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

Abstract

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; Famularo et al., 1996; Ford et al., 2000; Lipschitz, Morgan and Southwick, 2002; McLeer et al., 1998; Cuffe, McCullough and Pumariega, 1994; Husain, Allwood and Bell, 2008). 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; Daud and Rydelius, 2009; De Bellis, 2001; Ford et al., 2000; Jennings et al., 1997). 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). The overall rate for ADHD diagnoses varies from seven to twenty-nine percent among school-age children (see review by Barkley, 2006). Because both phenomena are prevalent, it is not surprising that they often overlap (Wozniak et al., 1999). 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.