By Maria Romaszkan
More and more research indicates that people with ADHD are more likely to have experienced childhood trauma.
A 2022 systematic review in the journal Brain and Behavior of 70 studies involving almost 4 million participants concluded that children who had multiple adverse childhood experiences, or ACEs, were more susceptible to ADHD. Having at least one adverse childhood experience and being female also increased the possibility of having ADHD, the review found.
Another study in the journal Academic Pediatrics found a significant association between childhood traumatic experiences and ADHD. Participants with a history of two or more adverse events were more likely to have more severe symptoms of ADHD. The study concluded that “children with ADHD have higher ACE exposure compared with children without ADHD.”
An important consideration: Screening tools for trauma are still scarcely used, and clinicians often rely on parents during ADHD assessments in children. That’s why it’s difficult to conclusively state whether ACEs increase the probability of being diagnosed with ADHD, or having ADHD makes you more at risk of childhood trauma, such as abuse or neglect. It’s possible the association between ADHD and childhood trauma can go in either direction.
Kerry Heckman, a licensed independent clinical social worker based in Seattle, specializes in somatic therapy, a body-centered therapy that focuses on the mind-body connection. She points out that growing up with ADHD can be difficult and even traumatic. “Children with ADHD often feel like they don’t fit in, are socially isolated and bullied, and receive constant negative feedback from the peers and adults in their lives,” she says.
Symptoms of ADHD vs. Childhood Trauma
Childhood trauma is also called developmental trauma, as it occurs as children undergo crucial physical and mental development. Childhood trauma causes many changes in the brain and nervous system, including in parts of the brain that are also changed if a person has ADHD.
Many symptoms of ADHD and stress from childhood trauma overlap, such as:
- Problems with concentration
- Dysregulation (difficulty in regulating your emotions)
- Restlessness and hyperactivity
- Issues with executive functioning skills — the mental skills that help people plan and execute goals
- Problems with sleep
Still, you may be dealing only with symptoms of childhood trauma if you experience:
- Emotional flashbacks
- Hypervigilance, looking out for threats
- Dissociation, where a person disconnects from their thoughts, feelings and even sometimes sense of identity.
- Going out of your way to avoid any reminders of trauma
- Panic attacks
- Significant trust issues.
It’s often difficult to differentiate between symptoms of ADHD and stress from childhood trauma, and to adequately diagnose childhood trauma stress.
“Even a highly trained clinician will have difficulty determining if a symptom is due to ADHD or childhood trauma if both are present,” says Heckman.
Yuliya Rae, a licensed counselor focusing on trauma, autism and ADHD, says that context is crucial.
“Looking at how and when each symptom emerges can pinpoint which condition is likely the culprit,” she says. “For example, looking at a negative self-image may mean exploring its origins. With ADHD folks, it will frequently be tied to not performing to the neurotypical expectations. With childhood trauma, it will point to relational ruptures and not having had emotional needs met as a child.”
Types of Therapy for Childhood Trauma
When it comes to treating complex trauma, talk therapy, such as traditional cognitive behavioral therapy, may not be enough. Counseling approaches that integrate both talk and somatic therapies could prove the most effective, Heckman says.
“When there is overlapping ADHD and trauma, it’s important to focus on nervous system regulation,” she says. “This can be done concurrently, with developing a better understanding of ADHD and strategies to make daily life easier. However, the more regulated a person’s nervous system, the more capacity they will have to implement those strategies.”
Here are some common helpful therapies for stress from childhood trauma:
Dr. Francine Shapiro in 1987 developed Eye Movement Desensitization and Reprocessing, or EMDR. Experts recommend it as an effective treatment for trauma by such organizations as the World Health Organization, the U.S. Department of Veteran Affairs and the U.S. Department of Defense.
During an EMDR session, you process your traumatic memories while moving your eyes left and right. Nowadays, visual or auditory stimuli are also possible if you prefer to have your eyes closed. Experts still are not sure why this method is so effective, though one of the most popular theories is that it simulates processes during the REM phase of people’s sleep. That’s when people’s eyes move rapidly during sleep while they process information from the previous day.
If you’re apprehensive about jumping into your most horrible memories right off the bat, rest assured. First, you spend some time with the therapist stabilizing yourself before diving into memories.
Dr. Peter Levine developed one of the most popular forms of somatic psychotherapy — called Somatic Experiencing. It’s based on the premise that trauma heavily dysregulates your nervous system, causing various mental and physical ailments and keeping you from properly processing traumatic experiences. It’s a so-called “bottom-up” approach, focusing on body awareness. That’s in contrast to “top-down” treatments that are primarily cognitive, like talk therapy.
Somatic therapy also can be very effective for people with ADHD, even those without complex trauma. It helps people gain more body awareness and teaches them to regulate emotions and stress reactions better, which can lead to their ADHD symptoms becoming less intense.
Some other somatic approaches to treating trauma are Hakomi Therapy and Sensorimotor Therapy.
Cognitive Behavioral Therapies
Cognitive behavioral therapy, or CBT, can be helpful for ADHD symptoms. But also, several types of CBT were designed to specifically address trauma and have proven effective in treating its symptoms, even in complex trauma survivors.
Cognitive behavioral therapies focus on how trauma affects you in the present — your thoughts, emotions and actions. It helps you challenge and change those harmful patterns and teaches you healthy coping skills.
Some of the cognitive behavioral therapies addressing trauma are:
- Cognitive Processing Therapy: It focuses on identifying unhelpful thoughts connected to traumatic experiences and changing them so they’re more realistic and no longer debilitating.
- Common Elements Treatment Approach: It aims to identify symptoms of Post-Traumatic Stress Disorder or Complex Post-Traumatic Stress Disorder, which can develop due to long-term trauma like childhood abuse or neglect. This approach helps your provider match treatment elements to your individual needs.
- Trauma-Focused Cognitive Behavioral Therapy: It is used primarily in working with children and adolescents but can also be applied to interventions with adult survivors.
Internal Family Systems
In this approach, developed by Dr. Richard Schwartz, your internal self is seen as being constructed from different parts representing aspects of your personality and experiences, both healthy and unhealthy. During treatment, a therapist helps you understand these parts of you and develop a compassionate relationship between them and yourself.
Art therapy can help with processing trauma and managing ADHD symptoms. It can be verbal and non-verbal and even integrate some somatic approaches, such as dance or drama therapy.
This type of therapy allows you to express your traumatic experiences and emotions in a controlled, safe and judgment-free environment. It also helps to regulate emotions, boost self-esteem and challenge perfectionism and shame, which are frequent after-effects of childhood trauma.