Differentiating between ADHD and Developmental Trauma

Hyperactivity, impulsivity and inattentiveness- signs of ADHD or Trauma?

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that is marked by above normal levels of inattention, hyperactivity and impulsivity. It usually begins in childhood, with a higher rate of diagnosis in boys than girls. Though no root cause has been found for ADHD, risk factors such as heredity, prenatal substance abuse, premature birth weigh and brain injury are noted. Differential activity in brain areas related to attention has been found in children with ADHD.

What is Developmental Trauma?

Developmental Trauma refers to a chronic traumatic experience that a child may have been involved in or witnessed. Accidents, natural disasters, physical or sexual abuse, neglect and death of a loved are examples of traumatic events. A range of risk and protective factors including child’s temperament and level of social support, influence a child’s likelihood of experiencing these difficulties. Exposure to traumatic events leads to changes in brain circuitry, and hence mood and behaviour of children.

Comparing ADHD and Developmental Trauma

Physiological reactions that develop as a results of exposure to a traumatic event may result in symptoms that mimic symptoms in ADHD. Constantly looking out for signs of danger or being “hyper-vigilance” may look similar to signs of hyperactivity or restlessness. Memories or reminders of trauma can induce feelings of agitation or nervousness in children, resulting in them displaying impulsive or aggressive behaviours. Symptoms of disassociation or subconscious avoidance of trauma triggers may reflect as inattentiveness in children.

Similarity in the presentation of symptoms may result in misdiagnosis of children. Though symptoms may appear similar, the causes are distinct in ADHD and Developmental Trauma. It is also possible for a child to have both ADHD and Developmental Trauma if there has been significant trauma exposure.

Diagnosis and Treatment

A trained psychologist is able to conduct comprehensive assessment to differentiate and provide an appropriate diagnosis. ADHD assessment involves educational and psychological evaluation, use of behaviour rating scales, and testing to rule out potential differential diagnosis. An assessment for Developmental Trauma includes assessing symptoms, exposure to traumatic events, child’s risk and protective factors, and gathering of information through clinical interviews and observations.

As the nature and cause of the difficulties are varied, treatment approaches are also different for both.

Treatment for ADHD

Treatment for ADHD would be determined by a trained psychologist or mental health professional based on the child’s strengths and needs. It may involve the following:

• Educating parents and providing them with necessary support on behaviour management
• Evidence based therapy for child to manage his/her difficulties and learn new skills
• Modifications to learning environment and access to educational programs or support

Treatment for Developmental Trauma

Treatment for Developmental Trauma varies with each child depending on the nature, intensity and timing of the traumatic event. It may involve the following: - Evidence-based therapy with a trained psychologist to enhance child’s ability to manage emotions and work on correcting unhelpful thoughts related to traumatic event - Sensory regulation activities as recommended by a trained occupational therapist or psychologist.