder, characterised by persistent patterns of inattention, hyperactivity and/or impulsivity that interfere with the everyday functions of the individual. Here, inattention means lack of focus or sustained attention, while hyperactivity refers to restless behaviour, which includes excessive talking, not sitting still, fidgeting, etc. 

It is a lifelong disorder that hinders one’s academic, professional, and interpersonal performance (Harpin, 2005). Research shows that its prevalence in children is about 8.4% while among adults, it is 2.5% (Danielson, 2018; Simon et al., 2009). 

Read More: Behavioural Disorders in Children

2. What is Trauma? 

“Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behaviour, and other aspects of functioning.” APA 

Trauma means “wound”. It is a form of mental response to any form of psychological or physical injuries caused by a stressful, disturbing situation that occurred during life. Trauma often affects the individual long after the distressing event has occurred. 

Read More: How  Does Trauma Affect Brain Function?

Why They Get Confused 

Neurobiological studies say that a brain impacted by trauma often shares similar responses as an ADHD-impacted brain (Spencer et al., 2016). This is because several of their symptoms overlap with each other, leading to confusion and often misdiagnosis problems.

The Mirror Effect: How Symptoms Overlap 

1. Hypervigilance vs. Hyperactivity

A brain impacted by trauma is always on the “lookout” for something unusual or fear-inducing. It is always sensitive to danger or threat (Kimble, Fleming & Bennion, 2013). This causes intense restlessness and agitation, with all sorts of stress hormones surging in the body and causing difficulty in sitting still and focusing or calmly paying attention. In this sense, it is very similar to the hyperactivity symptoms of ADHD. Dr Bessel van der Kolk says, “What we call ‘ADHD’ behaviours – hyperactivity, inability to focus, impulsivity – can actually be the body’s response to trauma.” 

Read More: Flow States Vs. Hyperfocus: How ADHD Challenges Traditional Motivation Theories 

2. Intrusive Thoughts vs. Inattention

Traumatic events that have been experienced by someone often resurface and are reexperienced by the people (Iyadurai, 2019). This often results in the person looking lost, distant or “not quite there”. This matches the inattentiveness caused by ADHD. 

3. Executive Dysfunction

Executive functions are all those mental skills that help in completing tasks and achieving goals. This includes planning, focusing, managing emotions and decision making, etc. Dysfunction in these aspects is a common issue for both ADHD and trauma-impacted brain (Mani et al., 2014; Martinez, 2016). 

4. Emotional Dysregulation

Emotional regulation is the ability to manage one’s emotions to respond and adapt to one’s environment. Individuals dealing with trauma may often have difficulty managing or regulating their emotions, leading to increased irritability and agitation (van der Kolk, Roth, Pelcovitz, & Mandel, 1993). This is similar to the case of people dealing with ADHD (Shaw et al., 2014). 

Read More: How ADHD Affects Emotional Regulation

5. Memory

A trauma impacts the brain, which goes through various changes in the memory. This includes forced forgetting, fragmented recall and often disassociation (Samuelson, 2011). In ADHD, this appears as deficits in working memory, creating a similarity. 

Key Differences 

1. Origin: According to DSM-5, ADHD is a lifelong neurodevelopmental disorder that is present since childhood and is often diagnosed in children below 12 years (DSM-5; American Psychiatric Association [APA], 2013a). However, trauma is related to a distressing situation or a significantly terrible event occurring with the person, which often leaves a mark on the individual. 
2. Symptoms as triggers: ADHD in a person is mostly consistent across numerous circumstances and situations. On the other hand, trauma is mostly situational, which is often tied to the reminders of the individual’s past.
3. Self-concept: The difficulties in both personal and professional life caused by ADHD result in lifelong guilt, frustration and often a feeling of helplessness in what to do. Sometimes the distressing situations are so harmful that they affect one’s daily functioning (Halleroid, 2015). Trauma, on the other hand, shapes the individual’s entire personality around protection, survival, safety, and trust. 
4. Psychological difference: While ADHD is linked with under-activation of the prefrontal cortex (Miao et al., 2017), trauma is the opposite, with over-activation (Selemon et al., 2019). 

Why This Matters: Misdiagnosis and Clinical Challenges 

1. Studies show a bidirectional association between ADHD and trauma, showing that one condition can increase the prevalence of the other condition. The comorbidity rate between ADHD and PTSD is found to be 2% to 37% (Wendy et al., 2023). 
2. It has become common, exceeding a million (Elder, 2010), in the recent past for children with trauma-related issues to be misdiagnosed as having ADHD. This is important because the child doesn’t receive adequate and appropriate care that they need. The use of stimulants that are useful for ADHD does nothing for trauma. 
3. In some cases of both mental health issues, unprocessed trauma (especially during wartime) is found to worsen ADHD (Halevi, Djalovski, Vengrober, & Feldman, 2016) and vice versa (Ford & Connor, 2009), which makes functioning even more difficult for a person. 
4. The misdiagnosis and untreated issues in such conditions have long-term negative consequences on the individuals, hindering their daily functioning. 

Healing and Treatment Approaches 

1. ADHD Interventions

1. Stimulants & Non-stimulants: Stimulants (Greenhill, 1999) and nonstimulants (Wood et al., 2007) are both found to be effective in reducing ADHD symptoms. Stimulants are found to be most helpful as they help in increasing chemicals like dopamine and norepinephrine in the brain. Non-stimulants are mainly for those who can’t tolerate stimulants or for whom they are ineffective. 
2. CBT: It is described as “a form of psychological treatment that is based on the principles that psychological problems are based, in part, on faulty or unhelpful ways of thinking, and learned patterns of unhelpful behavior, and can help them learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives” (APA, 2019). Research has shown improvement using this technique (Boyer et al., 2015). 

2. Trauma Interventions

1. EMDR therapy: It helps process and heal from trauma through bilateral stimulation. It helps the brain reprocess painful memories and add positive ideas and beliefs to them (APA, 2017). 
2. DBT: DBT offers a range of practical skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness (Oppenauer et al., 2023). It helps people manage emotions and promotes mental well-being by using mindfulness techniques. 
3. Trauma-focused CBT: This is the cognitive behaviour therapy that helps process emotions with special focus on traumatic experiences and reducing their impact on the individual’s daily functioning and life (Cohen & Mannarino, 2015). 
4. Integrated interventions: In cases where a person suffers from both ADHD and trauma, it becomes important to focus on both and provide people with the necessary integrated focus and care. 

Read More: Mindfulness Meditation has a Positive Effect on Mental Health

Conclusion 

ADHD and trauma are different psychological and mental health issues that are often misunderstood as one another. ADHD is a neurodevelopmental disorder characterised by inattention, hyperactivity or impulsivity, which hinders one’s daily functioning. On the other hand, trauma is a response to a distressful event. Various symptoms, such as difficulty focusing, recalling, executive functions, and emotional regulation, are common in both trauma and ADHD, which often makes it difficult to identify them as separate. 

However, major differences exist. ADHD often appears in childhood, while trauma can impact a person at any point in life. ADHD remains consistent, whereas trauma is situational. The prefrontal cortex under-activates in ADHD, while it over-activates in trauma. 

It becomes especially important to understand both the concepts and learn to differentiate between them because there are cases of misdiagnosis for both cases. While these conditions seem so similar, both need different intervention methods. Because accurate information at the right time becomes important to ensure that such impacted individuals are provided with the right help and care at the right time, and for their better mental well-being and functioning. 

FAQs 

1. Why are trauma and ADHD often confused? 

There are various symptoms in both conditions that seem to overlap so much that the line between adhd and trauma starts to blur. This creates confusion and often results in misdiagnosis of the condition. 

2. What are some symptoms that overlap between ADHD and trauma?

Some symptoms that overlap between both ADHD and trauma are distractibility, weakened memory, difficulty in executive functioning and emotional regulation, neurocharacterized developmental, as well as hyperactivity. 

3. How should both conditions be treated? 

Both conditions have specific needs and require different kinds of treatment and medication. While stimulants and nonstimulants, CBT etc, are suggested for ADHD, trauma needs a trauma-focused CBT, DBT, EMDR and other different approaches. If both conditions are present, they both need to be addressed, and the required care should be provided.