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Life can be filled with trauma. Can that affect your ADHD?



Recently, a member of the Attention Connection community posted in Questions & Answers about the difficulty of diagnosing co-occurring ADHD and PTSD.  Diagnosing both conditions at the same time can be hard, especially when they share symptoms. Why is this? 

While the underlying causes for the behaviors are different, ADHD and post-traumatic stress disorder—frequently referred to as PTSD—have similar symptoms. Inattention, distraction, restlessness, outbursts, depression, sleeping problems, memory issues—these and other symptoms are hallmarks of each disorder. 

A recent study found a high likelihood of adults affected by ADHD also experience PTSD—up to 10 percent of adults.  But there was no significant difference between the symptoms of those diagnosed with ADHD and those diagnosed with both ADHD and PTSD

ADHD professionals don’t routinely include an assessment of trauma during an ADHD evaluation. What do you need to know about PTSD and its impact on your ADHD? 

What is post-traumatic stress disorder?

PTSD is an anxiety disorder that develops in response to traumatic or life-threatening experiences, including war and acts of violence or abuse, accidents, sexual assault, or natural disasters. Symptoms can be emotional or behavioral (inattention, distraction, restlessness, outbursts, depression, sleeping problems, memory issues), as well as physical symptoms, such as high or low blood pressure, increased perspiration, and trouble eating or digesting food.

Among adults who have experienced at least one traumatic event in their lives, which the PTSD Alliance estimates 70 percent of adults have, 20 percent will experience PTSD. Half of those individuals will never reach out for help. 

For military veterans, the risk increases even more, with 30 percent of those serving in a war zone experiencing PTSD. Since adult ADHD is often missed, undiagnosed or unreported on military entrance exams, service members affected by ADHD may be at even higher risk for PTSD.

When people are exposed to prolonged trauma from events such as child abuse, sexual abuse, violent environments or neglect, they can suffer from symptoms over their lifetimes and experience changes in their brain chemistries as a result of the extreme stress. This is known as complex PTSD, and individuals who experience it can also be affected by anxiety, panic, personality or dissociative disorders, among other conditions.

Challenges in diagnosis

A comprehensive evaluation is required to diagnose ADHD, and should start with a thorough medical history that includes screening for trauma. The most frequent reasons trauma and its effects are not addressed include healthcare providers overlooking trauma and patients not reporting it, for any number of reasons. Patients might underestimate the impact of the trauma on their lives, they may be reluctant to discuss something that makes them feel uncomfortable or ashamed, or they may be concerned for their safety.   

When children are affected by ADHD, screening for trauma involves family members and others who know the child well. If a child is experiencing chronic, abusive trauma and it is happening within the family, it is possible that it wouldn’t be revealed during an evaluation. 

While many people diagnosed with ADHD are affected by other conditions, those people affected by both PTSD and ADHD were found to have higher rates of co-occurring conditions, including major depressive disorder, oppositional defiant disorder, social phobias, and generalized anxiety disorder—as well as lower quality of life ratings—than those affected by ADHD alone

When more than one condition is causing problems for someone, and symptoms can look similar to other conditions, diagnosis becomes far more complex.

Can you have both ADHD and PTSD? 

Researchers have seen a link in children and adults between ADHD and PTSD. In addition, a recent study found that individuals affected by ADHD, but not trauma, had fear circuit abnormalities similar to those who are affected by PTSD. The researchers conclude the findings may explain why there is a significant association between ADHD and PTSD. 

While recent articles have focused on the misdiagnosis of ADHD when PTSD is at play, David Rettew, MD, a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine, urges parents and healthcare practitioners to take a broad view. 

“Kids have only one brain that responds to both genetic and environmental factors,” Dr. Rettew tells  Psychology Today. “Attention and self-regulation begin to be learned early in life. When a negative environment impacts that developmental process, the brain physically changes. There is no evidence that kids who meet criteria for ADHD but have trauma histories have a brain that is any less ‘ADHDish’ than kids with ADHD who come from stable happy households.”  

Comprehensive, multi-faceted treatment plans that focus on the ongoing management of a person’s symptoms are most effective for managing symptoms of ADHD and other co-occurring disorders such as PTSD.

Tips for managing PTSD and ADHD

ADHD is different for each person. When combined with PTSD, there is no “right” approach for everyone. The most effective approach for you depends on how ADHD is affecting your life. Being proactive and involved with your healthcare provider to address your ADHD and PTSD symptoms is critical. Here are a few things to consider:

  • Learn more about ADHD and PTSD. Take the time to educate yourself. ADHD and PTSD are not personal failings. There are extensive evidence-based studies about ADHD, its variability, and how it manifests and changes over time. There are multiple resources available for help with addressing the symptoms of PTSD. If you have a conversation with your healthcare provider, and he does not seem to be concerned about trauma you may have experienced, consider finding another healthcare provider.

  • Seek help, including counseling. Working with a mental health therapist is helpful in exploring feelings about coping with ADHD and understanding your strengths. Cognitive-behavior therapy (CBT) has been shown to be the most effective type of counseling for PTSD and may be helpful in learning new techniques and personal coping strategies to manage living with ADHD. For more information about CBT, read Cognitive-Behavioral Therapy.

  • Emerging therapy for PTSD. Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new therapy that has been shown to be effective with PTSD. The goal is to process the experiences that are causing problems so they can be properly “digested,” stored with appropriate emotions in the brain, and help guide behavior in the future. For more information, see the EMDR International Association.

  • Exercise. Exercise is an important tool for reducing stress, with almost any exercise acting as a stress reliever. Even short periods of regular exercise can increase endorphins, the chemicals released in your brain that help you feel good,  and can help decrease symptoms of depression and anxiety, and can improve your sleep. Exercise is considered an important adjunct treatment for people with ADHD. Even though people affected by PTSD are less likely to start an exercise program, recent studies have shown that regular exercise reduces symptoms of PTSD. For ideas about starting, and staying with, an exercise plan, read Attention magazine’s Fitness & Your Brain: How to Start and Stick with Exercise.   

There is help available

ADHD varies in how it can affect you and those symptoms can change over time. It often occurs with other disorders like PTSD, and can be influenced by the co-occurring condition. ADHD evaluations often do not regularly include a trauma evaluation, so if you suspect that you or a loved one may be impacted by PTSD, discuss it with your healthcare provider. If you’re looking for a provider, visit Professionals Who Diagnose and Treat ADHD.

For more information:

This article appeared in ADHD Weekly on July 13, 2017.
     


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