Trauma and ADHD – Association or Diagnostic Confusion? A Clinical Perspective

In recent years, a growing body of research has developed to examine the relationship between exposure to traumatic events in childhood and Attention Deficit Hyperactivity Disorder (ADHD; Daud and Rydelius, 2009 Daud, A. and Rydelius, P.-A. 2009. Comorbidity/overlapping between ADHD and PTSD in relation to IQ among children of traumatized/non-traumatized parents. Journal of Attention Disorders, 13: 188–98. Crossref, PubMed, Web of Science ® , Google Scholar; Famularo et al., 1996 Famularo, R., Fenton, T., Kinscherff, R. and Augustyn, M. 1996. Psychiatric comorbidity in childhood post traumatic stress disorder. Child Abuse Ford et al., 2000 Ford, J. D., Rascusin, C. G. E., Daviss, J. R., Fleisher, A. and Thomas, J. 2000. Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Child Maltreatment, 5: 205–17. 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Crossref, Web of Science ® , Google Scholar). It is not surprising that these two areas are being evaluated, as cognitive and emotional disruptions that occur in response to trauma, such as difficulty concentrating, dysregulated affect, irritability, and hyperarousal, either overlap with ADHD symptomatology or exasperate it (Barkley, Grodzinsky and DuPaul, 1992 Barkley, R. A., Grodzinsky, G. and DuPaul, G. J. 1992. Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report. Journal of Abnormal Child Psychology, 20: 163–88. Crossref, PubMed, Web of Science ® , Google Scholar; Daud and Rydelius, 2009 Daud, A. and Rydelius, P.-A. 2009. Comorbidity/overlapping between ADHD and PTSD in relation to IQ among children of traumatized/non-traumatized parents. Journal of Attention Disorders, 13: 188–98. Crossref, PubMed, Web of Science ® , Google Scholar; De Bellis, 2001 De Bellis, M. D. 2001. Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13: 539–64. Crossref, PubMed, Web of Science ® , Google Scholar; Ford et al., 2000 Ford, J. D., Rascusin, C. G. E., Daviss, J. R., Fleisher, A. and Thomas, J. 2000. Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Child Maltreatment, 5: 205–17. Crossref, PubMed , Google Scholar; Jennings et al., 1997 Jennings, J. R., van der Molen, M., Pelham, W., Debski, K. and Hoza, B. 1997. Inhibition in boys with Attention Deficit Hyperactivity Disorder as indexed by heart rate change. Developmental Psychology, 33: 308–18. Crossref, PubMed, Web of Science ® , Google Scholar). From an epidemiological perspective, trauma exposure and ADHD are pervasive in childhood. Up to half of children in community samples, as well as two-thirds of children in psychiatric samples, have witnessed or experienced trauma (Boney-McCoy and Finkelhor, 1995 Boney-McCoy, S. and Finkelhor, D. 1995. Psychosocial sequel of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology, 63: 726–36. Crossref, PubMed, Web of Science ® , Google Scholar). The overall rate for ADHD diagnoses varies from seven to twenty-nine percent among school-age children (see review by Barkley, 2006 Barkley, R. A. 2006. Attention-deficit Hyperactivity Disorder, a Handbook for Diagnosis and Treatment, 3rd, New York: Guilford Press. Google Scholar). Because both phenomena are prevalent, it is not surprising that they often overlap (Wozniak et al., 1999 Wozniak, J., Crawford, M. H., Biederman, J., Faraone, S. V., Spencer, T. J., Taylor, A. and Blier, H. K. 1999. Antecedents and complications of trauma in boys with ADHD: Findings from a longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry, 38: 48–55. Crossref, PubMed, Web of Science ® , Google Scholar). There is an existing body of research that attempts to assess the trauma-ADHD link and to isolate possible mechanisms behind it. We will present a comprehensive review of the literature covering the trauma-ADHD relationship, and we will illustrate it using descriptive data from a hospitalized sample of children and adolescents. This article will address the following questions pertaining to trauma-ADHD association: First, is exposure to trauma a risk factor for the development of ADHD? Second, is the diagnosis of ADHD a misrepresentation of symptoms related to traumatic exposure? The clinical implications of both questions in context of identifying and treating children and adolescents who present with ADHD will be discussed.