One in 9 U.S. children (6.4 million) are currently diagnosed with ADHD. In recent years, many have questioned the reasons for the growing prevalence of ADHD, contributing it to hasty medical evaluations, increased advertisements for ADHD medications, or increased pressure for teachers to turn out high performing students in order to keep jobs. Dr. Nicole Brown, a pediatrician in the Bronx, believed there to be another possibility: inattentive, hyperactive, and impulsive behavior may mirror the effects of adversity and many physicians and mental health practitioners cannot, or don’t have time, to tell the difference.
What is adversity? For the purpose of mental health evaluations, adversity can be considered poverty, violence, substance abuse, partner violence, abuse, and neglect. It is, by definition, trauma. The symptoms of trauma often mirror those of ADHD and practitioners may be missing this in diagnosing and treating children.
While doing a residency at Johns Hopkins University, Dr Nicole brown looked at how many of her low income patients have been diagnosed with ADHD, a brain disorder characterized by inattention, impulsivity, and hyperactivity. These children lived in environments of violence and ongoing stress. Parents and teachers described their behaviors as hard to manage, disruptive and inattentive. When she looked closer she also found one other commonality: trauma. Many symptoms of trauma, such as hypervigilance and dissociation, can be mistaken for inattention. When trauma is experienced, the stress response is in overdrive, which could be mistaken for impulsivity. Most of these clients did not respond to stimulants and behavioral therapy in a way that got their symptoms under control which indicates perhaps there is more going on for these children.
Few researchers have explored the overlap between symptoms of ADHD and the effects of toxic stress or experiencing a trauma, such as abuse, maltreatment, and violence. Brown tested her hypothesis using a national survey about the health and well-being of 65,000 plus children. Her findings revealed that children diagnosed with ADHD also experienced higher levels of poverty, divorce, violence, and family substance abuse. Children who experienced four or more adverse childhood events were three times more likely to use ADHD meds. While her findings are food for thought, Browns results do not indicate that ALL the children were misdiagnosed. It’s not evident how trauma effects ADHD diagnosis and management, but it did shed light on the fact that some children experienced harm that the stimulants will not fix. The children may legitimately have ADHD, but also need to be treated for prior or ongoing emotional damage and trauma. Without this treatment, it may be difficult to see improvement in behaviors.
Brown’s research indicated that we need to do a better job of screening for trauma and creating trauma informed treatment plans. It can be difficult to connect trauma and symptoms if the trauma is not reported by the child or family due to fear or other factors. The American Academy of Pediatrics is currently developing new guidelines on ADHD that will include assessing trauma in patients, but it will not be completed until 2016. Until that time, it is our individual responsibility as parents, teachers, physicians, and mental health practitioners to learn about trauma and toxic stress, and to screen for adversity in order to create comprehensive treatment plans that will be successful for children.
We’re offering an online workshop for parents and professionals to understand the impact of chronic stress on children.
Participants will learn:
Understand the differences between tolerable stress and toxic stress
How parents can lessen the impact of toxic stress in themselves and their children.
Learn how toxic stress affects the developing brain, genetics and future generations
Increase your ability to accurately assess children who have endured toxic stress.
Understand the clinical applications for working with children who have endured toxic stress
Learn techniques for improving your effectiveness with families who have toxic stress
Click this link to register:
Rebecca Roebke, LCSW