ADHD: The Misdiagnosis Hiding a Larger Problem in Children
By: Amy Milner
ADHD is one of the most common diagnoses in children. Recently there has been a significant uptick in the number of children diagnosed per year. While some attribute this to hasty diagnosis, or issues in parenting, there may be a more significant problem at hand: trauma.
The ADHD diagnosis requires symptoms of both inattention and hyperactivity. These symptoms, crucial for an ADHD diagnosis, could be misinterpreted. Post Traumatic Stress Disorder and responses to trauma often include hypervigilance, jumpiness and dissociation. When placed in a school setting, it is easy to mistake dissociation and hyperarousal as inattention and hyperactivity. Children, often referred to psychologists by educational professionals, could easily be misdiagnosed with ADHD despite actually having underlying trauma.
The stimulants often provided for ADHD could worsen the PTSD symptoms. Stimulants, which help to focus an inattentive brain may create more hypervigilance, jumpiness and dissociation in a child with underlying PTSD. This would cause children to perform worse in school and the home setting, possibly leading to more abuse. This cycle exemplifies the importance of a proper diagnosis.
Dr. Nicole Brown at Duke university studied the connection between Adverse Childhood Experiences (ACE’s) and ADHD diagnoses. She studied over 65,00 children between the ages of 6 and 17 years of age. Their parents were questioned about ADHD diagnosis, severity and medication. They were also questioned about potential ACE’s that their child faced. Sixteen percent of the children diagnosed with ADHD had faced at least four ACE’s as opposed to the six percent diagnosis in children who faced no ACE’s.
ACE’s can include things such as poverty, death of a parent or guardian, divorce, domestic violence, violence in the community, substance abuse, incarceration, discrimination or familial mental illness. Depending on severity and personal response, most, if not all, ACE’s could qualify as trauma. Therefore, it is safe to say that many of the children experiencing ADHD, could potentially be suffering from PTSD from the trauma they are facing at home.
The study by Dr. Brown and her team at Duke University illustrate an important consideration in diagnosis. When there is potential for a child to be considered for ADHD, greater care should be taken. Psychologists and doctors should investigate their home life looking carefully for potential trauma. This will help identify children who are victims of abuse or allow for additional support for those in poverty or with unstable home lives.
New research showing the potential for misdiagnosis of ADHD will help psychologists, particularly in a school setting, intervene sooner in cases of children with difficult home lives. Often children facing multiple ACE’s and trauma can be overlooked and find themselves on pathways to develop mental illness and criminal behavior. By recognizing potential ADHD symptomology as part of possible trauma, we make it easier to spot dangerous behaviors before they spiral.
Hopefully, by calling attention to a highly diagnosed psychological issue, we can help to properly diagnose young children who may be dealing with Post Traumatic Stress Disorder rather than ADHD.
Szalavitz, M. (2007). Trauma in Disguise. Scientific American Mind, 18(4), 12-12. Retrieved from http://www.jstor.org.ezproxy.bu.edu/stable/24939673
American Academy of Pediatrics. (2014, May 6). Study finds ADHD and trauma often go hand in hand. ScienceDaily. Retrieved December 6, 2017 from www.sciencedaily.com/releases/2014/05/140506074719.htm